Inspection on 06/02/08 for Medihands Healthcare (149)

This inspection was carried out on 6th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Medihands Healthcare (149) 18/10/06

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 28/09/2008.

CARE HOME ADULTS 18-65 Medihands Healthcare (149) 149 - 153 Kingston Road New Malden Surrey KT3 3NS Lead Inspector David Pennells Unannounced Inspection 6 February 2008 10:10 th Medihands Healthcare (149) DS0000013394.V347770.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.V347770.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.V347770.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 Post Vacant Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th October 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. People who use this service are enabled and supported to independently access all local community amenities and facilities from this centrally placed establishment. 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. The home has close links with the Community Mental Health Team that is based conveniently very close by - at the Roselands Resource Centre. People using the Medihands services are predominantly placed by the host borough the London Borough of Kingston, so can access all the locally available mental health resources as of right, as residents. The accommodation consists of two adjacent houses; 151-153 accommodating nine people in single bedrooms, and the other (149) offering a service to eight people - again in single bedrooms. The two ‘sides’ of the home are joined by a covered walkway. The houses, owned by Mr Sawmynaden and Mrs Sawmynaden respectively, are registered and operate 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. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 2-star. This means people who use this service experience good quality outcomes. This unannounced inspection visit was undertaken on an ordinary mid-week morning and afternoon / early evening. We spent about seven hours at the home. During the visit, we met with Mr & Mrs Sawmynaden - in the absence of Marion Grubb - the acting manager of the house - who was unable to assist the inspection, as she was ill. The proprietor and her husband and a senior care worker assisted us with exploring administrative and operational issues. We were also able to meet with a good number of those who use the service; and also encountered a number of staff members on the morning and afternoon shifts. We sought to overview progress in addressing the requirements & recommendations set at the last visit to the home, as well as verifying information given in the Annual Quality Assurance Assessment (AQAA) that was completed by the previous manager. We are grateful to those who use the service, the staff and Mrs & Mr Sawmynaden, for the welcome, cooperation and hospitality extended throughout the inspection process. What the service does well: People using the service users generally appreciate the accommodation and the service offered - and it is apparent that all people are settled and generally quite content at the home. Most people living at the home 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. For some, however, the home is a vital ‘bolthole’ without which their security and sense of stability would be compromised; for others, the home is somewhere to ‘report back’ to in a busy cycle of rehabilitation in, and engagement with, the outside world. Since the last inspection visit, feedback from ‘stakeholders’ with interests in the home has again shown that the resource is valued, mental health practitioners being generally happy with the conduct of the home. Local GPs have previously fed back positive and general contentment with the service. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides people who use the service with full details to enable them to make an informed choice about choosing to live at the home. People’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 person 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 extremely comprehensive and provides an excellent resource for those seeking information about the home. A full Service User Guide is also in place – again with comprehensive information provided. A contract / statement of terms and conditions is fully available within the Statement of Purpose – this, again, is fully detailed and meets the required standard. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 9 There is a comprehensive assessment system in place for use with prospective service users. Service users have good opportunities to ‘test drive’ the home through visiting, taking meals and sometimes staying overnight. We found that most service users come to the home with a full Care Programme Assessment (CPA) document clearly setting out their needs. Other 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. The Royal Borough of Kingston places most service users here at the home; it is clearly seen as a useful, local, resource. Placements are supported by Community Mental Health Teams based in New Malden, Hounslow and Westminster. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home initiates and maintains care plans and assessment documents designed to ensure that the needs of people using the service are realistically met in a focused and individual way. People can be assured that their rights to individuality and self-expression 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. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 11 EVIDENCE: We spent time reviewing people’s case files and care plans – which were in the main based on the eCPA (enhanced Care Programme Approach) assessments. People’s 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. Care plans and other documentation have been revised and replaced by a far more simple approach to daily recording, where most 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. 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 and relapse plans seen and 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. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People 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 person’s own choice and decision-making. People living at the home can expect to be supported in forming & 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. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 13 EVIDENCE: The home has a ‘Lifestyle’ form, which identifies each person’s social, emotional and spiritual needs. This form is completed by the person using the service and keyworker together, and is used to identify what community facilities are needed / available to meet their identified needs. The person, their Care Manager and home staff discuss issues regarding personal development at regular reviews. 