Inspection on 06/12/07 for Maybank Residential Care Home

This inspection was carried out on 6th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Maybank Residential Care Home 11/12/06

Maybank Residential Care Home 07/02/06

Maybank Residential Care Home 12/09/05

Maybank Residential Care Home 09/03/05

Maybank Residential Care Home 08/09/04

Maybank Residential Care Home 20/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Maybank Residential Care Home 43 Slough Road Iver Heath Bucks SL0 0DW Lead Inspector Mike Murphy Unannounced Inspection 6th December 2007 10:00 Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maybank Residential Care Home Address 43 Slough Road Iver Heath Bucks SL0 0DW 01753 653636 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) maybank@regard.co.uk The Regard Partnership Ltd Lawrence Mudiwa Charamba Care Home 6 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (1) of places Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Physical Disability Included in the six service users with learning disabilities, the home can accommodate one service user with a physical disability. 11th December 2006 Date of last inspection Brief Description of the Service: Maybank is a care home providing personal care and accommodation to five service users with a learning disability. The home is owned and managed by the Regard Partnership Ltd. The home is located in Iver heath, which is accessible to local shops including a post office and public house. Other facilities and interests are accessed by car. The home is a large chalet type bungalow, which has been extended over the years. All of the bedrooms are single. The home has a secure large rear garden and a driveway at the front of the property. The current fees for this home range from £969.21 - £1738.53 per week. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector and an Expert by Experience (who was accompanied by a personal assistant) in December 2007. The inspection included a visit to the home, discussion with the registered manager, locality manager, staff and service users, observation of practice, consideration of information provided by the manager in advance of the inspection, consideration of CSCI survey forms returned in connection with the inspection, examination of records (including care plans and staff records), and a tour of the home and garden. During the course of the inspection the Expert by Experience focused in particular on the service users experience of living in the home. The home is a pleasant detached bungalow situated in Iver Heath, about four miles from Slough town centre. It is conveniently located for local shops, cafes and pubs. These are frequently used by service users and staff. The home is comfortable and pleasantly decorated and furnished. All bedrooms are single but vary in size. There is sufficient communal space for those living there and a good sized garden to the rear. The service users said that they liked living in the house. The home has not had an admission since the last inspection but the organisation has systems in place for assessing the needs of prospective service users. The home has developed a comprehensive care plan for each service user and, at the time of this inspection, was about to develop person centred plans (PCPs). These are to be in a form accessible to the person and to be retained in the service user’s own room. Service users attend a range of activities including an accordion club, a local nature centre, local shops , cafes and other amenities and one had recently been to a premier football match. The home endeavours to support service users to pursue their individual interests. Service users told the Expert by Experience that they could eat the things they like and that the food was good. They said they enjoy a variety of meals and it was noted that staff take care to assist service users who need support when dining. Arrangements for meeting service users healthcare needs are generally satisfactory The home liaises with the service user’s GP and other local healthcare services where required. The home has made adaptations to meet the care needs of a service user and staff training appears to be taking account of people’s changing needs. A new manager has been appointed since the last inspection and positive comments were received from service users and staff on the appointment. Overall, the home made a favourable impression on us. It provides a pleasant, comfortable and supportive environment for the people living there. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective service users are carefully assessed before admission to ensure the home can meet the person’s needs. EVIDENCE: The statement of purpose and service user’s guide have recently been updated and copies were provided for this inspection. Both documents provide information on the service to prospective and current service users, the ir families and professional staff working with them. All places in the home were occupied at the time of this inspection and no new service user had been admitted since the last inspection. The organisation’s systems for assessing the needs of prospective residents were outlined by the locality manager who was present for the latter half of the inspection visit. Referrals are sent to the organisation’s referrals department and the initial paperwork is reviewed by two staff. An initial decision is made on the suitability of a home. Where the referral is accepted contact is made with the referring care manager and with the home manager. