Inspection on 30/10/03 for Medihands Healthcare (2)

Care Homes For Adults (18 ­ 65)Medihands Healthcare (2)2 Westbury Road New Malden Surrey KT3 5BEAnnounced Inspection30th October 2003 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Medihands Healthcare (2) Address 2 Westbury Road, New Malden, Surrey, KT3 5BE Email Address Tel No: 020 8404 4108 Fax No:Name of registered provider(s)/Company (if applicable) Mrs Jayashree Sawmynaden Name of registered manager (if applicable) Mrs Jayashree Sawmynaden Type of registration Care Home No. of places registered (if applicable) 3Category(ies) of registration, with (number of places) Learning disability (3), Mental disorder, excluding learning disability or dementia (3) Registration number G040000165 Date First registeredDate of latest registration certificate 30th July 2002Was the home registered under the Registered Homes Act 1984 as amended? Do additional conditions of registration apply ? Date of last inspectionyes NO 14/1/03 If Yes Refer to Part CMedihands Healthcare (2)Page 1 Date of Inspection Visit Time of Inspection Visit Name of Inspector Name of Inspector Name of Inspector 1 2 330th October 2003 02:30 pm Sally MillID Code097769Name of Inspector 4 Name of Lay Assessor (if applicable) Lay assessors are members of the public independent of the NCSC. They accompany inspectors on some inspections and bring a different perspective to the inspection process Name of Specialist (e.g. Interpreter/Signer) (if applicable) Name of Establishment Representative at Mrs J Sawmynaden - Registered Manager Mr Sawmynaden - Registered Provider the time of inspectionMedihands Healthcare (2)Page 2 CONTENTSIntroduction to Report and Inspection Inspection visits Description of service Part A: Summary of Inspection Findings Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods Used & Findings The Standards. National Minimum Standards for Care Homes for Adults (18 ­ 65) 1. Choice of Home 2. Individual Needs and Choices 3. Lifestyle 4. Personal and Healthcare support 5. Concerns, Complaints and Protection 6. Environment 7. Staffing 8. Conduct and Management of the Home Part C: Part D: Part E: E.1. E.2. E.3. Compliance with additional conditions of registration ( if applicable) Lay Assessors summary (where applicable) Providers Response Providers comments Action Plan Providers agreementMedihands Healthcare (2)Page 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the National Care Standards Commission (NCSC) is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000 as amended. This document summarises the inspection findings of the NCSC in respect of Medihands Healthcare (2). The inspection findings relate to the National Minimum Standards (NMS) for Care Home published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum standards will form the basis for judgements by the NCSC regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Report of the Lay Assessor (where relevant) · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000 and the Children Act 1989 as amended. The following inspection methods have been used in the production of this report. The report is based on the findings of the specified inspection dates.Medihands Healthcare (2)Page 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. 2 Westbury Road is owned and managed by Medihands ­Care Services for people with mental health needs. It is home for three people and is situated in a quiet residential area close to local amenities and shops. The house is in keeping with the neighbouring properties and is not identifiable as a care home.Medihands Healthcare (2)Page 5 PART ASUMMARY OF INSPECTION FINDINGSInspectors Summary (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) The Registered Provider and Registered Manager were present throughout the inspection. The manager also manages 14 Green Lane Care Home which is situated close by and is run virtually identically. The inspections of the two homes took place on the same day. The owners/manager continue to demonstrate a commitment to meeting the Standards as laid down by The National Care Standards Commission and had met most of the requirements made at the last inspection. The principal outcome as on the last inspection is that a high standard of care and support is provided to the service users living at the home. Medihands philosophy supports its service users by promoting choice, independence and dignity, this is seen to be reflected in all aspects of its practice. Choice of Home(Standards1-5) 5 Standards were assessed and 5 were met. The home has developed an excellent Statement of Purpose and Service User Guide that clearly states what the home offers. All service users are assessed prior to admission and are involved throughout the process making as many visits to the home as they wish. Individual Needs and Choices(Standards6-10) 5 Standards were assessed and 5 were met. The home has a comprehensive care planning system. Care plans are maintained in good order and information is easily accessible. Service users have an allocated key worker who develops a special role and relationship with the service user. Care plans, weekly and daily programmes are drawn up