Inspection on 16/09/05 for Medihands Clifton

This inspection was carried out on 16th September 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Medihands Clifton 04/02/09

Medihands Clifton 05/02/07

Medihands Clifton 24/01/06

Medihands Clifton 08/11/04

Medihands Clifton 19/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Medihands Clifton 17 Bodley Road New Malden Surrey KT3 5QD Lead Inspector David Pennells Unannounced Inspection 16th September 2005 11:00 X10015.doc Version 1.40 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 Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 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 Older People. 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. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Medihands Clifton Address 17 Bodley Road New Malden Surrey KT3 5QD 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) 020 8949 3581 02082412664 Mrs Jayashree Sawmynaden Marion Grubb Care Home 15 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (12) of places Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 08/11/04 Brief Description of the Service: ‘Medihands’ is a small private organisation providing residential services predominantly to adults with mental health issues in three homes and - in the case of this home, Clifton, Medihands, providing care for older people, including some people with dementia. Clifton Medihands is a small and pleasantly domestic home that accommodates up to fifteen service users (65 ), currently the registration category allows for three service users to have a specific diagnosis of ‘dementia’. The home is an ordinary house in an ordinary street in New Malden, relatively close to the main road (A3) and the centre of New Malden. Transport links - by bus and train - are relatively close by. The home provides bedrooms over both the ground and first floors, and all the communal areas are sited on the ground floor. The main lounge extends from the dining area – providing substantial space, and there is a smaller sitting area – predominantly used by staff close by the kitchen. The lounge overlooks a pleasant, small, domestic garden and the front door and ground floor bedrooms face out into the street - Bodley Road – which is open, wide and remarkably quiet; parking is easy either in the horseshoe driveway of the home itself, or - at no charge - on the street itself. The home is managed by Mrs Marion Grubb – the registered manager, and overseen closely by Mrs and Mr Sawmynaden (known as ‘Mrs & Mr Sammy’) – the joint proprietors. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector spent the later morning and the whole afternoon at the home, spending time observing the general conduct of the home, sharing lunch with the residents, meeting a relative (a regular visitor), and spending some time – including touring the premises - with the registered manager of the home. The home has, to some extent been ‘on hold’ more recently as the registered manager was planning to leave the home’s employment – and to this end had been handing over to an acting deputy who would have ‘held the fort’ after Mrs Grubb had left. Happily, just a week or so before the inspection visit (which was unannounced) the manager made the decision to stay – so the inspection was conducted with the inspector understanding that some plans had been ‘put on hold’ but also used this opportunity to look forward with the home ‘getting going again’. This was the first visit by the lead inspector; he had inspected other homes within the ‘Medihands’ Group before, but not this home – the only dedicated to older people and dementia care. It was therefore with a ‘fresh pair of eyes’ that the inspector viewed the premises and the service provision. This explains the more than usual number of premises issues raised, and also may explain the requirement to review the issue around the proper registration category applicable to the service user group at the home. What the service does well: What has improved since the last inspection? Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 6 Due to the expected departure of the manager, not a lot - new - has been recently achieved in the home, save for the ongoing maintenance and servicing of equipment within the home. One ‘improvement’ is the undoubted stability the manager will continue to bring to the establishment. It is clear that a number of items will require improvement with the imposition of over twenty requirements on the home – however, some of these are tied up with the issue of category-specific issues – for instance, the identification of the need to improve areas around cross-infection reflect the growing levels of dependency that are encountered as an ageing client group lives to a greater age. Issues such as the question around the continued use of double rooms and the provision of a passenger lift or acceptable equivalent also reflect on the growing frailty and specific needs of the service users. What they could do better: Six requirements and a recommendation are brought forward from the last report – some of these issues were partially addressed by the home - but not wholly, and therefore they are reiterated. Requirements set in this report reflect [a] the ongoing requirement to train staff and address the service more towards the ‘dementia’ end of service delivery and [b] the need to fully acknowledge the requirements set by the National Minimum Standards relating to services for older people. In the first regard, staff training in dementia, appropriate activities and a realistic focus on the needs of the service users also is reflected by a requirement to review staffing levels – especially that of ancillary input – there currently only being a less-than part-time cook and no domestic worker in the house. Training