Inspection on 18/10/06 for Medihands Healthcare (149)

This inspection was carried out on 18th October 2006.

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 13 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) 24/01/06

Medihands Healthcare (149) 17/10/05

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 Key Unannounced Inspection 18th October 2006 11:50a Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 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.V309317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2006 Brief Description of the Service: Medihands Healthcare at 149 - 153 Kingston Road 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 - at the Roselands Resource Centre. Service users are enabled and supported to independently access all local community amenities and facilities from this centrally placed establishment. 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 Sawmynaden respectively, are registered as one home in the name of Mrs Sawmynaden and are run as such - though such detail as the staffing rotas continue to be ‘split’ between the two properties. The home is situated on the busy main road that leads from the centre of New Malden to Kingston. New Malden High Street / town centre is a short walk away. 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. There is limited hardstanding parking at the front of the house, directly off the street. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit was undertaken on an ordinary mid-week late morning and afternoon / evening, the inspector spending about seven and a half hours at the home. A second visit - to meet with service users more, was conducted a week later on the following Tuesday, in the early evening. During his visit, the inspector was able to meet with Mr Sawmynaden - the acting manager of the house - who was able to assist the inspector with administrative and operational issues. The inspector also engaged with a number of service users (principally on the second visit), and also a good number of staff members (being around to meet both morning and afternoon shifts on duty). The inspector was able to overview progress in meeting the requirements and recommendations set at the last visit to the home, as well as verify information given in the Pre-Inspection questionnaire - which had been returned to the commission by the Home’s proprietor. The inspector is grateful to the service users, the staff and Mr Sawmynaden, and Mrs Sawmynaden - the proprietor, for the welcome, cooperation and hospitality extended to the inspector throughout the inspection process. During the absence of an appointed / registered manager, Mr K Sawmynaden is overseeing the day-to-day conduct of the house, and will from this point onwards in this document be referred to as the ‘acting manager’. What the service does well: A service user at the house stated: ‘It’s very warm and homely here – they do a good job’. Service users generally appreciate the accommodation and the service offered - and it is clear that all service users are well settled and generally quite content at the home. Most service users 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 rehabilitation and engagement with the outside world. Feedback from ‘stakeholders’ with interests in the home again has proved generally positive – the local GPs both feeding back positively to the inspector and care managers recently encountered have also verbally indicated their general contentment with the service. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Requirements set from this inspection involve three concerning medication issues: two issues which had been previously raised by the Pharmacist, one relating to ensuring that information was fully dated and that information transferred to all necessary relevant documents, and one to ensuring that medication - such as eye-drops - received as significant attention as any other form of medication administration. The improvement of the sleeping-in facility in 151 is required - as was the consolidation of documents from this ‘open’ area into more secure locations. Staffing issues highlighted included the requirement to ensure that staff received the appropriate training to minimally NVQ Level 2 in Care - and the recruitment process is in need of opening up to the wider community to ensure that the staff team to a reasonable extent reflects the population of the home and the surrounding population. The informed use of references is also to be tightened up, ensuring that a wide perspective of comment concerning an applicant is held on file. An essential requirement from this inspection is the need to appoint a new manager to run the home on a day-to-day basis; the previous manager - who never got as far as being registered - left in January 2006. This new person must be proposed for registration with the Commission soon. It is also essential that job descriptions and person specifications are drawn up and state explicitly the relationship of the senior management team vis-à-vis the registered manager post. The proprietor - Mrs Sawmynaden - is a regular visitor / overseer to the home, and Mr K Sawmynaden - the proprietor’s husband, generally acts as ‘Support Services Manager’ to this home, alongside the other ‘Medihands’ registered services. Mr Sawmynaden was currently acting manager at the time of the inspection visit. The Commission received confirmation that a new recruit had started at beginning of December 2006. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 7 Following the manager’s induction, it is hoped that the Commission’s Central Registration Team will soon receive their application for registration. As a consequence of the appointment of a manager formally to the house, the proprietor will soon be in a more strategic position to conduct the necessary Regulation 26 Registered Provider visits to the home, ensuring that the home’s conduct meets appropriate standards, and she will be able to develop the home’s long-term goals through the implementation of a development and business & financial plan. 