between the key worker and service user and signed by both. Lifestyle(Standards 11-17) 7 Standards were assessed and 7 were met. Service users are actively encouraged and supported to participate in the local community and leisure facilities. They are encouraged to determine their own lifestyles and attain as much autonomy over their lives as possible. The two service users spoken with on the day of inspection stated they were happy living at the home and felt well supported. One went on to say It couldnt be better, Im doing so well Personal and Healthcare Support(Standards18-21) 4 Standards were assessed and 4 were met. Service users have their health care and supports needs met with assistance from staff when necessary. Documentation of health care needs is well recorded and service users are encouraged to manage as much as they are able for themselves. Medihands Healthcare (2) Page 6 Concerns, Complaints and Protection.(Standards22-23) 2 Standards were assessed and 2 were met. No complaints have been received by the home. There is a complaints procedure available for service users should they wish to complain but the manager and provider report that issues are dealt with on a daily basis and are usually resolved at an early stage. Environment(Standards 24-30) 7 Standards were assessed and 7 were met. The home is well maintained and furnished to a high standard. It offers service users a warm and homely environment and is very much like a family home. Staffing(Standards 31-36) 6 Standards were assessed, 3 were met and 3 were part met. There is a competent and caring staff team who receive regular training and support from the manager and registered provider. Some further work is required to fully meet these Standards with regard to developing individual training and development profiles for each staff and for staff to commence NVQ training. Staff spoken with on the day of inspection were able to demonstrate a good understanding of service users needs. Conduct and Management of the home.(Standards 37-43) 6 Standards were assessed, 4 were met and 2 were part met. The home was seen to be well run, it is orderly and staff are aware of the homes ethos. All record keeping, documentation and files are maintained to a very high standard. The owners/manager are very much hands-on and foster an atmosphere of openness and respect. The home must soon implement its monitoring systems for quality assurance and address the few issues noted in the health and safety Standard.Medihands Healthcare (2)Page 7 Requirements from last Inspection visit fully actioned? If No please list belowNOSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. No. Regulation Standard Required actions Timescale for action 1 18.1 36.6 Ensure all staff have annual appraisals to review performance and agree career development plans. Ensure there is an annual development plan for the home based on a cycle of planning ­ action- review of the service. Ensure staff receive training specific to the needs of the residents i.e. mental health. This must be documented in staffs individual files. Testing and recording of hot water temperatures is required. 31/3/03224.139.230/9/03318(1)(c)35.730/4/03413(4)4230/6/03Action is being taken by the National Care Standards Commission to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations StandardMedihands Healthcare (2)Page 8 CONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).MET (YES/NO)Medihands Healthcare (2)Page 9 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements and recommendations are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001, the National Minimum Standards and the relevant sections of the Childrens Act. The Registered Provider(s) is/are required to comply within the given time scales. No. Regulation Standard * Requirement Timescale for action All staff must have an individual training and development profile. Training records must include evidence of training specifically in mental health issues. All staff must receive at least six supervision sessions a year. 2 18.1 36 Staff must have an annual appraisal to review performance and agree career development plans. The manager must ensure there is an annual development plan for the home based on a cycle of planning ­action- review of the service. 31/3/04119(1)(c)3231/3/04324.13930/4/04413.442The manager must ensure that the buildings risk assessment is carried out which includes an emergency plan. Fire drills must be carried 31/1/04 out at least twice a year and recorded. Hot water temperatures are to be checked and recorded weekly.RECOMMENDATIONS Identified below are areas addressed in the main body of the report which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s) Medihands Healthcare (2) Page 10 No.Refer to Standard * 32Good Practice Recommendations1The manager should ensure staff commence their NVQ training in order to meet this Standard by 2005* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. YA10 refers to Standard 10.PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct Observation Indirect Observation Sampling · Pre-inspection Questionnaire · Records · Care Plans / Care Pathways · Meals · Activities · Other