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 joint cultural / religious celebrations, and the usual social activities / preoccupations of playing cards, ball games (there’s a baseball hoop in the garden) and the corporate enjoyment of listening to music, and watching the TV. New Malden centre is a short walk away, and Kingston and Surbiton (and even central London) are easily accessible by convenient public transport links. 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 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. Encouragement of family links and friendships is identified, and also the needs of service users to have intimate relationships. A policy exists covering sexuality and relationships. There are two dining rooms with kitchens within the home, 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 people who spoke with the inspector said that they were happy with the quality of the food served, stating that the food was generally good. Tea making facilities are available in most people’s bedrooms, unless a risk assessment has indicated that such a provision would be unwise. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured that their personal, health care and emotional needs will be recognised and met by the home’s daily input and through longer-term monitoring, assessment and care plan programming, thus assuring them of the care and attention to their needs as expected. The systems adopted by the home regarding medication, once one element of advice from the advising Pharmacist has been implemented, will fully ensure the safety and consistent treatment and support for each person requiring assistance with medication. EVIDENCE: Personal support is given to those who require such intervention, from promoting personal care to staff being aware of a service user ‘withdrawing into themselves’ - or recognising other mental health indicators. Most service users have access to a General Practitioner who is located nearby; whilst some service users use the services of another local doctor. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 15 Roselands Resource Centre, the principal professional mental health resource for most people living at the home, 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 regular contact with Community Psychiatric Nurses. The pharmacist of Boots the Chemist undertook an inspection visit to the home in October 2005 - which revealed that the home’s systems were generally running well - and that service users were in the main well supported in this aspect. A recommendation in this report covers the final aspect of advice given by the visiting Consultant Pharmacist. The issue raised concerns around having a discrete training matrix to evidence and monitor staff training in medication issues in particular. The home has now sought and gained consent in writing from people at the home concerning the staff managing their medication. Medication reviews are conducted at each person’s six-monthly review. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People 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 people to ensure that they are protected from harm and any form of abuse within the ‘Safeguarding Adults’ framework. 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. People living at the home and other stakeholders are provided with information about how to make a complaint. There are forms for the appropriate logging of complaints, including the outcome of investigations. The home is 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 people manage their own personal finances and bankbooks, etc; of the seventeen living at the house, most were described as competent and ‘independent’ – just a few have direct assistance from their placing local authority. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to live in a clean, warm and comfortable environment designed to meet their individual needs and providing adequate services and domestic facilities. People can be assured that, generally, the home - both private and communal space - is maintained as a safe environment in which to live without risk. The proprietor’s intention to address safety issues relating to hot radiator surfaces in bathrooms evidences their concern for potential risk areas. EVIDENCE: The home is generally well maintained, clean overall, tidy, odour-free and generally well furnished throughout. All fixtures and fittings were of a good standard and people’s bedrooms are 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. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 18 Lounges and dining rooms have been redecorated more recently, though the main dining area near the smoking area obviously suffers significant ‘wear & tear’ and will need attention soon. 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 the principal smoking area now the home has become ‘non-smoking’. All bedrooms contain the furniture and facilities in line with the national standards, mixed with people’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. People have been able to bring items of their own furniture with them; they are consulted regarding the way their bedrooms are decorated and furnished. Bedrooms are lockable, and each person using the service is provided with a key to their room. Staff sleeping-in accommodation provided on the ground floor between 151 and 149 opposite the main daily operations office has now been provided at an acceptable standard of privacy and security for staff sleeping over-night there. People can now move between the two parts of the building throughout the day and night, now that the nighttime ‘obstruction’ has been removed. 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 people resident at the home to keep their bedrooms clean and organised. 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. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be assured that they will be supported at all times by staff, some of whom are trained and competent in their work, the personnel being generally provided in sufficient numbers to meet people’s identified needs. People can expect to be provided a service that ensures their safety and protection from abuse through recruitment processes and ongoing staff support arrangements, with the staff seeking to empathise with the service user group. EVIDENCE: Thirteen care workers currently staff the main home and also provide staffing input to the smaller mental health home in the proprietor’s ownership opposite this home. All staff members work at the main home from time to time, however, and so are included in the staffing and training formulae. We found that staff training in regard to NVQ Level 2 in care is ‘behind’ the expectation of the Commission, due to movement of staff; there is a need for a concentration to attain the 50 proportion of care staff who are thus trained. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 20 It is the declared intention of the new manager to ensure that NVQ training is accessed for more staff soon, to raise the current 25 to the required 50 minimum. This focus must be an absolute priority for the manager within the next year as we, the Commission, may be minded to take statutory action in regard to this ongoing deficit if it is not urgently addressed. Staff meetings were minuted, as were service user meetings; there is also a daily handover of information provided to staff - evidencing the home’s focus on communication between shifts. The inspector has ‘sat in’ on handovers between shifts in the recent past, this aiming to pass on the best information between the staff team. It is a continuing reality that almost the entire staff team at the home are Mauritian - the gender balance of staff is 50:50, and the age range is predominantly in the 25 -34 age range, with just a few older staff and a similar number under 25. Although these staff members are willing and generally well able to provide a basic service, the cultural / ethnic origin of people using the service is overwhelmingly white British (with just one new person of middle eastern origins) and generally mid-to-old age - of an equal gender split. The home is therefore seeking to develop a policy of finding a more balanced staff team, who reflect both the multi-cultural nature of the community in which the home is situated, whilst also providing staff from a cultural, gender and age-specific background that better matches the people using the service. It is the declared intent of the proprietor that recruitment at the home is going to be opened up to competitive interview - to attract a wider cross-section of the community into the home’s workforce. There are plans to hold an ‘Open Day’ to attract potentially local workers - and the Jobcentre is being used to advertise for staff of all origins. We found that staff files seen evidenced the enhanced Criminal Records Bureau and reference checks being undertaken, and generally the recruitment procedure followed best practice. Staff members have a training folder each - and training profiles are being completed for each staff member; this enabling the manager to assess an individual staff member’s competence based on certificated achievement - and also allowing for the planning for ‘refresher’ courses - this ensuring that timelimited courses do not run ‘out of time’. Ongoing staff training occurs, largely as in-house input (especially mental health focused training). Recent training provided and undertaken by staff have again included: ‘Fire Safety’, ‘Health & Safety’, ‘Manual Handling’, ‘Medication’, & ‘First Aid’. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 & 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home operates systems that ensure that people benefit from a reasonably managed and generally safe environment, and the appointment of a registered manager will benefit all at the home. People can be assured that generally their opinions will be heard, and their rights and interests be well served and protected, through the home’s approach to record keeping, through the home’s policies & procedures, and through the day-to-day conduct of the home. People can be assured that their welfare, health and safety is, safeguarded through the home’s adherence to appropriate guidance and regulations concerning best safety practice. People would benefit far more from the service if it were strategically planned and clearer in its intent, goals and aspirations. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 22 EVIDENCE: Currently the owner of one half of the home - Mr K Sawmynaden - the proprietor’s husband - continues to support the home through his presence, whilst the new manager ‘finds her feet’ prior to applying for CSCI registration to the home. Mrs Sawmynaden, the proprietor of the whole service, owns a small mental health establishment - for which she is the registered manager and she also owns a large establishment for older people - which she also actively oversees in the capacity as proprietor. The need for the fully registered manager to run 149 -153 Kingston Road is therefore vitally important. Alongside the registration of the manager, the lines of responsibility and governance in the home, need to be clearly evolved - stating the respective roles of all the senior members within the organisation. Mrs Sawmynaden stands as registered provider - a role which will bring 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 and instruction of the person actually running the home (and to make it available to the CSCI). 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. Residents have meetings and so do staff - but a more structured feedback process, which informs a more strategic future plan for the home, is necessary. A single page Development Plan Statement was previously available at the home - the initial efforts of such an initiative - but this now needs integrating with the information from a properly developed business and financial plan to ensure that the underpinning of further developments. We were informed that the proprietor’s accountants were producing such a document. This remains to be provided. Health & safety issues such as regular maintenance and servicing contracts were all found to be in place and up-to-date. Attention to issues brought to the proprietors attention - such as the potential risk of burns to people should they fall against a fully ‘on’ radiator, has resulted in covers being provided for such radiator surfaces in bathrooms and toilets. This ‘immediate’ action that was taken reflects the concern and focus of those who own the home to provide the best possible service. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 23 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 3 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 3 34 3 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 3 X 3 3 3 X 3 3 2 Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA32 Regulation 18(1) Requirement That at least 50 of care staff employed at the home must be qualified to NVQ Level 2 in Care or equivalent. Previously a time-limited recommendation to 2005. Once the current manager is registered to the home, the Registered Provider must implement unannounced (‘Regulation 26’) monthly visits to check / ‘inspect’ 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. 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 since 24/12/05 not met. Timescale for action 15/06/08 2. YA38 26 30/07/08 3. YA43 24 & 25 15/06/08 Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 25 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. Refer to Standard YA20 Good Practice Recommendations Following the advice of the visiting Consultant Pharmacist: A training matrix should be established to show dates and types of training undertaken by staff in regard to medication procedures - and be kept with the medication documentation. Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Medihands Healthcare (149) DS0000013394.V347770.R01.S.doc Version 5.2 Page 27 - 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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