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 9 Arrangements are then made for an assessment of the person’s needs. This is carried out by the area manager and the locality manager. Where it is felt the home can meet those needs a meeting is arranged between the prospective service user and the home manager. Where the matter is taken forward, the prospective service user is invited to lunch or an evening meal, meets current service users and staff, and may participate in an activity. A series of visits which may lead to admission are then arranged. At the same time communications take place with the referring care manager with regard to funding arrangements. If all parties - the prospective service user, the person’s family, the care manager and the home - agree to admission then a trail admission is arranged. A review is held at six weeks and again at twelve weeks. If all parties agree that the home is able to meet the person’s needs, and if the person wishes to continue living there, then a permanent place is confirmed. The next review takes place at six months. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive care plan is in place for each service user. Care plans include details of service user preferences and a range of risk assessments. The views of service users are sought through day-to-day encounters in the home. Together, these activities aim to ensure that service users needs are met, that their independence is supported, that risk is minimised, that care is provided in line with the person’s wishes, and that service users can influence life in the home. EVIDENCE: A care plan was in place for each service user. At the time of this inspection care documents were comprised of four files: a red file for all care related documentation not required for day to day use, a green file which included current care documents, a person centred plan (PCP) file– essentially a proforma for PCPs at this stage, and, a diary in which entries are made at the end of each staff shift. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 11 The system was under review and it is planned to develop the PCPs in a format suited to the needs of individual service users and for that, together with the typed up care plan (in the green file), and the diary to be the working documents for day to day use. The files of four service users whose care was being ‘case tracked’ during the inspection visit were examined. Care plans are detailed, well structured and well presented. Care plans include a photograph of the person, a ‘pen portrait, ‘missing person profile’, details of the services involved with the person, a comprehensive ‘care needs assessment’, a detailed care plan for some matters (such as the management of epilepsy), and a summary of needs and action required under such headings as;’ diet’, ‘personal care’, ‘mental health/behaviour’, ‘daily living skills’, ‘day services/activities’, ‘communication’, ‘social life’, ‘leisure activities’, ‘mobility’, ‘finance’, ‘religious and cultural needs’, and ‘likes and dislikes’. The structure of the care plan includes details of the problem, the support needed, who provides the support, the goal to be achieved and comment. A weekly activity diary for each service users is drawn up and a copy of this is also available in the service user’s room. Care plans are reviewed every six months in the home and annually with the care manager. Care plans included a copy of the annual community care plan review meeting (in one case this was overdue by a few months and the manager had written to the local authority concerned). Service users are involved in decision making through day-to-day interactions with staff and with their key worker and through house meetings. The expert by experience reported ‘They had house meetings; one person said that they had ‘a say in what happens here’, the other said ‘we gossip, but are listened to’ [in the meetings]. The new manager had made sure that there were meetings. They said they had influence over house rules’. ‘The residents seemed to get on well together and knew each other well. They had their own private rooms as well as a variety of communal places. Risk assessments cover a range of activities including; disorientation at night, scalding, boarding the house vehicle, tripping, verbal and physical aggression, self-neglect, refusal to use support aids, exploitation by others, and absconding. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lead a varied lifestyle according to their individual interests, abilities and wishes. This ensures that service users experience a range of social, leisure and other activities and are involved with the local community. Service users are provided with a varied diet. EVIDENCE: A weekly activity diary, in text and picture form, is drawn with each service user. A copy is on display in the office and a copy given to the service user. Service users attend a range of activities. The expert by experience who spoke to two service users reports ‘Both the residents talked about doing a variety of activities in the home and outside. One goes to an accordion club and works at a local Nature Centre, independently [by taxi], another has 1:1 support to go shopping by bus. They mentioned a wide variety of day and evening/weekend activities; one had been supported to go and watch a match at her football Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 13 club. They had been encouraged in their hobbies and interests by the staff and had cooked or played music for the other residents [for example]’. On the day of the inspection visit one service user was at a centre in Slough, another