enter details here `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting Professionals survey / feedback Tour of Premises Formal Interviews Document reading Additional Inspection Information: YES NO YES YES YES NO NO NO YES YES YES NO NO YES NO NO NO YES NO YESMedihands Healthcare (2)Page 11 Number of Service Users spoken to at time of inspection Number of Relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the Responsible Individual seen CRB check for the Manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total No. of care staff employed (excluding managers) Total No. of staff with nursing qualifications employed Date of Inspection Time of Inspection Duration Of Inspection (hrs)2 X X NO NO YES YES 4 X 30/10/03 14.30 2.45The following pages summarise the key findings and evidence from this inspection, together with the NCSC assessment of the extent to which the National Minimum Standards have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No Shortfalls) (Minor Shortfalls) (Major Shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Medihands Healthcare (2)Page 12 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · Prospective service users have the information they need to make an informed choice about where to live. Prospective service users individual aspirations and needs are assessed. Prospective service users know that the home they 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.Standard 1 (1.1 ­ 1.4) The registered person produces an up to date statement of purpose setting out the aims, objectives, philosophy of the home, its services and facilities and terms and conditions; and provides each service user with a service users guide to the home. The statement of purpose should clearly set out the physical environmental standards met by the home in relation to standards 24.2, 24.9, 25.3, 25.5, 27.2, 27.4 and 28.2; and a summary of this information should appear in the service users guide. 469.02 X Range of fees charged From To £ £ (per week) YES Any charges for extras If yes, please state what the extras are Hairdressing, toiletries, newspapers, clothing. 3 Key findings/Evidence Standard met? The home has developed a Statement of Purpose and Service User Guide that clearly state the homes aims and objectives and what the home has to offer. They are comprehensive documents with particular emphasis on empowering the service user.Medihands Healthcare (2)Page 13 Standard 2 (2.1 ­ 2.8) New service users are admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective service user using an appropriate communication method, and with an independent advocate as appropriate. 3 Key findings/Evidence Standard met? The inspector was able to see that care management assessments were in place for all service users. These form the basis for the care plans which are gradually built up during the first 4-6 weeks after admission. The home also has its own comprehensive assessment documentation. The manager stated that a service user is only admitted following a full assessment, this includes a mental health and risk assessment. The most recent person admitted to the home was on 1st February 2003 and is funded by another London Borough.Standard 3 (3.1 - 3.10) The registered person can demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 3 Key findings/Evidence Standard met? Throughout the inspection the manager demonstrated the homes ability to meet the needs of the residents. The inspector was able to evidence this by examining care plans, activity programmes, daily notes where input from specialist services was seen e.g. Community Mental Health Teams with whom they have close working links. The manager reported that service users are generally admitted for long term care but that does not necessarily rule out the possibility of a service user moving on to a less supportive environment. The home does not admit service users for respite care. Standard 4 (4.1 - 4.5) The registered manager invites prospective service users to visit the home on an introductory basis, before making a decision to move there, and unplanned admissions are avoided wherever possible. 3 Key findings/Evidence Standard met? The manager reported that any prospective service user is encouraged to visit the home as often they wished. They are able to meet and have a meal with other service users, meet the staff and see the room they will have.Medihands Healthcare (2)Page 14 Standard 5 (5.1 - 5.5) The registered manager develops and agrees with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user. 3 Key findings/Evidence Standard met? The home owners have developed a new contract format for the terms and conditions of service and is now a separate document from the Service User Guide. It clearly sets out all the terms and conditions of stay and includes the fees payable, rooms allocated, notice conditions and services provided.Medihands Healthcare (2)Page 15 Individual Needs and ChoicesThe intended outcomes for the following set of standards are: · · · · · 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.Standard 6 (6.1 ­ 6.10) The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home and how these services will meet current and changing needs and aspirations and achieve goals. 