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.V309317.R01.S.doc Version 5.2 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.V309317.R01.S.doc Version 5.2 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): 1, 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Statement of Purpose is extremely comprehensive 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 is available within the Statement of Purpose – this, again, is fully detailed and meets the required standard. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 10 There is a comprehensive assessment system in place for use with prospective service users. Service users have good opportunities to ‘test drive’ the home. Four new service users were reported to have moved into the home since the last inspection, with two moving out - one to another of the ‘Medihands’ establishments. Documentation is available, detailing the assessment of needs that had been carried out prior to the service users moving into the home. Most service users come to the home with a Care Programme Assessment (CPA) document. Written assessments were also 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 - many signing their own documentation. Service User Plans are based on these needs assessments. Weekly fees range around the level of £500. The Royal Borough of Kingston places most service users here at the home; it is seen as a useful local resource. Placements are supported by Community Mental Health Teams based in New Malden, Roehampton, Hounslow and Surbiton. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 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 & 9. 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. 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 involves, and takes into account, the wishes and aspirations of the single service user – as an individual, as well a member of the home’s wider 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 12 EVIDENCE: The inspector spent time reviewing service user case files and care plans – based on eCPA (enhanced Care Programme Approach) assessments – which became the basis of all the home’s care plans. Care plans and associated documentation has been revised substantially since the concerns expressed by the inspector at the previous inspection regarding there being too many ‘types’ of records being kept - hence overwhelming staff by the challenge of recording in the ‘appropriate / correct’ location (resulting sometimes in little or not record) This system has been replaced by a far more simple approach to recording, where almost all information is now stored in one place on a simple chronological basis - this enabling a fully ‘connected’ picture to be portrayed of each individual and their progress. The move towards six-monthly reviews, the inspector was assured was progressing well and review date monitoring was mapping this progress. Service user care plans examined by the inspector contained good detail regarding individually assessed needs, and identified personal goals. There was also detail about how staff members should be involved in supporting the service user to meet their goals / aspirations. 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. Risk assessments seen in files sampled were full and comprehensive – the content assisted by the Care Programme Approach documentation. All such assessments are regularly reviewed and / or amended as necessary, in the light of developments noted for each individual. On the second day of the inspector’s visit, he was able to sit down in the lounge with a group of four service users and check out how they felt about the service; the general response was positive - all felt at home and compared the home with others they had known and Medihands came out ‘on top’. For one service user, this was their first experience of residential care and they were finding a positive experience. A couple of other individual service users encountered as the inspector walked around the home were also very complimentary about the service. A concern expressed by a couple of service users about one specific visitor to the house was being dealt with by the home - in conjunction with the CMHT under the RB Kingston ‘Safeguarding Adults’ procedure. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 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 - 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 positively supported in forming and maintaining relationships with friends, family and those of an intimate personal nature. 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 14 EVIDENCE: The home continues to actively support and assist 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. Activities at the home include Barbecues, planning and attending meals out, house parties for birthdays and other celebrations, and the usual social activities / preoccupations of playing cards, ball games (there’s a baseball hoop in the garden) and the enjoyment of listening to music and watching the TV. The home has devised a ‘Lifestyle’ form, which identifies each service user’s 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 few 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 (and even central London) are easily accessible by public transport. Support service users to maintain family links and friendship is identified, and also covers the needs of service users to have intimate relationships too. A policy exists covering sexuality and relationships. The home has a clear policy stated within the Statement of Purpose - with regard to service users’ families and friends, who are positively welcomed to the house. Day-to-day notes on service users again reflected the number who engaged with family and friends, many by going out visiting, as much as them visiting the house. There are two dining rooms in the home, both of which have recently been redecorated – though only one - the larger of the two - is used for mealtimes; this by the express choice of the service users. Mealtimes are flexible, and some service users 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 generally ‘fine’. Tea making facilities are available in most service user’s bedrooms, unless a risk assessment has indicated that such a provision would be unwise. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 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 fully adopted – will ensure the safety and consistent treatment and support for each service user. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal support is given to those who require such intervention - such as encouraging mobility exercises for those who have such difficulties, through promoting personal care, to staff being aware of a service user ‘withdrawing into themselves’ - or recognising other mental health indicators; such features are monitored and ‘looked out’ for - discussions in handovers between staff evidencing this. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 16 Roselands Resource Centre - the principal professional mental health resource - 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. The MIND Café is also located here - providing peer support right through into the evening. Access to the consultant psychiatrist is also enabled through good relationships with the CMHT, and contact with Community Psychiatric Nurses is regular. Most service users have access to a single General Practitioner, who is located nearby; some service users use the services of another local doctor. Questionnaires submitted by the two GPs providing a service to the home indicated that they both viewed the service provided positively - neither had received a complaint about the home, and both found that good standards were maintained with regard to their dealings with their patients. The Pharmacist from Boots the Chemist undertakes pharmacy inspections at the home. A previous inspection visit to the home back in October 2005 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 medication for when a service user is on holiday or away, perhaps for the weekend, was well organised. A requirement in this report covers unheeded aspects of advice given by the visiting Consultant Pharmacist at her visit. The outstanding issues raised (concerning having a discrete training matrix to evidence and monitor staff training, and ensuring that service users sign their consent to staff managing and administering their medication) are ‘blocked together’ as one requirement below. Concerns about ‘PRN’ (‘when required’) medication have been solved, following the introduction of a criteria / profile for such individually administered medication. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 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 within the ‘Safeguarding Adults’ framework. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an appropriate complaints policy and procedure. 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. The home’s own procedure is closely aligned with this document. The proprietor has a good understanding of the issues around ‘Safeguarding Adults’ procedures in general, due to issues arising within the home regarding concerns about some service user’s vulnerability. All service users manage their own personal finances and bankbooks, etc; of the seventeen living at the house, most were described as competent and ‘independent’ – a few have direct assistance from their placing local authority. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 & 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 - both private and communal space - is maintained as a safe environment in which to live without unnecessary risk. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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, odour-free and generally well furnished, throughout. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 19 All fixtures and fittings were of a good standard and service user’s bedrooms were decorated and furnished to their own taste. There are seventeen single occupancy rooms. Seven toilets, five baths and two showers provide for a ratio of less than 3:1 on a sharing principle. Both lounges and dining rooms have been redecorated in the past year. The bathroom & toilet in 151 have been refurbished, with a new bathroom suite provided, to a high standard. A new shower has been installed in the ground floor bathroom in 149. 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 and enjoying the warmer weather, is being developed further as resources allow the proprietors to do so. All bedrooms contain the furniture and facilities that are in line with the national Standards, mixed with service user’s personal items, ensuring individuality and personality. Kettles are held in a number of rooms and lockable items of furniture are also provided to all. 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. Staff sleeping-in accommodation provided on the ground floor between 151 and 149 (in the main daily operations office) was really provided at an unacceptably poor standard of privacy and security for staff sleeping overnight there. The current provision also obstructs service users from moving between the two parts of the building from 10.00pm to 7.00am each day. The acting manager agreed with the inspector to implement a plan whereby the current bed area would be walled / doored off - thus providing a ‘corridor’ off which the (admittedly still small) sleeping-in room would be provided, through which service users could pass at all times of the day and night. Lockers have now been provided in greater quantity that staff may secure any personal valuables whilst they are present and on duty within the home. The home does not employ domestic staff. Support workers are reported to be responsible for maintaining cleaning of the communal areas and hygiene standards in the home, and for supporting service users to keep their bedrooms clean and organised. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected 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, many of whom are trained and competent in their work, the personnel 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 the current recruitment processes and ongoing staff support arrangements, though the present somewhat closed recruitment process may limit the staff members’ cultural understanding and perspective, when seeking to empathise with the service user group. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Twenty-two care support workers currently staff the main home and also provide staffing input to the two nearby smaller mental health homes in the proprietor’s ownership. All work at the main home from time to time, however, so are included in the staffing and training formulae. It is clear that staff training in regard to NVQ Level 2 or above is ‘behind’ the expectation of the Commission, and there is a need for a concentration in this next year to attain the 50 proportion of care staff who are thus trained. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 21 Staff meetings were minuted every two months throughout the past year; as with service user meetings - a great improvement on the previous year’s performance, evidencing the home’s focus on communication between shifts of staff. The inspector has also ‘sat in’ on handovers between shifts in the recent past, this again aiming to pass on the best information between the staff team. It is a clear (factual) reality that the entire staff team - excepting two staff members - are Mauritian - and, predominantly, young male workers. Although these staff members are willing and generally able to provide a service, the culture / ethnic origin of the service users is generally British (with one of Punjabi and one of Sri Lankan origins) and mid-to-old aged (with eleven out of the seventeen being female), whilst the staffing is young, Mauritian and male. Comments from service user’s professional supporters have fed back concerns about a lack of verbal / communication capacity of staff at times - with one professional stating that they feel they can only deal with the manager when wishing to communicate issues of significance. There is clearly a need - and this was discussed with the proprietor - for the home to develop a policy of finding a balanced approach to providing staff who reflect both the multi-cultural nature of the community in which they find themselves, whilst also providing staff from a cultural, gender and age-specific background which matches the service user group themselves. It is required that recruitment at the home is opened up to competitive interview - to attract a wider cross-section of the community into the home’s workforce. Staff files seen evidenced the enhanced Criminal Records Bureau checks being undertaken and generally the recruitment procedure followed best practice excepting the idea of competitive interview as suggested above. Concerns also arose where if applicants appeared from abroad, referees were difficult to find and in some respects two references from (for example) the same training college are not really adequate to ‘triangulate’ an opinion / endorsement on the person in question. Each staff member now has a training folder - and training profiles have almost been completed for each staff member; this enables the acting manager to assess an individual staff member’s competence based on certificated achievement - and this also allows for planning for ‘refresher’ courses - and ensures that certain time-limited courses do not run ‘out of time’. The crossreferencing of the profiles also enables the manager to see ‘at a glance’ the profile of training for the whole home - this enabling the assessment, prioritising and planning of training both within the home and through specialist providers. Ongoing staff training occurs, largely as in-house input (especially mental health training). Recent training declared by the proprietor included: ‘Fire Safety’, ‘Health & Safety’, ‘Manual Handling’, ‘Medication’, and ‘First Aid’. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 - 43. The home operates systems that ensure that service users benefit from a reasonably managed and generally safe environment, however the appointment of a registered manager and 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 opinions would be heard, and their rights and interests be well served and protected through the home’s developing approach to record keeping, through the revision of policies & procedures, and through the day-to-day general 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. Service users would benefit far more from a service if it was strategically planned and clearer in its goals and aspirations. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 23 EVIDENCE: Currently the owner of one half of the home - Mr K Sawmynaden - the proprietor’s husband - continues to stand in the ‘acting manager’ role at present - the job of manager having been vacated back at the beginning of the year. Mrs Sawmynaden, the proprietor of the whole service, owns two small mental health establishments for which she is the registered manager - and she also owns a larger establishment for older people - which she also actively oversees, in the capacity as the proprietor. The need for a fully appointed and registered manager to run 149 -153 Kingston Road is obvious, therefore - and vitally important. At the time of the inspection visit, Mrs Sawmynaden reassured the inspector that she had identified a potential manager for the home, and that they were due to start at the home relatively soon after the inspection visit. Sadly, however, a personal issue impeded this start for some while - but it is understood that there is now a manager in place on a trial basis, with a longterm view to proposal for registration. The home can clearly not progress satisfactorily for more than a year without a person properly inc charge of the home and the commission is minded to take steps to apply statutory action if the situation has not resolved - and a suitable person is proposed for registration - by the end of February 2007. Alongside the nomination of a manager, the need to ensure that a clear job description for the home manager is in place - and a similar statement for other associated senior staff (such as Mr Sawmynaden - who styles himself otherwise as the Training Manager) is essential. Such statements would state the lines of responsibility and governance in the home, which must be evolved - clearly stating the respective roles of all the senior members within the organisation. Within the stated understanding of the respective roles of each senior staff member, must be the recognition of Mrs Sawmynaden as the registered provider - a role which brings with it the requirement to visit the home, unannounced, at least once in every month - to form an opinion about the conduct of the home - and to write a report of those observations for the benefit of the person actually running the home (and available to the CSCI). Service users’ meetings were minuted regularly every second month throughout the year in 2006 - a positive improvement on 2005 performance. It is clear that the acting manager and the proprietor are actively involved in listening to the opinions of the service users and in looking to ways to improve the service. However a more strategic approach to planning and development is needed, with the owners taking a more critical rather than active role would benefit the service as a whole. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 24 A single page Development Plan Statement was available at the home - the first signs of such an initiative - and which now needs integrating with the information from a properly developed business and financial plan to ensure that the underpinning of further developments. Administratively, the home is required to rationalise its storage of written / paper documentation - especially information relating to service users - this relates in part of the reorganisation of the ‘open’ office between 149 and 151, where insufficient attention was paid to ensuring the proper security of personal documentation. The proprietor is also in mid-process of updating policies and procedures; they have been dated but not as yet signed by her or a manager in charge - to indicate the ownership and integrity of the papers by the registered provider. Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 2 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 1 2 3 2 3 3 2 Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 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 YA20 Regulation 13(2) Requirement 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 area. [b] Service users must be asked to sign to indicate their consent to medication being administered and also to agree that any additional medication obtained by them is notified to the home. Timescales for the above, of 24/12/05 & 31/03/06, not met (three other elements have now been ‘met’). Medication instructions must be dated at all times to ensure that there is never a question as to the implementation date of any change. The end of any short course of medication must also be stated in both medication profile and the current administration sheet. Action was implemented at DS0000013394.V309317.R01.S.doc Timescale for action 28/02/07 2. YA20 13(2) 18/10/06 Medihands Healthcare (149) Version 5.2 Page 27 the time of the inspection. 3. YA20 17 - Sch 3.3(i) The administration of items such as eye drops must be recorded consistently; such medication is in need of regular administration as any other drug. The acting manager agreed to take immediate action in this regard. The current use of the ‘open’ office between 149 & 151 is challenged. Staff sleeping-in accommodation must be improved and provided with improved security and privacy; the proposal agreed between the inspector and the acting manager must be brought to fruition. 18/10/06 4. YA28 23(3) 28/02/07 5. YA32 18(1) That at least 50 of care staff 28/02/07 employed at the home must be qualified to NVQ Level 2 in Care or equivalent. Previously a time-limited recommendation to end of 2005 - now a requirement. Recruitment processes used in 28/02/07 the home must be openly competitive, to ensure that applicants from all sectors of the local community apply for, and may be recruited to, the service - thus reflecting more accurately the cultural / gender / age composition of service users at the home. Recruitment processes must ensure that references are obtained from sources that ensure that a broad and independent opinion can be formed concerning a DS0000013394.V309317.R01.S.doc 6. YA33 18(1) 7. YA34 19 - Sch 2 28/02/07 Medihands Healthcare (149) Version 5.2 Page 28 candidate’s suitability prior to appointment. 8. YA37 9 A clear job description for the 28/02/07 home manager and other senior staff, stating the lines of responsibility and governance in the home, must be evolved clearly stating the respective roles of senior members of the organisation. Timescale of 24/03/06 not met. The registered provider must urgently seek out and appoint a new suitably qualified and competent manager for the home and subsequently propose them for registration to the Commission. Timescale of 31/03/06 not met. The Registered Provider must implement unannounced monthly visits (under ‘Regulation 26’) to the home. The purpose of these being to monitor and inspect the quality of the facilities and service provided (the ‘conduct’ of the home). A written report must be prepared after these visits, and copied to the Commission. Timescales of 24/12/05 & 31/03/06 not met. The Registered Provider must ensure that all policies and procedures developed are signed to reassure staff members they are using the documents specifically sanctioned by the proprietor. Timescales of 24/12/05 & 31/03/06 not met. 28/02/07 9. YA37 8&9 10. YA38 26 28/02/07 11. YA41 24(1) 28/02/07 Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 Page 29 12. YA41 17 The registered provider must ensure that all paperwork relating to individual service users is kept securely and access is limited to those who have an appropriate and legal right to such documentation. Immediate action in this regard was taken by the acting manager whilst the inspector was on site. The registered provider must ensure that a development plan and a business & financial plan for the home is available, to inform the long-term development of the service. Timescales of 24/12/05 & 31/03/06 not met. 28/02/07 13. YA43 24 & 25 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Medihands Healthcare (149) DS0000013394.V309317.R01.S.doc Version 5.2 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.V309317.R01.S.doc Version 5.2 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. 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