Inspection on 17/10/05 for Medihands Healthcare (149)

This inspection was carried out on 17th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Medihands Healthcare (149) 06/02/08

Medihands Healthcare (149) 18/10/06

Medihands Healthcare (149) 24/01/06

Medihands Healthcare (149) 23/02/05

Medihands Healthcare (149) 02/09/04

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

CARE HOME ADULTS 18-65 Medihands Healthcare (149) 149 - 153 Kingston Road New Malden Surrey KT3 3NS Lead Inspector David Pennells Unannounced Inspection 17th October 2005 11:00 Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 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 Healthcare (149) DS0000013394.V254374.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 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. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Medihands Healthcare (149) Address 149 - 153 Kingston Road New Malden Surrey KT3 3NS 020 8949 7860 020 8408 0767 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) Mrs Jayashree Sawmynaden Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23/02/05 Brief Description of the Service: Medihands Healthcare is a care home for seventeen adults with varying degrees of mental health needs. The home has close links with the Community Mental Health Team that is based conveniently very close by the Roselands Resource Centre. Service users are enabled and supported to independently access all local community amenities and facilities. The accommodation consists of two adjacent houses; one (151-153) accommodating nine service users in single bedrooms, and the other (149) offering a service to eight – again in single bedrooms. The two ‘sides’ of the home are joined by a covered walkway (unfortunately) passing through the day-to-day office. The houses, owned by Mr Sawmynaden and Mrs respectively, are registered as one home and are run as such – though such detail as the staffing rotas are ‘split’ between the two properties. The home is situated on the busy main road that leads from New Malden to Kingston. New Malden High Street / town centre is a short walk away. There is limited parking at the front of the house off the street. Public transport links are immediately accessible outside the home (busses), and a walk away (trains), the overground trains leading to Kingston, Surbiton, and into London Waterloo. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit spanned from 11am in the morning through to the inspector leaving the house at 8.45pm. In a busy visit to the home, the inspector was able to ‘sit in’ on a Pharmacist’s inspection visit, attend the afternoon staff handover meeting - speaking to staff about his role working for the Commission. Subsequent time was spent with the nominated manager of the home, Rakesh Phanda, discussing aspects about the operation of the home and reviewing the requirements and recommendations from the last inspection visit conducted in February of this year. The registered proprietor and both owners of the properties – Mrs and Mr Sawmynaden – were also present at the home – providing an additional broad perspective to the service provided. The overarching view of the inspector is that the home is running relatively well, with a growing understanding of the new regulatory requirements of the Care Standards Act 2000 and best social care practice. The feedback from service users encountered as the inspector toured the premises was generally positive about their home; the building – having various lounges and dining areas – keeps a homely aspect to it, whilst, in fact, being also quite a ‘maze’ of corridors and the ubiquitous fire break doors. The inspector looks forward to working in the near future with the manager – he is due, hopefully, soon to be registered to the home formally by the Commission - once a single final check is completed. Once formally in place, this registration of Mr Phanda as ‘in day-to-day control’ of Medihands 149 will release the registered provider, Mrs Sawmynaden, to oversee her two other (smaller) care homes – for which she, herself, holds the registered manager’s responsibilities. What the service does well: A comparatively new service user at the house stated: ‘It’s homely here – and the food’s great!’ Service users throughout the building echoed this opinion and it is clear that all service users are well settled and generally quite content at the home. Due to the relatively ‘younger’ age of service users, most are encouraged to engage with the local community - attending resource centres, clubs, and accessing everyday community facilities - rather than staying within the ‘security’ of the home. Clearly for some, however, the home is a vital ‘bolthole’ without which their security and sense of stability would be compromised; for others, however, the home is somewhere to ‘report back’ to in a busy cycle of engaging with the outside world. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 6 Feedback from ‘stakeholders’ to the home (which is now being extended to a wider respondent base) was generally positive – not identifying any ‘poor’ issues about the service offered; a local healthcare provider scored the home as ‘excellent’ throughout the survey - and a care management response had indicated they were happy with the service in general, whilst scoring as ‘fair’ the home’s activities, cleanliness and staff skills. What has improved since the last inspection? What they could do better: Requirements set at this inspection - of various natures - revolve around: ensuring that service user care plans are regularly reviewed each six months; responding in a timely fashion to the recommendations of the visiting pharmacist – particularly those relating to training records, written records, and ‘prn’ (‘when required’) medication. The removal of certain redundant locks from doors and the tidying up of rubble heaps immediately outside the premises is required as well as the refurbishment of bathrooms on the 151/153 side - and then checking of extractor fans throughout the building. Relating to staff facilities, individual lockers must be provided for the safe storage of personal items, whilst individual training records are essential. On the health and safety front, the need to complete all risk assessments fully was identified – along with requirements to clarify steps taken to address mains electricity safety issues and to evidence the annual portable appliances testing. The testing of hot water restrictor equipment is also to be increased in frequency - to a weekly monitoring system - to ensure the safety of service users. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 7 Management issues revolved around the role of the day-to-day manager and his relationship to two proprietors who are significantly ‘on site’. Once registered, it is clear that the manager has the overarching responsibility to run the home and should be ‘left to it’ – to evolve /develop his own style. A clearer designation of management roles and responsibilities must be evolved and agreed; it is essential that such clarity be introduced. This will then leave the proprietor (or a nominated representative) – as the registered responsible person – to undertake the required monthly statutory Regulation 26 visits checking that the manager is undertaking the day-to-day job competently. Of course, both Mrs Sawmynaden and Mr Sawmynaden can (and should) remain interested / involved in the running of the home – but the ideal would be for each to hold a clearly designated ‘portfolio’ of responsibility – (such as Mr Sawmynaden and his focus/interest on staff training), which then also clearly indicates some level of boundary and delineates the registered manager’s areas of authority and responsibilities. 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 Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 8 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 Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): I, 2 & 5. The home provides service users & other interested parties with full details to enable them to make an informed choice about choosing to live at the home. Service user’s individual needs and aspirations are assessed, understood and implemented at the home – through the thorough and considered exploration of information provided, and fully including the service user’s views. Each service user can expect to have a statement of terms and conditions – clearly stating the ‘rules’ of the home and providing information about their rights in, and obligations to, the home. EVIDENCE: The home’s Statement of Purpose is very comprehensive (almost too much detail!) and provides an excellent resource for those seeking information about the home. A Service User Guide is also in place – again with comprehensive information provided. A service user’s contract / statement of terms and conditions was seen in the Statement of Purpose – this, again, is fully detailed and meets the required standard. There is a comprehensive assessment system in place (and a new one coming into being) for prospective service users. Service users have good opportunities to ‘test drive’ the home. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 10 Four new service users were reported to have moved into the home since the last inspection. There is documentation available detailing that assessment of needs had been carried out prior to the service users moving into the home. Most service users come to the home with a care Plan Assessment (CPA) document. Written assessments are available as appropriate from care managers, occupational therapists and consultant psychiatrists, and there was evidence that service users have been involved in this assessment / planning process. Service User Plans are based on these needs assessments. Weekly fees range around the level of £480 - £500. Most service users are placed locally by the Royal Borough of Kingston, though placements are also supported by Richmond (1), Hounslow (2) and Wandsworth (1). Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10. The home creates and maintains care plans and assessment documents designed to ensure that the needs of individual service users are realistically met in a focused and individual way; the move towards regular six-monthly reviews will ensure that all are kept ‘live’ throughout a service user’s stay. Service users can be assured that their rights to individuality and selfexpression are protected, whilst acknowledging the community aspect of living at the home. Consultation and sharing of information will involve, and take into account, the wishes and aspirations of the single service user – as an individual and also as a member of the home’s community. Service users can generally be assured that risk-taking will be an integral part of the support / protection plans put in place by the home. Service users and staff can be assured that information kept personally relating to them will be kept appropriately safely in line with legislative requirements. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 12 EVIDENCE: The inspector spent some time, in the early evening, reviewing case files and very full care plans – based on eCPA (enhanced Care Plan Approach) assessments – which were the basis of care plans evolved. Keyworkers and Co-keyworkers are allocated to each service user, thus enabling the development of a closer more focused relationship between the home and each individual service user. The requirement that the registered provider must ensure that each Service User Care Plan is reviewed and updated to reflect changing needs at least every six months, with the involvement of the service user, is still to be fully implemented on a regular cycle. Most have professional intervention on a regular basis, however this may not fall within the six-monthly calendar routine. Service User Plans examined by the inspector contained good detail regarding assessed needs and personal goals. There was detail about how staff members should be involved in supporting the service user to meet goals. Documentary evidence of service user meetings (held about once every four months) showed that the agenda was almost entirely focused on food issues – a subject that cannot keep a meeting going for too long – and the occasional mention of outings. It would be beneficial if the meetings could be more structured and have a more ‘live’ agenda –including information giving and providing a real space for service users to become more involved in local decision-making. This is a focus the new manager must persevere with over the months to come. Risk assessments were in place and the inspector read through a number; some were not fully completed or signed off. This is important – to evidence that a holistic approach has been taken, and that the whole process has been taken seriously. This issue is raised under the ‘health & safety’ standard No 42. The home has a clear policy on confidentiality relating to service users. Staff members have signed to indicate that they have read and understood this policy. Staff member have demonstrated a good knowledge regarding their responsibilities regarding service users and confidentiality. Service user’s records were noted to be stored securely in locked cabinets - in the home’s offices - at the time of this inspection. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 16 & 17. Service users can be assured that the service provides opportunities for them to engage in activities both within and outside the home, and to adopt a lifestyle suited to their individual needs and preferences. Relatives / friends can expect a positive welcome from the home, within the context of respect for a service user’s own choice and decision-making. Service users can expect to be provided with a good standard of nutritious and wholesome food, whilst acknowledging the right to their own stated choice and ensuring that mealtimes are a pleasant and enjoyable time. EVIDENCE: The home actively supports and assists service users to reach their optimum level of independence; through support in finding employment when possible and through offering and encouraging opportunities to maintain links with family and friends. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 14 Activities at the home include Barbecues, planning and attending meals out, house parties for birthdays and other celebrations, and the usual social activities of playing cards, ball games (there’s a baseball hoop in the garden) and the enjoyment of music and the TV. The home has devised a ‘Lifestyle’ form, which identifies service users’ social, emotional and spiritual needs. This form is completed together by the service user and keyworker and is used to identify what community facilities are needed / available to meet identified needs. Service users, Care Managers and home staff discuss issues regarding personal development at the regular reviews. A number of current service users are in paid employment. Local community resources used include: the nearby Roselands Resource Centre, Springboard Industries (based close by Tolworth Hospital), the New Malden Centre and the Crescent Resource Centre. The town centre of New Malden is a short walk away and Kingston and Surbiton are easily accessible by public transport. There are two dining rooms in the home, both of which have recently been redecorated – though only one - the larger of the two (in 151/3) - is used for mealtimes – by express choice of the service users. Mealtimes are flexible, and some service users are able to take meals in their bedroom. All service users who spoke with the inspector said that they were happy with the quality of the food served, stating that the food was ‘good’. Records of food served in the home were available for inspection, detailing a varied and nutritious menu. Menus evidenced a wide variety. The written menu did not evidence a choice being actively offered at each meal, though the home does state that this is a reality. The inspector intends to explore this element more thoroughly at the next visit. Food storage and preparation areas were found to be clean and hygienic. Systems are in place for monitoring fridge and freezer temperatures and also hot food serving temperatures. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Service users can be assured that their personal, health care and emotional needs will be recognised and met by the home’s daily service input and through longer-term monitoring, assessment and care plan programming. The systems adopted by the home regarding medication – once advice from the advising Pharmacist has been adopted – will ensure the safety and consistent treatment and support for each service user. EVIDENCE: Personal support is clearly given to those who require such intervention - such as encouraging mobility exercises for those who have such difficulties, to staff being aware of a service user ‘withdrawing into themselves’ - or recognising other indicators (such as an increase in continence difficulties); such features are evidently monitored and ‘looked out’ for. Roselands Resource Centre is just a few steps away from the home, along the main road. This excellent Centre provides the opportunity to access a variety of mental-health focused resources through the Community Mental Health Team. Access to the consultant psychiatrist, Dr John Murphy, is also enabled through good relationships with the CMHT. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 16 Most service users have access to a single GP who is located nearby; one service user uses the services of another doctor. Mrs K Patel – the Consultant Pharmacists from Boots the Chemist – was booked in to undertake a pharmacy inspection at 11.30am on the day the inspector visit ed the home. With her agreement, the inspector observed and participated in the inspection process. The inspection revealed that the home’s systems were generally running well and that service users were in the main well supported in this aspect. Medication reviews are conducted at each 6-monthly service user review. The system for the home to arrange ‘TTO’ (‘to take out’) medication – for when a service user is on holiday or away, perhaps for the weekend, was well organised. The issues raised at this inspection visit are blocked together as one requirement in the section below. Of particular concern was the absence of clear criteria for the administration of ‘prn’ (‘when required’) medication. |It is absolutely vital that service users are only administered medication at the “staff’s discretion” when a clear checklist of criteria have been satisfied. A checklist must be in place for any service user who has such ‘discretionary’ medication prescribed. A new ‘homely remedies’ protocol and signing sheet (approved by the Borough of Kingston and the local PCT) – for GPs to sanction the use of minor informal treatments at the home, was introduced and left for the home to complete in regard to service users before submitting for the GP’s authorisation. The Consultant Pharmacist has arranged for two training sessions to be run at the home in late November / early December to ensure that all staff are formally accredited with training regarding the administration of medicines. All present staff members undertaking medicines involvement have already completed a ‘Care of Medications’ training session in March 2004. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Service users can be confident that their comments and complaints are responded to, with appropriate action being taken in a timely fashion. The home provides support to service users to ensure that they are protected from harm and any form of abuse. EVIDENCE: The home has an appropriate complaints policy and procedure. Just one (oblique) complaint had been made - and resolved as far as practicable - since the last inspection of the home. Policies and procedures in relation to making a complaint are available in the Statement of Purpose / Handbook. Service users and other stakeholders are provided with information about how to make a complaint. There is documentation for the appropriate logging of complaints including the outcome of any investigation. The home is very familiar with the Local Authority (Kingston)’s Adult Protection procedure; a member of staff has been suspended under this provision for some time, following an allegation made against them by a service user. Both the house and the Borough dealt with this particular situation appropriately – but due to the investigation of the allegations taking some long time, this has lead to the staff member (without prejudice) still being suspended. All service users manage their own personal finances and bankbooks, etc; of the seventeen people living at the house, over half were described as ‘very independent’ – about six were of ‘medium dependency’ category and needed, therefore, a more structured input. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30. Service users can expect to live in a clean, warm and comfortable environment designed to meet their individual needs and providing adequate services and domestic facilities. Service users can be assured that, generally, the home is maintained as a safe environment in which to live without unnecessary risk. EVIDENCE: The home is in keeping with local residential housing. It is situated on a main road close to the centre of New Malden. Local amenities and public transport are easily accessible. The home was generally well maintained, clean overall, tidy, and generally well furnished throughout. All fixtures and fittings were of a good standard and service user’s bedrooms were decorated and furnished to their own taste. Both lounges and dining rooms have been recently redecorated. The bathroom & toilet in 149 have been refurbished with the floors tiled to a high standard. The Registered Provider has now clarified that water services and facilities in the home comply with the Water Supply (Water Fittings) Regulations 1999. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 19 All bedrooms seen contained furniture and facilities, which are in line with these Standards, ensuring individuality and personality. Kettles were noted in some rooms and lockable items of furniture were also observed. Service users have been able to bring items of their own furniture with them. Service users are consulted regarding the way their bedrooms is decorated and furnished. Service users’ bedrooms are lockable and each service user is provided with a key to their room. Star key locks noted on most doors in house no 153 are required to be removed to avoid any unintentional entrapment. The home – assessed as an ‘existing home’ - has five bathrooms and seven toilets. These rooms have suitable locks. Bathrooms and toilets were variable in the sense of decoration and maintenance on the day of this inspection; the registered provider has agreed to upgrade certain bathrooms areas in the 151/3 side of the home. In one bathroom a significant improvement has been made since the last inspection of the home. One ground floor bathroom has the special facility of a ‘hip bath’ to enable less able persons to bathe. There are five communal rooms in the home; all are warm and homely. There is a quiet sitting room and two dining areas – though one is barely used now – service users preferring to congregate in the larger and brighter of the two spaces. A lounge and one of the dining areas have been dramatically decorated more recently. A conservatory to the rear of the building overlooks the paved rear garden area. This large attractive paved garden area, which has covered seating and is ideal for summer BBQs, is being developed further as resources allow the proprietors to do so. It was good to see relatives with a service user – granddaughters as well - in the garden, with the latter playing netball whilst the adults talked. A pile of rubble in this area is to be removed, pending enhancement of the sun lounge / veranda area. Staff sleep-in facilities are provided in the office and lounge. Staff members do not have access to proper secure lockers – an essential facility in such a busy home – these must be provided. Laundry facilities, which are domestic in scale, are provided; situated upstairs and hand-washing facilities are prominently sited. The inspector noted the home to be generally clean, hygienic and free from offensive odours at the time of this inspection. Policies and procedures for control of infection are in place. The home does not employ domestic staff. Support workers are reported to be responsible for maintaining hygiene standards in the home, and for supporting service users to keep their bedrooms clean. The non-slip mats in bathrooms was one area for important cleansing / attention in future – to minimise the risk of cross-infection. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35. Service users can be assured that they will be supported at all times by staff who are trained and competent in their work, staff being provided in sufficient numbers to meet service user’s identified needs. Service users can expect to be provided a service that ensures their safety and protection from abuse through thorough recruitment processes, and ongoing staff support arrangements. EVIDENCE: On the day of the inspection, the inspector had been in the home’s office for no more than five or so minutes at the very beginning of his visit when Mr Sawmynaden arrived with a large amount of training materials, folders, workbooks and portfolios under his arm – ready to collate them and hand them out to staff. The material seen (containing an overview of mental health history / glossaries / care plan examples and clear descriptions of various mental health conditions) was based on a City and Guilds competency structure at NVQ Level 2 – so will enable the direct linking in to certificated awards in Mental Health Skills for all staff. This is a most commendable development. The Registered Provider has still to ensure that individual staff member’s training profiles are developed – so that each staff member can ‘own’ their own record, and to enable the management to fully assess the competencies and Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 21 training needs for each individual. Various proformas were discussed with the inspector – all this is necessary now is the management decision and implementation. The Registered Provider reported that all staff members receive induction training – this is the straightforward home’s induction – the new Skills for Care Induction matrix is awaited to tie in this present process with the commencement of NVQs. Fourteen staff are currently employed by the home; two are already qualified - and five are currently undertaking their NVQ qualification. The home still has a small way to go to achieve the 50 threshold for trained care staff (by the end of 2005) – the figure will need to be exceeded if the house continues to see a turnover of staff as it has in the past year. Ongoing staff training occurs, largely in the form of in-house training. Recent training declared by the manager included: ‘Fire Safety’, ‘Health & Safety’, ‘Medication’, ‘Food Hygiene’, and ‘No Secrets - Adult Abuse’ training. Staffing is shown on a rota as being divided between the two houses – though as previously