in First Aid is also required to ensure a trained worker duly covers each shift on the home’s rota. Premises–wise, some important issues were identified such as the appropriateness of the locking of the front door and the side gate – this potentially compromising the fire safety of users. A bedroom was also identified to be a fire exit and therefore appropriate provision is to be restored in this area. Finally, under the fire safety heading, a review of furniture and furnishings is required to ensure the safety of items ‘supplied’ by the home. Reviewing against the national minimum standards, the home is required to cease the use of the two very small double rooms and to provide some form of passenger lift / transportation to the first floor – where the predominance of bedrooms are situated. In recognition of the home’s ageing population, its specialist category, and the special / cultural needs of the home, the provision of an assisted bathing seat is required, as is the restoration of the shower facility - and the more focused cleaning of all communal areas. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 7 The risk of potential cross-infection is identified through the requirement for better and safer provision for hand washing in all toilets and bathrooms, and the provision of a sluice-cycle washing machine to reduce the risk of handling soiled items. The house’s crockery is also to be replaced, to provide a level of ‘quality’ instead of the current piecemeal, jumbled provision. Record keeping, whilst generally well undertaken, was found wanting in regard to aspects of medication records, whilst the frequency of fire drills and the testing of hot water outflow temperatures (revealed by the checking of such records) are required to be more frequently undertaken. A planned programme of maintenance - with records kept – is also required; no doubt the requirements as set in this report will ‘spur’ the manager into devising a suitable strategy and timeline. 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. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4, & 6. Service users can expect to be provided with adequate information about the home, including a fully detailed contract that will reassure them that they have some ‘security of tenure’ within their room and the home. Service users can expect the home to competently meet their general ‘ageing’ care needs, though the home must focus more substantially on the needs of service users with dementia or those who are exhibiting signs of dementia. EVIDENCE: The home has previously been commended for its Statement of Purpose and Service User guide; this element was not inspected this time, therefore. The service user contract has now been amended to ensure that the room to be occupied by the service user is specifically mentioned in the contract. Requirements concerning the development of a full activities programme and another regarding training for staff in dementia care are reiterated. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 10 The need for staff to enhance their knowledge of working with people who have dementia is important – both due the current registration focus of three people definitely having dementia, and also to meet the needs of the remaining frail service users at the home. It was understood from the manager that up to seven staff are expecting to undertake some training in dementia care in Merton in October. The requirement set at the last inspection visit – exceeded by over six months is reiterated to ensure that this focus is maintained. Of the current thirteen service users at the home, it was noted that three were definitively in the dementia category and the remaining ten were all described with some degree of ‘pleasant confusion’ or ‘mild confusion’. This inspection requires the proprietors and the registered manager to cooperate in a reassessment of the categories of all service users – to ensure that the home is registered in the category most appropriate and fitting to the service that is expected of it. The need for staff to be very well trained in dealing with issues relating to dementia is clearly of paramount importance bearing in mind these figures. The current scale of charges at the home ranges from £380 to £450 per week. The home does not provide intermediate care, and therefore Standard 6 is not applicable to Clifton Medihands. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8, 9 & 10. Service users can expect their health care needs and subsequent medication / treatment regimes to be well supported by the home’s staff, following appropriate procedures. Service users may expect their privacy and dignity to be respected – through the staff providing sensitive and appropriate personal care. EVIDENCE: The hairdresser visits the home each fortnight, charging reasonable rates and access to other personal care services is arranged as required. A relative interviewed at the home indicated they were happy with the personal care from staff members – whom they described as collectively ‘very nice’. Bearing in mind the condition of the said service user, it was commendable that staff were recognised by the service user – and have their confidence. Access to healthcare includes the use (generally) of a specific local GP based at New Malden Health Centre and associated district nursing services (though one service users does have a different practitioner). Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 12 The ‘house’ GP returned a questionnaire to the Commission indicating their positive views on the service and their relationship with the home. Medication procedures and processes were examined, including the current active records of medication given. It was noted that some records were deficient – in that there was a code to use to indicate something other than ‘given’ – and these were not being accurately used. A code system of ‘A’ – ‘G’ exists to assist staff to indicate reasons for non-administration – including an opportunity to ‘declare’ the reason. Staff must be vigilant and ensure they accurately record such outcomes. As an example, an analgesia balm specifically prescribed to alleviate pain had been prescribed ‘twice a day’ but was only – in nine days – ‘signed off’ once in the evening and four times in the morning. As a parry to this identified recording problem, staff members had been quite correctly and consistently recording the giving of ‘one’ or ‘two’ tablets where this was allowed, for analgesic purposes – following good practice guidelines. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Service users can expect the home to be sensitive to their individual needs and aspirations and choices - recognising social, religious and cultural needs - and encouraging engagement with and involvement of relatives and friends. The home provides wholesome and nutritious food provided in an environment conducive to service users enjoying this experience, though this enjoyment would be enhanced through crockery being renewed. EVIDENCE: Requirements set at the last inspection under Standard 4 also covers items within the above set of standards, for instance, the recruitment of an Activities Officer and ensuring a more focused and properly planned Activities programme – based on the needs and wishes of the client group – is implemented. This requirement was backed up by the response of a service user’s relative, who certainly felt that .entertainment appears to be limited’; inadequate time was devoted to talking, singing and playing games, as opposed to ‘the practicalities of running the home’. The manager explained that steps had been taken to try to identify and recruit a designated activities worker, but the home had been unsuccessful - and therefore the solution was to appoint a current staff member to an ‘Activity Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 14 responsibility’ each and every afternoon. The manager is currently monitoring records to assess the success of this move, which only started recently. Puzzles and Books (including mobile library resources) as well as activity cards are available. Reminiscence cards and artwork is also being used to stimulate individuals. Ball games are also popular. The house has a daily newspaper delivered, and a service user also subscribes to the Daily Telegraph. Engagement observed at the home between staff and service users could be described as ‘informal’ – but it was also friendly and respectful. The local Anglican Church, St James, has connections with the home and a local School, Beverley Boys School, has an arrangement for placements / events (Harvest / Christmas) at the home. There is only one (non-practicing) Roman Catholic service users at present. Relatives and friends are clearly positively welcomed at the home; this was endorsed both by a relative met during the inspection, and through a questionnaire returned to the Commission by a relative. Trips out from the home have not been so frequent this year, due to the uncertainty of senior lead staffing; outings to Brighton and Richmond have been enjoyed, and afternoon trips to Teddington TV studios for Programme recordings have been enthusiastically supported and appreciated. A choice of menu is available, with individual service user’s likes and dislikes acknowledged and accommodated. A couple of service users do make drinks and / or snacks in the kitchen – but most, for health and safety reasons, are not encouraged to use this area. Just one service user has a slightly limited diet, due to tablet-controlled diabetes. One service user has been assisted through staff and the involvement of a relative – to overcome eating problems. Relatives confirmed that good food is served, including fresh vegetable s on a regular basis. The inspector noted that crockery was of many and various designs – dinner plates and mugs / cups & mismatched saucers being a jumble of different types / designs. They were, therefore, neither pleasing to the eye - nor expressing any sense of order or ‘unity’ on the table. Clearly some investment is needed in providing appropriate sets of crockery of a suitable type for the older and frail service users at the home. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Service users and their advocates can be assured that their comments and complaints will be actively listened to, and appropriately handled. The home acts appropriately to ensure that service users as vulnerable adults are recognised and suitably protected from exploitation or abuse. EVIDENCE: The home has a complaints procedure which is made available to service users and their relatives. Relatives indicated their awareness of the said policy. No complaints had been received by the home since the last inspection, neither has the Commission been contacted. The home has adopted the Royal Borough of Kingston’s Vulnerable Adults policy and procedures, and staff members have been duly trained in this area. The home also has a whistleblowing policy. Two service users have taken a close liking to each other and their relationship was currently developing; the manager is clearly well aware of issues of vulnerability - and also the rights of an individual to their own expression of sexuality and the protection of their privacy. The manager was rightly moving towards calling a meeting between the service user’s care managers and nextof-kin to ensure that all were happy with this developing interaction. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. Service users can expect the home to respond to issues raised regarding their safety and wellbeing; the home operates generally in a well-maintained and safe environment. The premises provide generally suitable accommodation for service users, though the use of double bedrooms as such is now challenged. The absence of some equipment such as a shower facility, a passenger lift or similar, and a powered bathing seat may place some service users at risk, due to their frailty and need for this extra assistance. The home, whilst generally clean and well maintained, needs to address issues around possible cross-infection to ensure the best and safest standards of hygiene. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 17 EVIDENCE: The home is an ordinary house in an ordinary street in New Malden, relatively close to the main road (A3) and the centre of New Malden. Transport links - by bus and train - are relatively close by. The home provides bedrooms over both the ground and first floors, and all the communal areas are situated on the ground floor. The main lounge extends from the dining area – providing substantial space, and there is a smaller sitting / dining area – predominantly used by staff, close by the kitchen. The lounge overlooks a pleasant, small, domestic garden and the front door and ground floor bedrooms face out into the street - Bodley Road. A requirement set at the last inspection that a planned maintenance programme for the home be established, with records kept, had not been met at the time of this inspection. A clear pathway of renovation and renewal should be stated and records of maintenance and refurbishment kept, evidencing such important activity. The inspector would also like to see the windows regularly cleaned to enable the service users to enjoy an unhindered view into the back garden. The registered provider was also required to ensure that an (power-) assisted bath seat / chair was provided in the downstairs bathroom; this issue is also outstanding. Clearly with the frailty, both mental and physical, of many service users, this is an essential item of equipment to provide. Immediately on entering the premises, the inspector was aware of the staff’s locking the door behind him with the use of a ‘star key’; this must be avoided, as any door – especially the front door – for fire safety reasons - should be operable without the use of a key. Outside, the inspector also noted that the evacuation route to the front of the house was obstructed by a shopping trolley, and the garden gate was padlocked shut; the same ‘simple fastening’ requirement is set on this exit; (though steps must be taken to provide adequate protection to vulnerable service users, who may find their way out). The inspector’s tour of the premises brought the ‘fresh pair of eyes’ to the premises; one issue arising included the questioning of the use of bedrooms (No 6 and its counterpart) for double occupancy, when they are very significantly under the minimum standard size (measuring 13.5 sq metres - as compared to the minimum standard [NMS 23.8] of 16 sq metres). Privacy screens are provided in these rooms, but the availability of space for personal possessions / furniture and the provision of significant personal care is, obviously, severely restricted. The proprietors are challenged to reply to the Commission indicating their intention with regard to these two rooms that clearly fail to address even the absolute minimum standard. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 18 The manager has indicated that all the eleven single bedrooms in the home (seven upstairs and four downstairs) are under 10 sq metres; as an existing home, these bedrooms may remain in use - as they provide individual space and privacy – and none is close to the 6.75 sq metres available to each of those who share a double room (see paragraph directly above). The need to maintain a fire passage route through a bedroom (No 3) that has a fire exit door leading from it (and at the time of the inspection a break-glass point behind the wardrobe) was also identified. Another bedroom (No 10) had an electrical point directly under a wash hand basin; this should be riskassessed - and preferably moved away from any source of water. In the same bedroom, an unsuitable lock was to be removed from the door. Toilets and bathrooms are required to have liquid soap, paper towels and lidded bins provided – and the cotton (communal) towels removed - to avoid / minimise the risk of cross-infection. Baths were noted to be heavily scaled up and need thorough cleaning – as did the bath seat and non-slip mats – again potential sources of cross-infection. The facility of a shower must be restored to working use, to ensure that a variety of facilities are available to meet service user’s varying / cultural needs. Laundry facilities at the home are provided but the inspector noted that the washing machine is clearly not a sluice-cycle machine. This must be introduced to address the probable, if not certain, occurrence of incontinence within the home. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30, Staffing at the home is provided to meet the basic care needs of service users, however - to fully respond to their evident specialist needs – staffing levels require reviewing and modification. A consistent staff team provides a service that is based on consistency, familiarity and a developing knowledge of each individual’s needs and aspirations. Staff members are well trained in general care practices; the planned provision of a ‘dementia care focus’ will ensure appropriately sensitive service delivery for the future. EVIDENCE: Staffing is provided at a level of three care workers on duty at all times during the twelve-hour day with two staff at the home during the night time hours. These workers, however, have the task of both cleaning the home and undertaking catering duties as well when the part-time cook is absent (she works 8am - 1pm on three days a week – sometimes the hours being blended with care hours); this therefore severely impedes the possibility of active focused work with service users at a number of strategic times during the day. The inspector noted an ‘inert’ sense – a lack of activity when he arrived at 11.00am the morning of the inspection – possibly due to staff commencing the focus – for example – on cleaning / housework or the lunchtime meal. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 20 Issues such as the windows being difficult to see out of due to lack of regular cleaning also indicated that staffing is not sufficient to fully meet the needs of the home. The proprietors do employ a handyperson who provides a number of hours input for maintenance issues, but this clearly does not cover ‘spring’ / ‘deep cleaning’ well enough. The previous inspection requirement that a Deputy Manager be appointed is being ‘held’, currently, for when a staff member achieves their NVQ at Level 3 in care. A second senior staff member is clearly needed at the home, so this requirement is reiterated. Staff training is seen as a real priority at the home; the home has at least 60 of its care staff qualified to NVQ at level 2 in Care. Four staff only hold first aid qualifications; this should be worked up to ensure that each shift at the home is covered by a currently qualified First Aider. Training undertaken in the last year has included in-house fire training, a course on Adult Protection run by Age Concern, ‘Managing Challenging Behaviour’ run by Merton College; Boots the Chemist ran training in medication processes, and two staff undertook Manual Handling training also at Merton. Merton College is also providing Dementia Care training to seven staff in October 2005, and further manual handling training in January 2006. Only one staff member (a senior care worker) has left the home – to move to new employment – since the last inspection; the manager was reminded that Criminal Records Bureau checks were no longer ‘portable’ and that checks must be made by the home for each new staff member employed prior to them starting work. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The management input at the home is reliable and skilled in its application; the need for support to the manager – through the appointment of a deputy - will ensure consistent management supervision and encourage staff development. The home will benefit from the quality assurance surveys and research soon to be implemented at the home; without this feedback service user’s views will not be fully incorporated into plans for the development of the home. Service users can be assured that financial aspects of their stay will be managed and protected as appropriate – through the home having a clear policy of encouraging advocate’s involvement. Service users can expect their general health and safety to be protected by the maintenance activity and servicing contracts of the home. Certain improvements in in-house checks will enhance the safety of service users through more frequent precautionary safeguards being implemented. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 22 EVIDENCE: The inspector is pleased to learn that despite an intention to the contrary, the registered manager intends to stay and run the home. Having been employed at the home for eleven years fours year now in the management role), the manager is clearly an important link in ensuring the home is well maintained and run. The manager has a clear concept of best practice in the home and is committed to the welfare of the service users. Responsibilities within the home are delegated to other senior carers, with the registered manager having overall supervisory responsibility. The previous requirement that quality assurance / satisfaction surveys be put in place, and the results duly published had progressed as far as the manager informing the inspector that a survey had been created – but this was not in use at the time of the visit. The home does not engage with service user’s finances – preferring relatives / next-of-kin / solicitors / care management to take on this responsibility. The manager confirmed that neither she nor the proprietors act as appointee to any service user. Health & Safety issues were generally in good order; all records were available for inspection and evidence was available that all maintenance and servicing of equipment within the home has been undertaken – save for the central heating servicing just being overdue (this is contracted out to Gasforce). The inspector requires that Fire Drills be increased in frequency to ensure that all staff members have experienced a drill at least once in each twelve-month period, and the testing of the hot water outflow temperatures is increased from the current fortnightly tests to minimally weekly checks. Statutory records such as accident and incident records were fully maintained. Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 2 1 1 2 2 3 1 STAFFING Standard No Score 27 1 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? YES 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. 