had an appointment with her hairdresser, one was due to go to a horticultural centre around lunch time, and two service users were in the home for the day. Service users make use of local shops and cafes, do the shopping with staff at a large supermarket and their own personal shopping in Slough town centre. It had been agreed that service users and staff would go to a pantomime after Christmas. It was reported that birthday parties in this home and in other homes are celebrated – friends and family are invited. It was expected that a Christmas party would be held over the forthcoming season. Five service users had taken a holiday with staff earlier in the year. One had gone to Berwick-on-Tweed, three to Centre Parcs in Wiltshire, and three to Cornwall. The cost of one holiday per year is included in the fees. The home had held a barbeque in the summer. One resident told the expert by experience ‘that they had tried a befriending service in the past for getting out to his music club and it worked well, but that there was no-one now available locally, so it he could not use this service. He said his social worker was very helpful and worked well together with the staff of the home. He had not heard of self-advocacy groups and said he would like to know of a local one [the expert said that he would send him some details]. Both residents interviewed said they were ‘happy [in the home]’. The house has developed a routine which is said to suit the service users living there. The routine varies at weekends and people tend to have a take away or a meal in a pub most weekends. The two people interviewed by the expert by experience said they could eat the things they liked and that the food was good. Both were aware of the need to eat healthily and had help from staff if they needed it [in the one case with diabetes]. They said they had a good variety of meals; one resident had cooked a meal for the others and said it was good. The food was prepared in different ways to enable those with eating difficulties to cope and staff took great care to encourage a resident to eat when he was having problems; they were very patient with him and he seemed used to this. A dietician was involved with two service users. All service users are weighed monthly. However, it was noted that all the residents wore ‘bibs’ at mealtimes and the necessity of this for everyone is questioned. We would ask managers to review this practice and to use ‘bibs’ only when necessary. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff support residents as required. Arrangements for liaising with health and services in the community are good. Arrangements for the control and administration of medicines are generally satisfactory. Together, these aim to ensure that service users healthcare needs are met. EVIDENCE: Service users need for support is outlined in their care plan. Service users are supported by staff as required and are not compelled to participate in activities. Over the course of the day of the inspection visit some service users were out for part of the day, others sat in the lounge, another acted as guide to those conducting this inspection by showing us around the house, and when not involved in that spent time either in his room or chatting downstairs. The pace of life in the home seemed to suit those living there. The home is not currently equipped to provide care for service users with moderate physical care needs. The office had recently been relocated upstairs in order to provide accommodation downstairs for one service user (who was in hospital on the day of this inspection visit). It has a walk-in bath on the Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 15 ground floor. The training session on dementia reflects an awareness on the part of the organisation of the changing needs of some service users and the need to adjust staff knowledge and skills accordingly. These changes are also likely to have implications for the accommodation. All service users are registered with a local GP practice in Iver. Service users access NHS opticians and dentists in Uxbridge. Physiotherapy and occupational therapy are obtained through the GP or care manager. All service users are under the care of a psychiatrist based with the community learning disability team (CLDT) in south Bucks. One resident talked to the expert by experience about their problems with diabetes. They said they had had a change in behaviour, began drinking lots of water and ‘not feeling right’. It was reported that this was not picked up as a possible health issue by the staff until they became quite ill. The manager then acted swiftly and the doctor was involved and the problem dealt with appropriately [they now have a community nurse as well]. Staff practice in the administration of medicines is governed by the organisation’s policy on the subject. This was last reviewed in October 2007. Medicines are prescribed the GP or the service user’s psychiatrist and dispensed by Boots Chemists in Slough. Staff training is organised by Regard Partnership with staff completing the course receiving a certificate of achievement. Staff may also follow the Boots training course. Arrangements for storage are generally satisfactory given current levels of stock held. The arrangements are checked weekly by the manager. Most medicines are dispensed in the Boots monitored dosage system (MDS) and administered by staff who have undertaken training as above. Depot (long acting) injections are administered by the practice nurse in the GP surgery. It was noted that the home is holding stocks of rectal diazepam