described the houses operate as one at mealtimes – and there is little division seen at handovers. Staffing is provided at a level of four staff members and the manager (supernumerary) being present. There are also two staff members on duty at nighttimes – one for each house. Criminal Records Bureau checks were seen for the staff members newly employed at the home. Eight staff have left since the last inspection visit (five twenty-hour staff, and three full time workers); the pre-inspection questionnaire stated that two had left due to moving / returning to own country, but two left “without notice”, and three left with “no reason given” another just “resigned”. This is a quite high level of turnover of staff – which can create an effect (due to lack of continuity) that can be detrimental to service users; it is advised that this staff retention aspect of the home’s operation be explored more closely, to try to minimise the ‘fall out’ for the service itself. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 42 & 43. The home operates systems that ensure that service users benefit from a wellrun, competently managed and generally safe environment, however the clarification of management roles and those of the registered providers would benefit all at the home. Service users can be assured that generally their rights and interests are well served and protected through the home’s approach to record keeping, policies & procedures, and through the day-to-day conduct of the home. Service users can be assured that their welfare, health and safety is, in general, safeguarded through the home’s adherence to appropriate guidance and regulations concerning best safety practice. EVIDENCE: Rakesh Phanda has applied to be registered as the manager of the home – he has been interviewed – and is awaiting the CRB check outcome with the Commission to complete this application. He is currently undertaking his NVQ at Level 4 (the Registered Manager’s Award) at Nescot. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 23 Clarification of the role of the day-to-day (registered) manager - and his relationship to two proprietors who are significantly ‘on site’ – is essential to the smooth running of the establishment. Once registered, it is clear that the manager has the overarching responsibility to run the home - and should therefore be ‘left to it’ – to evolve / develop his own management style and influence. A clearer designation of management roles and responsibilities must be evolved and agreed; it is essential that such clarity be introduced. This will then leave the proprietor (or a nominated representative) – as the registered responsible person – to undertake the required monthly statutory Regulation 26 visits (which are currently outstanding) - checking that the manager is undertaking the day-to-day job competently. The Registered Provider / manager is also obliged to develop an annual development plan (underpinned by the registered provider’s Business and Financial Plan) for the home; this is important to show the listening / responding / planning / implementation cycle necessary to ensure the development of the establishment. As commented on in the earlier ‘needs and choices’ section, the Registered Provider should ensure that meetings involving service users are facilitated on a more regular basis in order to allow service user’s views to be taken into account in the development of the home – currently they are being held about every four months – which is a less than ideal frequency, as decisions and actions can get lost over such a long time frame. It is recommended that twomonthly is a frequency that can ensure a ‘connection’ between one meeting and the next. The Registered Provider should seek to ensure that all policies and procedures developed are dated in order to maintain their regular review; this again could be a management role, once Mr Phanda is registered. The Registered Providers have devised a detailed quality assurance form, which has been designed to gain feedback from service users about the quality of the service. An additional form has been developed aimed at seeking the views of other stakeholders such as social workers and family members. Surveys received from stakeholders – a local health care professional stated ‘excellent’ in all categories of question; a care management response had indicated they were happy with the service in general, whilst scoring as ‘fair’ the home’s activities, cleanliness and staff skills. Examination of ‘Health and Safety’ issues revealed a number of matters: The home has systems in place for fire safety including weekly fire alarm tests, fire drills and the testing of emergency lighting and fire fighting equipment. All areas of the home have been risk assessed. Fire drills at the home are to be stepped up; there were only two undertaken in 2005 so far; these should be Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 24 staged at a frequency to ensure that all staff undertake a drill on a regular (minimally annual) basis. Clarification of the homes’ five-yearly electrical installation checks is required to ensure that both full checks have been undertaken, and that any identified work resulting from these checks has been satisfactorily completed. Portable appliance testing was also overdue. Hot water checks – ensuring the safety and effectiveness of the thermostatic mixer valves - must be increased to a minimally weekly test; the current fortnightly routine being a little too infrequent to observe trends if the valve is starting to fail. Gas servicing and soundness tests, though regularly annually undertaken, were out of synchronisation - leading to a ‘gap’ of certificated cover – these are now in order. Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 2 2 2 3 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Medihands Healthcare (149) Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 2 3 X 2 2 2 DS0000013394.V254374.R01.S.doc Version 5.0 Page 26 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 YA6 Regulation Requirement Timescale for action 24/12/05 15(1) & The Registered Provider must 15(2)(b) (c) ensure that each Service User Care Plan is reviewed at least every six months, with the involvement of the service user, and updated to reflect changing needs. Timescale of 01/05/05 not met. 13(2) In regard to the handling of medication and following the advice of the visiting Consultant Pharmacist: [a] A training matrix must be established to show dates and types of training undertaken by staff in regard to this discipline. [b] Specimen initials and signatures of staff authorised to administer medication must be kept as a record. [c] Service users must be asked to sign to indicate their consent to medication being administered and also to agree that any additional medication 2 YA20 24/12/05 Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 27 obtained by them is notified to the home. [d] ‘PRN’ criteria / profiles must be established for any service user on medicines which may be give ‘when required’ clearly stating the criteria under which they may be administered. [e] Administration charts should always be signed – ‘refusals’ or other reasons must be carefully written up and be fully described (20). 3 YA26 13(4) ‘Star key’ locks on doors in house no 153 must be removed to avoid any unintentional entrapment. 24/12/05 4 YA27 23(2)(b) Bathrooms – especially in 24/12/05 house no 151 - need refurbishment as discussed with the proprietors at the time of the inspection visit. The rubble heap next to the sun lounge must be relocated or concreted over to ensure safety and a pleasant visual amenity for all service users. Staff lockers must be provided in sufficient quantity that all staff are able to individually lock away their possessions when on duty in the home. Items such as bathing non-slip mats must be kept clean to avoid risk of cross-infection. Extractor fans throughout the house must be reviewed and replaced, where necessary. Routine cleaning helps stop DS0000013394.V254374.R01.S.doc 5 YA28 13(4) & 23(2)(b) 24/12/05 6 YA28 23(3) 24/12/05 7 YA30 13(3) 24/12/05 8 YA30 23(2)(p) 24/12/05 Medihands Healthcare (149) Version 5.0 Page 28 such units from burning out so quickly. 9 YA35 18(1)(c) The Registered Provider must ensure that individual staff’s training profiles are developed. Timescale of 01/05/05 not met. The Registered Provider must implement unannounced monthly visits to the home by the Registered Provider for the purpose of inspecting the quality of the facilities and service provided. A written report must be prepared following these visits, with a copy being supplied to the Commission. The Registered Provider must ensure that all policies and procedures developed are signed - and dated in order to maintain their regular review. All risk assessments must be fully completed, signed and dated to ensure that the document is fully understood by all and therefore effective. 24/12/05 10 YA39 26 24/12/05 11 YA41 24(1) 24/12/05 12 YA42 13(4) 24/12/05 13 YA42 13(4) One window on a staircase in 24/12/05 the home (pointed out to the manager) must be restricted to avoid any risk of accident in this communal area. Clarification of the homes’ five- 24/12/05 yearly electrical installation checks is required to ensure that both full checks have been undertaken, and that any identified work resulting from these checks has been satisfactorily completed. 14 YA42 13(4) & 23(2)(b) Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 29 15 YA42 13(4) Hot water checks to be undertaken minimally weekly not fortnightly. Evidence of the annual Portable Electrical Appliances testing is to be provided to the Commission. The registered provider must ensure that a business and financial plan for the home is available, to inform the longterm development of the home. 24/12/05 16 YA42 13(4) 24/12/05 17 YA43 24 & 25 24/12/05 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 4 5 Refer to Standard YA32 YA34 YA37 YA39 YA39 Good Practice Recommendations At least 50 of care staff employed at the home should be qualified to NVQ level 2 by the end of 2005. Staff retention should be examined as an issue of concern bearing in mind the high turnover of staff this last year. The manager should be qualified to ‘RMA’ - Level 4 NVQ in Management and Care - by the end of 2005. The Registered Provider should develop an annual development plan for the home (39). The Registered Provider should ensure that meetings involving service users are facilitated on a more regular basis in order to allow service user’s views to be taken into account in the development of the home (39). Medihands Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 30 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 Healthcare (149) DS0000013394.V254374.R01.S.doc Version 5.0 Page 31 - 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. 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