1 Standard OP4 Regulation 18(1)(a) (c) Requirement The registered provider must ensure that all staff members are given training to increase their knowledge and skills in working with people with dementia. Timescale of 01.03.05 not met. The registered providers and manager are required to cooperate with the Commission is assessing the specific needs of the service users accommodated at the home and to ensure that the Registration category, the Statement of Purpose and the service provision is appropriate to the needs of the current service users. The registered provider must [a] devise and implement a structured and planned activity programme to meet the assessed needs of all service users; and [b] ensure that there is a detailed record of each activity, listing those involved and the success of the activity. This record must be used to DS0000013380.V251139.R01.S.doc Timescale for action 15/11/05 2 OP4 6 & 14(1) (2), 16(1) 15/11/05 3 OP4 16(2)(n) 15/11/05 Medihands Clifton Version 5.0 Page 25 support planning for future activities. Though slowly developing, elements of this requirement remain outstanding since originally set at 30.06.04 4 OP9 13(2) & 17 Medication records must clearly indicate the outcomes of administration or nonadministration of medication by using the coding system provided on the Medication Administration Record charts. Crockery throughout the home must be reviewed and replaced to provide suitably matching and pleasant tableware for the service users’ use. 16/09/05 5 OP15 16(2)(g) 15/11/05 6 OP19 23(2)(b) The registered provider must 15/11/05 implement a planned programme of maintenance with records kept. Timescale of 01.02.05 not met. The front door must be operated by a suitable device which does not require the use of a key; a coded key pad, integrated with the fire alarm system, may well be the best device to use, bearing in mind the vulnerability of service users with dementia. The escape route through the garden to the front of the house must newer be obstructed, and the garden gate should not be locked with the use of a key. A suitable device to secure the gate whilst being integrated again with the fire alarm system must be considered. Bedroom No 3 - with a fire route through it - must have the break DS0000013380.V251139.R01.S.doc 7 OP19 13(4) & 23(4)(c) 15/11/05 8 OP19 13(4) & 23(4)(c) 15/11/05 9 OP19 13(4) & 23(4)(c) 15/11/05 Page 26 Medihands Clifton Version 5.0 glass exposed for use (by the moving of the wardrobe or the break glass location [with fire officer’s permission], and the evacuation route through the bedroom must be kept available / ‘sterile’ at all times. 10 OP20 16(2)(c) The quality of furnishings provided by the home (as distinct from service user’s items) must be reviewed - and any which do not meet current Furniture (Fire Safety) Regulations must be replaced with items that do comply with the current standards. The registered provider must ensure that a power-assisted bathing seat / hoist is provided in the ground floor bathroom. Timescale of 01.02.05 not met. Shower fittings in bathrooms must be restored to use to enable a variety of bathing facilities to be available; thus meeting the varying / cultural needs of service users. A passenger lift or a suitable device to enable / assist service users to climb the stairs must be provided at the home to meet their present and future needs. 15/11/05 11 OP21 23(2)(n) & 13(4) 15/11/05 12 OP21 23(2)(j) 15/11/05 13 OP22 23(2)(n) 15/12/05 14 OP23 23(2)(a) (e) The registered provider must 15/11/05 communicate to the Commission its intentions with regard to the future use of the two ‘double bed rooms’ – which are only of a size suitable for use as single rooms in the future. Bedroom No 10 must have both the unsuitable lock removed and DS0000013380.V251139.R01.S.doc 15 OP24 13(4) 15/11/05 Page 27 Medihands Clifton Version 5.0 the electrical socket moved from the washbasin area and re-sited elsewhere in the room where it will be convenient to the service user. 16 OP26 13(4) & 16(2)(j) A sluice-cycle washing machine must be installed to meet the needs of disinfection standards and to comply with current Water Regulations (26.7, 8 & 9). All communal bathrooms and toilets must be provided with liquid soap, disposable towels and lidded bins – and to avoid further risk of cross-infection, the cotton (communal) towels must be removed. All bath / bath seat / non-slip bath mats and washbasins must be kept scrupulously clean and kept free from the build-up of lime scale – which is a potential source of cross-infection. The registered provider must recruit to the vacant position of Deputy Manager. Timescale of 01.03.05 not met. Staffing input must be reviewed in the light of the clear growing dependency levels in the home. The position of cleaner / domestic must be filled with a person working sufficient hours to release care staff from this burden, and also the kitchen domestic duties. Previously a recommendation – now clearly, due to changing circumstances, set as a requirement. DS0000013380.V251139.R01.S.doc 15/12/05 17 OP26 13(3) & 16(2)(j) 15/11/05 18 OP26 13(3) 15/11/05 19 OP27 18(1) (2) 15/11/05 20 OP27 18(1) 15/11/05 21 OP27 18(1) 15/11/05 Medihands Clifton Version 5.0 Page 28 22 OP30 13(4) Training of staff in First Aid must be made a priority over the next few months, to ensure that a competent First Aider covers each shift. Questionnaires – in the form of a customer satisfaction survey – now apparently devised by the proprietor, must be actively used and the results of this and other stakeholder surveys should be published. Timescale of 01.03.05 not met. Fire drills must be held more frequently, to ensure that each staff member has undertaken a drill minimally once each twelvemonth period. 15/11/05 23 OP33 24(1)-(3) 15/11/05 24 OP38 23(4)(d) (e) 15/11/05 25 OP38 13(4) The testing of maximum hot 15/11/05 water outflow temperatures from sources where thermostatic restrictor valves are fitted must be conducted at least minimally to ensure sufficient monitoring of the valve’s effectiveness. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. N/a Refer to Standard *RCN Good Practice Recommendations Not applicable Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 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 Medihands Clifton DS0000013380.V251139.R01.S.doc Version 5.0 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!