3 Key findings/Evidence Standard met? Two care plans were examined by the inspector. They give a detailed account of all assessed needs of health and social care and how the care is delivered. All service users are allocated a key worker on admission. A client centred approach is used and weekly and daily activity programmes are drawn up with and signed by each service user. Two of the service users are on an Enhanced Care Programme Approach these included risk management strategies. Both service users were seen to have had a social services placement review but the date of the next in - house review needed to be set. The manager did report that she has to actively follow up the routine annual social service reviews to ensure they take place. Standard 7 (7.1 ­ 7.7) Staff respect service users right to make decisions and that right is limited only through the assessment process, involving the service user and as recorded in the individual Service User Plan. 3 Key findings/Evidence Standard met? The manager stated that service users are supported in making choices and are encouraged to do so whenever and wherever possible, this was confirmed when speaking with two service users. Service users draw up their own daily routines which reflect how they choose to spend their time. Minutes from service users meetings were seen, however being a small home, many decisions are made individually. All service users manage their own money and keep their own benefit books. Receipt for rent books were seen.Medihands Healthcare (2)Page 16 Standard 8 (8.1 ­ 8.5) The registered manager ensures that service users are offered opportunities to participate in the day-to-day running of the home and to contribute to the development and review of policies, procedures and services. 3 Key findings/Evidence Standard met? The manager stated that service users are involved in the running of the home in a range of ways. They are involved in showing prospective residents around the home. Any changes to policies and procedures are discussed at house meetings. The daily and weekly programmes drawn up by the service users and their key workers state service users routines.Standard 9 (9.1 ­ 9.4) Staff enable service users to take responsible risks, ensuring they have good information on which to base decisions within the context of the service users individual Plan and of the homes risk assessment and risk management strategies. 3 Key findings/Evidence Standard met? The inspector was able to examine risk assessments for two service users, they are contained as part of the care plan. These are completed prior to admission by the care manager as well as by the homes staff and are regularly reviewed. The inspector examined and approved the procedure should a service user go missing.Standard 10 (10.1 ­ 10.6). Staff respect information given by service users in confidence and handle information about service users in accordance with the homes written policies and procedures and the Data Protection Act 1998 and in the best interests of the service user. 3 Key findings/Evidence Standard met? The home has a confidentiality policy which is in line with the Data Protection Act. Confidentiality is referred to in the homes Statement of Purpose. The manager informed the inspector that all staff are trained in record writing in service user files. The inspector also noted guidelines for this within files. All files were seen to be stored securely.Medihands Healthcare (2)Page 17 LifestyleThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 11 (11.1 ­ 11.4) Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. 3 Key findings/Evidence Standard met? On examining two care plans the inspector was able to identify how staff support service users in developing their skills. Budgeting skills ,personal care skills, use of community facilities are examples in which staff will work with residents to achieve greater independence. Two service users attend different houses of worship regularly.Standard 12 (12.1 ­ 12.6) Staff help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities 3 Key findings/Evidence Standard met? One service user is doing his NVQ Level 2 in bakery at a local college and hopes to gain employment at a bakery. The other service user informed the inspector that he would like to do an engineering course at some stage. Currently he chooses not to participate in any structured activity.Medihands Healthcare (2)Page 18 Standard 13 (13.1 ­ 13.5) Staff support service users to become part of, and participate in the local community in accordance with assessed needs and the individual Plans. 3 Key findings/Evidence Standard met? The home is well situated for local shops and transport which enables integration into the local community. The manager reported that staff accompany and support service users in using a wide range of facilities. These include restaurants, cinemas, shopping, post office. This was evident from residents daily progress books. All service users are on the electoral register and vote.Standard 14 (14.1 ­ 14.6) Staff ensure that service users have access to and choose from a range of appropriate leisure activities. 