for use in epilepsy. According to the care plan the service user’s GP had expressed an unwillingness to accept responsibility for its administration by home staff. In discussion the managers said that they accept the GPs position and that home staff are not permitted to administer the medication. It is held in case a paramedic might wish to administer it in an emergency. It was also noted that external preparations are not routinely dated when opened. References for staff include a 2004 British National Formulary (BNF) and a 1997 general text on medicines. If the home wishes to retain the BNF it would be advisable to obtain a more recent edition. The general textbook is now out of date and should be replaced – a 2007 text was suggested at inspection. The home should also obtain a copy of the 2007 guidelines on the administration of medicines in social care published by the Royal Pharmaceutical Society of Great Britain. CSCI guidance on the subject is available through the CSCI professional website. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sound procedures for recording and investigating complaints. It has a framework of policy, reporting arrangements and staff training with regard to safeguarding vulnerable adults. Together, these aim to protect service users from abuse and to ensure that complaints are thoroughly investigated. EVIDENCE: A copy of the complaints procedure is on the office wall. This was last reviewed in 2006. It includes a flow chart of the process. There is a picture version of the procedure on the residents’ notice board. It is noted that some versions of the procedure gives details of the former Aylesbury office of CSCI. That office has closed and services transferred to Oxford. CSCI now has a central contact number for complaints 0845 0150120. Services should include that number on their complaints literature from now on. The home has a good system for recording complaints. The record was inspected and seven complaints have been recorded since the last inspection. CSCI has not received any complaints about this service since the last inspection. Service user respondents to the CSCI survey all ticked ‘Always’ on whether they knew how to make a complaint. All four relative respondents ticked ‘Yes’ Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 17 on whether they knew how to make a complaint. Three of four relatives ticked ‘Usually on whether the care service responded appropriately to complaints. The fourth ticked ‘Always’. In its website (www.regard.co.uk) the Regard Partnership outlines its ethos. It says ‘The company is committed to equality of opportunity and antidiscriminatory practices for both service users and staff in all areas of our business…We ensure that procedures are in place so that all staff and Service Users have access to equality of opportunity and are free from bullying, harassment and discrimination’. The organisation’s policy on the protection of vulnerable adults (POVA) is a well written and comprehensive document. This subject may now also be referred to as ‘safeguarding’ adults to distinguish it from the POVA list maintained by Government. The organisation’s policy includes a flow chart of the process. A copy of the flow chart is on a notice board in the home. The home also had a copy of the current version of the statutory multi-agency policy for Buckinghamshire. The policy is included in the induction process for new staff and training sessions are offered at times over the course of the year. The home has responded promptly and effectively to suspected abuse and has worked in partnership with statutory agencies in the investigation of allegations. Training is given to staff on dealing with aggression. The next two-day course is scheduled for January 2008. The home has a ‘no restraint’ policy. The organisation has a benefits department which has a lead responsibility for ensuring that service users finances are managed appropriately. A bank account is opened for service users where required. The home has facilities for the secure storage of cash and valuables. A cash box is maintained for each service user. All transactions are recorded. Policy sets a limit on the amount of cash held for each person. The arrangements are checked as part of the monthly Regulation 26 visits and the manager reports that they were audited by internal auditors within the last twelve months. The cash boxes for two service users were checked by the manager on this inspection visit and balances were found to correspond with records. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides an accessible, pleasant and well-maintained environment which provides those living there with a comfortable and generally safe place to live. EVIDENCE: The home is a detached house located in the residential area of Iver Heath, near Slough. The home is situated just off of the main A4007 road between Slough and Uxbridge. There is limited parking and drop off space to the front. Alternative unregulated parking is available in nearby side streets. The home is about four and a half miles (just under seven kilometres) from Slough station and is on a bus route to Slough town centre. The Expert by Experience states ‘One resident said that ‘everything was very convenient here’ ; meaning shops, pub, ‘Nature’ where he does voluntary work, the doctors… They talked of using a variety of transport; the house car, taxis, buses, friends for lifts, a train for holidays’. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 19 It is a comfortable home. The ground floor accommodation comprises: entrance hall, four bedrooms, lounge, conservatory/dining room, kitchen, laundry (entry from outside), WC and shower room, and WC and walk-in bath. The home has a good sized garden with patio, seating areas, lawn, flowerbeds, shrubs and fencing. Stairs lead to the first floor. The home does not have a lift. The first floor accommodation comprises: WC, bathroom, two bedrooms, and the office. The Expert by Experience report states ‘The home was pleasant, clean and ‘homely’. It felt like the people’s own home. We were shown around by a resident and interviewed him in his room which was pleasant and spacious and was very much ‘his’. The building had been altered over time to cope with the resident’s changing needs [E.g. office relocated upstairs]. Both the residents interviewed said they liked the house. We felt very comfortable there’. On the day of the inspection visit, a wet day in early December, all areas of the home were tidy, clean and warm. No untoward odours were noted. It is noted that the radiator in the hallway is unguarded. There is significant variation in the size of bedrooms. None have en-suite facilities. Bedrooms are well furnished and were reported to have been decorated in accordance with the service user’s wishes. It was possible from outside to see through a gap in the curtains in the recently converted bedroom on the ground floor. This could compromise the privacy of the resident if staff are not vigilant. Doors are held open with ‘Dor-Guard’ fire safety retainers. The conservatory was a bright and pleasant room which doubles as a dining room and is also used for other activities. The lounge is well furnished and includes sofas, chairs, coffee table, a mirror, TV, stereo, and video/DVD player. The kitchen was tidy, clean and in good order. It is equipped with an electric cooker, microwave, dishwasher, sinks, fridge, freezer, and store cupboards. It was noted that all food in the refrigerator was labelled when opened. The laundry is accessed from outside. A service user said that this had changed relatively recently. The laundry is equipped with a domestic washing machine, domestic dryer, iron and ironing table, and store cupboards. The gas boiler is also located there. The laundry is considered adequate for current use but the entry from the outside was not popular with at least one person living in the home. Overall, this is a pleasant and comfortable home which meets the needs of current residents. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels, procedures for the recruitment of new staff, and for staff training, development and support are good. These aim to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet the needs of service users living in the home. EVIDENCE: The current staffing provides for two staff in the morning, two in the afternoon and evening and one waking member of staff at night. Those numbers do not include the manager. According to information supplied by the manager, at the time of this inspection four of nine staff have acquired a care NVQ at level 2 or above and four of nine staff are working towards a care NVQ at level 2 or above The expert by experience, on the subject of staff support found that ‘The two interviewees said the staff were ‘very good’ and ‘helpful’. One of them compared them to past staff and said that they were much better and that he got on well with all of them now. He especially praised the manager, saying the home was well managed and that he had a good relationship with the staff. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 21 They had tried to bring in better ideas, like asking ‘what food do you want this week?’ The other interviewee said she was ‘happy with the staff’. The personnel records of four staff appointed since the last inspection were examined in the presence of the manager and the locality manager. All files included a completed application form (which included reference to the reason why the applicant had left a previous care position where relevant), two references, health declaration, a POVA First received before the person started work and an Enhanced CRB certificate. Three of the four files had a recent photograph of the person. With the exception of one file not having a recent photograph – which the managers undertook to rectify promptly – all records were in order. All staff are provided with copies of the GSCC codes of practice. New staff are required to undertake the organisation’s comprehensive induction programme which need to be completed within the first two weeks. The home is now in the process of introducing the ‘Skills for Care’ Common Foundation Standards which new staff will be required to complete in addition to the organisation’s own induction programme. New staff undertake mandatory training within the first three months. A spreadsheet on training was on the notice board in the office. This listed the names of staff, and the subject and dates of training attended by staff. The list included training on health and safety, food hygiene, abuse/POVA, medication, moving & handling, CPI (Crisis Prevention and Intervention), first aid and infection control. On the day of the visit to the home a training event run by an external consultant on dementia took place. A member of staff interviewed communicated a positive view of the new manager who was described as understanding and supportive. The member of staff could recall attending a five day induction programme and confirmed that the organisation is supportive of staff undertaking NVQ training. The person also confirmed that supervision is in place – at intervals of around two months. All care staff receive personal supervision with the manager. At present this happens six times a year – at approximately two monthly intervals. From looking at records during the inspection visit the process is well structured and detailed notes are taken. Dates for staff meetings and forthcoming supervision sessions are on display in the office. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home where a positive approach to monitoring the quality of the service is providing good care outcomes for service users. With one exception, arrangements for health and safety are generally thorough and aim to maintain a safe environment service users, staff and visitors. EVIDENCE: The present manager was appointed to the post in February 2007. The manager has been employed by the organisation since 2002 and was acting manager in the home from September 2006. The manager has acquired NVQ3 and is currently pursuing the registered manager’s award (RMA) at Thames Valley University. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 23 The organisation has accreditation with ‘Investors in People’. The organisation’s ‘Quality Department’ oversees quality assurance across its services and carries out monthly Regulation 26 visits in ths home. The records of Regulation 26 visits were examined. The records are well structured and of good quality. They include; what the home does well, record of discussion with service users, record of discussion with staff, review of incidents and complaints records, inspection of premises, action on outstanding CSCI requirements, review of staff training, examination of care plans and notes on any matters of health and safety. The report leads to an action plan to be carried out by the manager. The locality manager and the manager said that a stakeholder survey is carried out twice a year. The stakeholders contacted are service users, care managers, families, and GPs. The most recent survey was reported to have been carried out in November 2007. The results were not available at the time of this inspection (on 6 December 2007). Respondents to the CSCI survey carried out in connection with this inspection were generally positive in their views of the home. There appeared to be a gap between the prompt and effective response of managers to matters, which respondents acknowledged, and an apparent discontinuity in communication, skills gap or other issues among the wider staff group. One respondent suggested that the appointment of an assistant manager would lead to improvements. A relative respondent said that the home ‘Provides a comfortable unhurried atmosphere’. The same person added that the employment ‘..of more senior staff, with perhaps medical experience or understanding’ would be an improvement. Another relative respondent praised the home for being ‘A small care home catering for a small number of residents in a family and individual atmosphere’. The same person suggested that ‘More outings and events laid on and suited to the different types of residents’ would lead to improvements. A third relative respondent desribed the home as ‘Friendly, Informative, (and) Caring’. The same person suggested that ‘More attention to diets and regular eating’ and an explanation of the service users ‘income and expenditure’ would be considered an improvement. Another relative thought that the home did “Everything” well. The standard of record keeping in the home is good. Records are well structured, well maintained and accessible in the staff office on the first floor. Policies and procedures are periodically reviewed and amended where necessary. Polices include the date of review and the date when the next review should take place. Arrangements for health and safety are generally satisfactory but radiators without covers in areas to which service users have access pose an ongoing Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 24 risk – in particular given the changing needs of some service users. Managers accepted that this matter needs attention. A fire risk assessment was carried out in October 2007. The home was inspected by the fire authority in July 2007. One requirement was made and was carried out within the timescale permitted. Fire training took place in September 2007. Contracts are in place for the maintenance of fire safety equipment. Internal checks on fire safety are carried out weekly. According to records the gas boiler was checked by a CORGI engineer in February 2007. Portable electrical appliances were checked in September 2007. The homes fixed wiring was checked in September 2006. All hot water outlets in areas to which service users have access are temperature regulated. The ‘Health and Safety Department’ carries out twice yearly ‘health and safety’ visits to the home. All staff receive training in health and safety including fire safety, moving and handling, food hygiene, and infection control. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 3 3 2 X Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA17 YA20 YA42 Good Practice Recommendations The manager should review the routine use of ‘bibs’ at meal times and only authorise their use where there are clear indications in the individual plan of care. The manager should ensure that external medical preparations are labelled when opened. The manager should take action to ensure that unguarded radiators do not pose a hazard to service users. Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Maybank Residential Care Home DS0000059317.V352228.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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