3 Key findings/Evidence Standard met? The service users living at Westbury Road are able to express their leisure needs and interests. Staff support service users in persuing these when necessary. One weeks annual holiday is included in the fees charged. Alternatively, service users may choose to go for short or day trips out. The homes proprietors own other homes nearby so residents often link up for visits and social activities. Leisure activities include cinema, leisure centre for swimming, cookery and BBQs. Standard 15 (15.1 ­ 15.5) Staff support service users to maintain family links and friendships inside and outside the home, subject to restrictions agreed in the individual Plan and Contract (subject to standards 2 and 6 if necessary). 3 Key findings/Evidence Standard met? One service user told the inspector about his recent trip to the north of England when he met with his parents after a long period. Another service user goes to visit his mother frequently. Staff are available to support service users in maintaining these family links whenever necessary.Medihands Healthcare (2)Page 19 Standard 16 (16.1 ­ 16.11) The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual Plan and Contract (subject to Standards 2 and 6 if necessary). 3 Key findings/Evidence Standard met? The homes ethos is one of fostering independence, building on strengths and promoting choice. Service users all have their own bedroom and front door keys and mail is given directly to them. Service users spoken with indicated how valuable the privacy of their own rooms was to them. All service users have their own tea/coffee making facilities in their rooms. Service users responsibilities regarding household tasks were seen to be documented in the care plans. There is a policy on smoking in designated areas and a policy on the use of drugs and alcohol.Standard 17 (17.1 ­ 17.9) The registered person promotes service users health and wellbeing by ensuring the supply of nutritious, varied, balanced and attractively presented meals in a congenial setting and at flexible times. 3 Key findings/Evidence Standard met? Service users get their own breakfasts and lunch when at the home. The evening meal is chosen from a 4 week rolling menu which was seen to offer a wide range of nutritious meals, however, the manager reported that these are very flexible. Service users preferences and dislikes are recorded in the care plans. A diary of all meals eaten was seen to be recorded.Medihands Healthcare (2)Page 20 Personal and Healthcare SupportThe intended outcomes for the following set of standards are: · · · · 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 homes policies and procedure for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish.Standard 18 (18.1 ­ 18.11) Staff provide sensitive and flexible personal support and nursing care to maximise service users privacy, dignity, independence and control over their lives. 3 Key findings/Evidence Standard met? The service users currently living at the home do not require direct personal care, one requires prompting at times. The two files seen by the inspector contained correspondence from a variety of professionals. These included input from psychiatrist, social worker, Kingston Eye Hospital and psychologist. Other specialist support is sought as and when required. There are no `house rules as such, service users determine their daily routine themselves. This was verified in the care plans seen. Consistency and continuity of care is provided by a staff group who are supported by the manager and provider. Standard 19 (19.1 ­ 19.5) The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. No. of incidents where service users have been taken to Accident & Emergency during last 12 months No of service users with pressure sores at the time of inspection (from information taken from care notes) 2X3 Key findings/Evidence Standard met? The manager reported that service users may retain their own G.P. or a local one will be recommended. Service users receive as much support as they require in managing their health needs. One service user attends and manages all her needs independently whilst a care plan seen showed another service user still required some degree of support. The home has close working links with the nearby Community Mental Health Team who they can call on for advice . Personal files showed all medical, dental and other health care appointments are recorded. Medication received by service users, their consent, reasons why and any changes to medication are recorded in the care plans. Medihands Healthcare (2) Page 21 Standard 20 (20.1 ­ 20.14) The registered manager and staff encourage and support service users to retain, administer and control their own medication, within a risk management framework, and comply with the homes policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. 3 Key findings/Evidence Standard met? Medication was seen to be stored,ordered and disposed of according to the procedures. No omissions in the Medication Administration Records(MAR) were seen. Photos were present on all of the MAR sheets and evidence of recent full medical check ups and reviews of medication were seen. Care plans contained service users consent to medication. Staff receive training in the administration and are supervised by the manager until assessed as proficient. The procedure states medication will be retained for seven days in the event of the death of a service user. Service users going on leave have medication dispensed individually for the period they are away. Standard 21 (21.1 ­ 21.8) The registered manager and staff deal with the ageing, illness and death of a service user with sensitivity and respect. 3 Key findings/Evidence Standard met? The home has a procedure in the event of the death of a resident. The manager stated that service users would be able to stay in the home as they grew older providing the homes staff could provide the necessary care. At the last inspection a requirement was made regarding the wishes of a service user in the case of death, the two care plans seen showed this has now been addressed.Medihands Healthcare (2)Page 22 Concerns, Complaints and ProtectionThe intended outcomes for the following set of standards are: · · Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm.Standard 22 (22.1 ­ 22.7) The registered person ensures that there is a clear and effective complaints procedure which includes the stages of and times-scales for the process and that service users know how and to whom to complain. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to NCSC Percentage of complaints responded to within 28 days X X X X X X X 3 Key findings/Evidence Standard met? The home has not received any complaints. The inspector was supplied with the new complaints procedure. This is a good, clear step by step guide of how to make a complaint. As stated earlier in this report service users are encouraged to discuss and air their views and iron out any concerns at an early stage.Medihands Healthcare (2)Page 23 Standard 23 (23.1 ­ 23. 6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, or inhuman or degrading treatment, through deliberate intent, negligence, or ignorance, in accordance with written policy. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the DOH Guidance No Secrets No of staff referred for inclusion on POCA/POVA lists YESX3 Key findings/Evidence Standard met? The home uses the Local Authorities policy on abuse to vulnerable adults. A whistle blowing policy is also in place. The manager stated these are given to staff and addressed as part of the induction programme. The inspector examined the guidelines on managing aggression.Medihands Healthcare (2)Page 24 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 24 (24.1 ­ 24.13) The homes premises are suitable for its stated purpose; accessible, safe and well maintained; meet service users individual and collective needs in a comfortable and homely way; and have been designed with reference to relevant guidance. 3 Key findings/Evidence Standard met? The premises were seen to be well maintained and provide a comfortable and homely environment. There is a high standard of decoration throughout the home with the furniture and fittings being of good quality . The home has access to regular maintenance staff, ensuring all repairs are dealt with swiftly. The home is situated within a short walk of local amenities and transport.Medihands Healthcare (2)Page 25 Standard 25 (25.1 ­ 25. 11) The registered person provides each service user with a bedroom, which has useable floor space sufficient to meet individual needs and lifestyles. Total no. of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1st April 2003) ­ single bedrooms below 10 sq.m usable space or additional compensatory space Total no. of wheelchair users accommodated for in rooms at least 12 sq.m Total no. of wheelchair users accommodated for in rooms less than 12 sq.m Total no. of shared rooms at least 16 sq.m Total no. of shared rooms below 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total no. of single bedrooms Number of single bedrooms with en suite Total no. of double bedrooms Number of double rooms with en suite Key findings/Evidence All residents have their own single rooms. YES NO NO 3 X X X Standard met? 3 X XX X X XMedihands Healthcare (2)Page 26 Standard 26 (26.1 ­ 26.4) The registered person provides each service user with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. 3 Key findings/Evidence Standard met? All the rooms were seen and found to be personalised and decorated to each service users individual taste. Each room has a wash hand basin and a lockable space for personal/valuable possessions. Service users are also provided with tea and coffee making facilities in their rooms.Standard 27 (27.1 ­ 27.6) The registered person provides service users with toilet and bathroom facilities which meet their assessed needs and offer sufficient personal privacy. 3 Key findings/Evidence Standard met? There is one bathroom and two toilets available to service users, this is sufficient to meet their needs.Standard 28 (28.1 ­ 28.3) A range of comfortable, safe and fully accessible shared spaces is provided both for shared activities and for private use. 3 Key findings/Evidence Standard met? The communal areas, including a garden, were seen to provide sufficient space for service users living in the home. There is a designated smoking area in the conservatory. Staff are provided with a lockable space in the sleep in room.Medihands Healthcare (2)Page 27 Standard 29 ( 29.1 ­ 29.8) The registered person ensures the provision of environmental adaptations and disability equipment necessary to meet the homes stated purpose and the individually assessed needs of all service users. 3 Key findings/Evidence Standard met? The manager stated that no adaptations are required for the present client group.Standard 30 (30.1 ­ 30.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of inspection, in accordance with relevant legislation, published professional guidance and the purpose of the home. 3 Key findings/Evidence Standard met? The home was found to be clean and free of offensive odours. The laundry area was seen to be situated in the conservatory to the rear of the house. This provides sufficient facilities for the service users living in the home. Service users clean their own rooms with assistance as required. Staff clean communal areas, sometimes with input from service users.Medihands Healthcare (2)Page 28 StaffingThe intended outcomes for the following set of standards are: · · · · · · 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 homes 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.Standard 31 (31.1 ­ 31.7) The registered manager ensures that staff have clearly defined job descriptions and understand their own and others roles and responsibilities. 3 Key findings/Evidence Standard met? The inspector examined two staff files. Each contained job descriptions. The staff are issued with the homes code of conduct which now include the General Social Care Council codes of conduct.Medihands Healthcare (2)Page 29 Standard 32 (32.1 ­ 32.6) Staff have the competencies and qualities required to meet service users needs and achieve Sector Skills Council workforce strategy targets within the required timescales. Staff numbers/hours relating to the needs of service users are based on guidance recommended by the Department of Health. Personal Care No. service users High needs No. service users Medium needs No. service users Low needs Total no. of hours needed No. of staff with NVQ level 2 or above No. of Trainees registered on Sector Skills Council training programme X X X X X No. of full time equivalent Staff with nursing qualification (where applicable) No. staff hours allocated No. staff hours allocated No. staff hours allocated Total Hours Provided X X X X Nursing X X XXX2 Key findings/Evidence Standard met? The pre inspection questionnaire states that three staff have a first aid certificate and that all staff are responsible for administering medication. Currently there are no staff who hold an NVQ, the manager should commence NVQ training in order to meet this Standard by 2005.Standard 33 (33.1 ­ 33.11) The home has an effective staff team with sufficient numbers and complementary skills to support service users assessed needs at all times. 3 Key findings/Evidence Standard met? The duty roster confirms that there is one staff member on duty at all times and one staff sleeps in at night. The managers time is shared with the other Medihands 3 bedded home nearby. The inspector observed that the manager and registered provider are very much `hands-on, providing additional support and guidance to service users and staff.Medihands Healthcare (2)Page 30 Standard 34 (34.1 - 34. 8) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 3 Key findings/Evidence Standard met? Two staff files were seen, they are in good order and included all the information required in this Standard. Both files contained satisfactory CRB checks.Standard 35 (35.1 - 35.8) The registered person ensures that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 2 Key findings/Evidence Standard met? Evidence of the in-house two week induction undertaken by staff was seen by the inspector. This included all the mandatory training topics such as health and safety, food handling, first aid, administration of medication and fire prevention. Evidence of training in report writing and confidentiality were also seen. Each staff member must have an individual training and development programme. This should include evidence of training undertaken specifically on mental health issues.Standard 36 (36.1 - 36.8) Staff receive the support and supervision they need to carry out their jobs. 2 Key findings/Evidence Standard met? The two staff files seen by the inspector showed evidence of recorded supervision sessions. However, they were not as frequent as this Standard requires. All staff must have supervision sessions at least six times a year. There was no evidence of staffs annual appraisals. One file contained documentation that the person had completed the two week induction training.Medihands Healthcare (2)Page 31 Conduct and Management of the HomeThe intended outcomes for the following set of standards are: · · · · · · · 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 homes policies and procedures. Service users rights and best interests are safeguarded by the homes 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.Standard 37 (37.1 ­ 37.4) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Registered manager qualified to level 4 NVQ in Management and care or equivalent. YES0 Key findings/Evidence Standard met? This Standard was not assessed on this visit. On the last inspection it received a score of 3.Standard 38 (38.1 ­ 38.6) The management approach of the home creates an open, positive and inclusive atmosphere. 3 Key findings/Evidence Standard met? The inspector was able to observe the open and inclusive management style. Regular meetings are held with service users and staff with the aim of enlisting their views. In discussion the manager and registered provider it is evident that there is continuous reflection and reviewing of the service provided.Medihands Healthcare (2)Page 32 Standard 39 (39.1 ­ 39.10) Effective quality assurance and quality monitoring systems based on seeking the views of service users are in place to measure success in achieving the aims, objectives and statement of purpose of the home. 2 Key findings/Evidence Standard met? The inspector was able to examine the format devised by the registered provider for assessing quality in the home and the business plan. It included a statement of the homes objectives, its current position, financial forecasts and marketing plans. This has not yet been implemented.Standards 40 (40.1 ­ 40.6) The homes written policies and procedures comply with current legislation and recognised professional standards, covering the topics set out in Appendix 2 of the National Minimum Standards for Younger Adults. 3 Key findings/Evidence Standard met? The home has in place all the polices and procedures as listed in Appendix 3. Many of these were seen to have been reviewed recently. Staff sign to state that they have read and understood policies and procedures. Service users have access and are supplied with the homes policies and procedures when appropriate.Standard 41 (41.1 ­ 41.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained up to date and accurate. 3 Key findings/Evidence Standard met ? The inspector noted that residents are involved in drawing up and maintaining their care plans. These, along with the care programme approach documents, were seen to be signed by each resident. The inspector observed that all individual records and homes records are up to date, stored securely and in good order. This is commended.Medihands Healthcare (2)Page 33 Standard 42 (42.1 ­ 42.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 2 Key findings/Evidence Standard met? The home health and safety checks included: two weekly testing of the smoke alarms, COSHH data sheets were available, the gas landlords safety certificate was available and first aid boxes are checked monthly. The manager reported the Environmental Health Department had visited in February and recommended the testing and recording of food temperatures. The Legionella test certificate was seen. The pre inspection questionnaire stated that work on the wiring system was in progress. The home did not have evidence of the last fire drill or the buildings risk assessment. These must be carried out without delay. All service users have been risk assessed regarding the use of hot water, but hot water temperatures require testing weekly.Standard 43 (43.1 ­ 43.7 ) The overall management of the service (within or external to the home) ensures the effectiveness, financial viability and accountability of the home. 3 Key findings/Evidence Standard met ? The homes profit and loss account was supplied to the inspector which demonstrated the homes financial viability.Medihands Healthcare (2)Page 34 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Locality Manager DateSally Mill Norma VieiraSignature Signature SignatureMedihands Healthcare (2)Page 35 PART D(where applicable)LAY ASSESSORS SUMMARYLay Assessor Date Public reportsSignatureIt should be noted that all NCSC inspection reports are public documents.Medihands Healthcare (2)Page 36 PART EE.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 30 October 2003 and any factual inaccuracies: Please limit your comments to one side of A4 if possible Comments and an Action Plan were not received from the Provider.Action taken by the NCSC in response to provider comments: Medihands Healthcare (2) Page 37 Amendments to the report were necessaryNOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateNONONONote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. E.2 Please provide the Commission with a written Action Plan by 20/01/2004, which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request.You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationNOAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planNOYESYESOther: enter details here Medihands Healthcare (2)Page 38 E.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.E.3.1 I of confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or E.3.2 I of am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Medihands Healthcare (2)Page 39 - 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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