Inspection on 08/09/05 for Mereside

This inspection was carried out on 8th September 2005.

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

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

Other inspections for this house

Mereside 24/10/07

Mereside 08/11/06

Mereside 10/03/06

Mereside 16/03/05

Mereside 13/10/04

Mereside 17/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Mereside 42 ST Bernards Road Solihull West Midlands B92 7BB Lead Inspector Kerry Coulter Announced 8 September 2005 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 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 Stationary 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. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Mereside Address 42 St Bernards Road Solihull West Midlands B92 7BB 0121 707 6760 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Tom Eyton Tom Eyton Care Home 15 Category(ies) of Leaning Disabiity (15) registration, with number of places Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. May also provide care, subject to appropriate and ongoing assessment, to people with a Learning Disability over 65 years of age. Date of last inspection 16 March 2005 Brief Description of the Service: Mereside is a privately owned Care Home, for adults with learning disabilities. The owner is also the registered care manager. The Home, which opened in 1986, is registered to provide accommodation, board and support for up to 15 adults. Some of the residents have severe learning disabilities with challenging behaviour and profound communication difficulties. The lack of a vertical lift combined with steep steps to the second floor makes the Home unsuitable for very frail or people with a physical disability. The Home, which blends in with its surroundings, is located in a residential area and easily accessible by public transport. Local amenities such as GP’s surgeries, churches and a grocery shop are within walking distance. The Home is approximately three miles from the centre of Solihull. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this announced inspection over seven hours. The Inspector was pleased to be able to meet with most of the fourteen residents that live at Mereside during the inspection. The Inspector also had the opportunity to meet and talk to the staff on duty, and both the owner manager and deputy manager. The Inspector looked at all the communal areas of the premises, and most bedrooms. The Inspector spent time talking to residents who live in the home, and observing the support and interaction between them, staff and visitors. The Inspector looked at the records of care and care plans for three of the residents. Other records including fire safety records, rotas, staff supervision and training were also inspected. Information was provided by the Manager on the CSCI pre inspection questionnaire. A number of comment cards were received from service users, relatives and health and social care professionals. What the service does well: The home had a relaxed atmosphere. Residents meet on a monthly basis to discuss the home and issues important to them. Staff include and engage with the residents. Residents appeared to be comfortable and relaxed with the staff that support them. Residents made positive comments about their home. They said staff were helpful and friendly and that there is always someone to talk to. Residents are supported to take part in a wide range of activities in the home and in their local community. Residents are offered opportunities to do things for themselves, and to participate in their life and the running of their home. The Manager supplied the CSCI with a prompt action plan addressing the immediate requirements made at the inspection. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 6 The standard of the environment within this home is generally good providing residents with an attractive and homely place to live. What has improved since the last inspection? What they could do better: Staff must do more training so that they have the skills and knowledge to do their job and support the residents. Staff need more training on how to manage challenging behaviour. Staff refresher training on Fire safety matters was required so that staff has the up to date skills and knowledge to deal with any fire emergency situations. The care planning system in place needs further development to provide staff with all the information they need to satisfactorily meet residents needs. Risk assessments for residents need to be completed where risks have been identified to ensure that risk is reduced. Residents do not have individual health action plans. This is something that the Government paper, ‘Valuing People’ recommended that each person with a learning disability had by 2005. The provision of call bells in bedrooms needs to be considered given that the home does not provide waking staff at night. Daytime staffing levels are satisfactory but further review of the night time staffing arrangements are required to ensure residnets needs are safely and consistently met. Some of the systems in place to promote the health and safety of residents need improvement. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 7 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. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 3 The Statement of Purpose and Service User Guide provide prospective residents with relevant information about the home to enable them to make a choice about if they want to live there. The arrangements for the admission of new residents including assessments ensures their wishes and needs can be met. EVIDENCE: The Home has a Statement of Purpose and accompanying Service User Guide. This was found to meet the required standard at the inspection in March 2004. The Manager stated that the document had been updated to reflect the recent environmental changes to the home. The Deputy said that for residents who are unable to read staff explain the guide to them. The Manager will need to consider how the service user guide can be made more accessible to residents living at the home who cannot read. Consideration should be given to the use of pictures, video or audio as suitable to individual need. The records of a recently admitted resident were sampled. These included a social worker care plan, basic care plan completed by staff at Mereside and initial pre-admission questionnaire. The Manager and Deputy reported that trial visits had been made to the home. A record of these were available. It is recommended that the pre-admission questionnaire used by Merside is expanded to include possible risks, behaviours that may challenge the service Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 10 and night time support needs. This will enable the Manager to have a fuller picture of the needs of prospective service users before any trial visits take place. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 and 10 The care planning system in place is lacking and fails to provide staff with all the information they need to satisfactorily meet residents needs. Residents are supported to take responsible risks, however some written assessments fail to provide staff with all the required information they need. EVIDENCE: The care documents of three residents were assessed. The care files contain current and historic information that is mixed, not enabling staff to refer to, or use the documents easily. The Home has a document called ‘This is Me’. The document forms part of the care plan and is compiled in conjunction with the resident and other key people such as family members and day care staff. In addition to the written word, information was recorded via photographs and personal drawings. The document also included a family history, likes, dislikes, favoured activities and aspirations. The care plans detailed how staff were to support the resident to meet their needs. These included mobility, social and leisure, daily living skills, family contact, communication, choice, privacy, dignity, rights, independence, fulfilment, health and self-care. Individual short and long- term goals were identified. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 12 The care plan is reviewed annually by the home and then again after six months. It was observed that often some documents were undated within the plan, for example the date on which the six monthly review took place. The Manager needs to ensure that these records are dated and signed to show that the review actually took place within the six month time frame. Some residnets who live at the home have behaviours that include verbal and or physical aggression. Not all of the behaviour management strategies sampled contained enough information to ensure that staff are managing such behaviours in a consistent way. Strategies need to include triggers for behaviours and detail both pro-active and reactive strategies. It is good practice that key-workers complete a monthly summary within the care plan. However the quality of the content of these was variable. It is recommended that the Manager introduce a template document with headings to direct staff on what to include. For example accidents, incidents, activities, health appointments, progress towards meeting goals etc. During the inspection many positive examples of residents being encouraged, or enabled to participate in the life of the home were observed. This involved staff including residents in conversations, and activities. From talking to residents and staff, from sampling records and from observations made it is evident that residents can make decisions about their day-to-day lives. Residents told the Inspector that regular residents meetings are held in the home, records of these were available. Residents contribute towards the cost of the home vehicle. However up to date agreements for this were not available detailing how the cost is worked out and signed by the resident or their representative, ideally this should be someone external to Mereside such as a relative or advocate. There is evidence that residents are supported to take manageable risks, and staff encourage individuals to have an independent lifestyle. Risk assessments have been completed for a variety of residents activities that could pose a risk. Assessments sampled included self administration of medication, accessing the community without staff, unsupervised bathing and kitchen activities. Resident records indicate that one service user has the behaviour of looking in bins for items such as tea bags and cigarette ends. Discussion with the Manager and Deputy indicates that staff have tried to reduce the risk, however a written risk assessment was not available. A risk assessment was completed after the inspection took place and was forwarded to the CSCI. The Manager was further advised of how the assessment could be further improved. The risk assessments sampled had been regularly reviewed. To enable risk assessments to be located easily it is recommended that a log of assessments is introduced. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 13 Each risk assessment should be directly cross-referenced to the element(s) of the care plan to which it relates, and vice versa, so that the reader is naturally directed from one to the other. One of the outcomes for completing risk assessments and care plans should be that the finished article is a simple and effective working document, in which essential information can be easily found. Information about residents was observed to be stored securely. The pre inspection questionnaire indicates that the home has policies and procedures in place for confidentiality, record keeping and access to files by staff/ residents. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16 and 17 Residents are supported to live independent lifestyles and arrangements are in place to enable them to engage in a range of activities. Residents are fully involved in meal planning and are supported to eat a healthy diet. EVIDENCE: The majority of residents attend day placements at local day centres or supported work placements. One resident works at a farm four days a week. All residents spoken with were happy with their day placements. It was apparent from person centred plans undertaken in liaison with the day centre, and in some conversations with residents that this is a valued and important part of their life. Residents records sampled indicated that they go shopping, to the bank, restaurants, to pubs and to church. Residents are involved in shopping trips for clothing, food and various items for the Home. Where residents are able to they use public transport. Where one resident declined the opportunity of a shopping trip staff respected his decision. Discussions with staff and residents evidence that a holiday away from the home has been offered. Several residents are involved in caring for and walking the home’s pet dog. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 15 Five comment cards were received from residents. Four people said that they had lots to do at the home. One responded that there was not lots to do but did not wish to discuss this further with the Inspector. Records confirmed that residents are enabled to maintain contact with their family and friends. The Inspector met with one relative at this inspection who was very pleased with the home. Four comment cards that the home had sent out to relatives had been returned identifying that they were pleased with the care and support their relative received. One comment included ‘couldn’t be more satisfied with the care’. Residents said there were no rigid rules in and that staff are always there to help and support them. They have their own keys to their bedroom. Residents meetings take place on a regular basis. Menus and records of food provided to residents were sampled. Menus indicated that a variety of food is provided. Staff informed the Inspector that records of food are only maintained for the main meal if residents have something different from the main menu. This was observed to have been completed on a regular basis since the last inspection in March 2005. All resident comment cards recorded that they choose what to eat. The proprietor buys fresh fruit and vegetables from a local farm each week. Shopping is done by residents and staff at local supermarkets. At the time of this inspection adequate food stocks were provided in the home. The Inspector ate lunch with staff and the few remaining residents who were not out at day care. Lunch was a relaxed time with staff chatting with residents. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Residents healthcare needs to be better planned and monitored. The current system could result in needs remaining unmet, compromising residents health and welfare. EVIDENCE: All the residents the Inspector met with appeared to have undertaken, or been supported with personal care that day. The residents all appeared very individual in style. Each resident is registered with a local GP. Resident records sampled included details of health appointments attended. Records sampled indicated that where appropriate residents are referred to health professionals including the community nurse, psychiatrist, psychologist and speech and language therapist. Four comment cards were received from Health and Social Care professionals. All had positive views about the home, comments included ‘ staff at Mereside have previously and presently received advice and support from other professionals which they openly accept’. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 17 The Inspector was unable to find a plan or monitoring to underpin one residents needs regarding epilepsy. Generic information on epilepsy was available but guidance specific to the individual is required. One is recorded as having insomnia. A clear plan is needed for staff on how to support this. Staff stated that this was monitored via the general residents records. The Inspector recommends that this is recorded on a separate sheet, the Manager can then audit this on a week by week basis to identify need. Residents do not have individual health action plans. This is something that the Government paper, ‘Valuing People’ recommended that each person with a learning disability had by 2005. This is to ensure individuals receive all the care they need to stay healthy. It was not possible to assess if resident accidents and illness are responded to satisfactorily. Several accident records were missing and the record keeping of when residents were ill often did not record the care provided and return to good health. Discussion with the Manager and observation of the homes training records indicates that staff have received accredited medication training. Medication was observed to be stored securely in locked cabinets. Medication administration records were sampled and observed to have no gaps. Some medications are administered ‘as required’ medication for behavioural reasons. The standard of recording was variable and whilst some staff had completed satisfactory records many entries did not record if the medication had been effective. Effective recording is essential to establish if the medication is making a difference, its use can then be properly reviewed. The Manager must also ensure that clear protocols on the use of all ‘as required’ medication are available to direct staff as to when they should be given. The Manager must ensure that photocopies of prescriptions are retained and non blistered medication is subject to regular auditing to ensure stock balances are correct. The Manager stated that as required staff had now received training from the Community Nurse in the administration of stesolid. This needs to be evidenced in staff training records. The Manager of the home is a registered nurse. He currently administers a Clopixol injection to one service user on a regular basis. A letter from the GP was available giving the Manager permission for this practice. However it is unclear if all the required safeguards for this practice are in place. It is intended that this will be explored further by a visit to the home from the CSCI Pharmacy Inspector. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Residents are listened to. The complaint procedure required minor amendment so that residents are fully aware of the procedure to follow. The arrangements for adult protection are not fully developed to ensure that residents are being protected from abuse and that their welfare is being promoted. EVIDENCE: Residents spoken with said they feel that staff listen to them and they said there is always someone to talk to if they are not happy about something. Records of residents meetings show that they have been made aware of the complaints procedure. The procedure was observed to require minor amendment to make it clear that the CSCI can be contacted at any stage with a complaint. It was positive to hear that the majority of staff had been provided with Adult Protection training with further training booked. The adult protection policy stated that the Manager decides whom to involve from other agencies if an allegation of abuse is made or abuse is suspected. It was required at the inspection in March 2005 that this must be amended to ensure that multiagencies are involved and not solely the Manager. The Manager stated that he had amended a copy of the policy but was unable to locate it at the time of the inspection. Records indicate infrequent incidents of residents hitting out at other residents and staff in the home. The CSCI had not been notified of these incidents. It was not evident in some of the plans sampled how these risks had been assessed, planned, or if satisfactory strategies had been put in place to protect residents or staff from harm. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 28, 29 and 30 The standard of the environment within this home is generally high providing residents with an attractive and homely place to live. However the lack of safety features to enable residents to raise staff assistance could compromise their safety and well being. EVIDENCE: The home has undergone recent building works to provide all residents with a single bedroom, increase the number of en suite bathrooms and re-site the laundry. The kitchen has been upgraded and a new office is in use. Décor throughout the home was observed to be in good order. The Home provides a number of safe and accessible communal areas for both shared and private use. These consist of a dining room, large sitting room next to which is situated a smaller sitting room. All are located on the ground floor. The larger of the sitting rooms overlooks a private and secure garden. The home now benefits from staff sleep in facilities. When the alterations were taking place it was anticipated that this would resolve the unsatisfactory practice of the sleep in member of staff having to sleep in the communal lounge. Unfortunately, due to the recent increase to two sleep in staff the main lounge is still being used as a sleep in room for one member of staff. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 20 This is not ideal. Bedrooms were finished to a very high standard with good quality furniture and soft furnishing that met with the needs and preferences of the occupant. Residents were happy for their rooms to be seen and all spoken with said that they were very happy with their bedrooms, which were comfortable and very personal. The two bedrooms on the ground floor have en suite shower and toilet. Some bedrooms on the first floor and second floors have en suite facilities. A bathroom with a WC, bath and shower attachment is provided on the first floor. A bathroom with a WC and bath is provided on the second floor. A WC is provided on the ground floor near to the communal areas of the home The home provides a variety of specialist equipment. This includes walking frames and wheelchairs as well as aids to assist with bathing. In addition smaller pieces of equipment such as plate guards, slip mats and wide handled cutlery is available. Two bedrooms have been built on the ground floor to accommodate more dependent residents . Call bells are not provided in bedrooms, but two call bells are sited on each landing. It is unclear how residents would be able obtain staff assistance if for example they had mobility difficulties. The provision of call bells in bedrooms needs to be considered given that the home does not provide waking staff at night. Alterations to the ground floor have included ramped access to the new facilities and rear garden. The rear garden has been landscaped and includes ramped access from the back door down to a seating and barbecue area. As required at the last inspection handrails have been fitted to the ramps. Due to conservation restrictions the home is unable to fit ramped access to the front of the property. The home was clean and free from offensive odours at the time of this inspection. The laundry is newly built and is situated so that soiled laundry does not have to be carried through areas where food is stored, prepared or eaten. There is a washing machine and tumble dryer in the laundry. A wash hand basin is provided. Hand towels and hand wash were provided. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 21 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35 and 36 The home has enthusiastic staff who are provided with most of the training and supervision they need to enable them to work positively with residents to improve their whole quality of life. Daytime staffing levels are satisfactory but further review of the night time staffing arrangements are required to ensure residents needs are safely and consistently met. EVIDENCE: Residents made positive comments about the staff that work at Mereside. They all knew who their key worker was and felt that they could talk to any of the staff if they weren’t happy about something. Staffing levels in the home during the day are satisfactory. There are two staff and the manager and deputy manager on the early shift and three staff on the late shift. Previous reports have required that full assessments of the night time staffing needs of the service users are completed. Since the last inspection the Manager has increased night time staffing from one sleep in member of staff to two. However given the needs of some residents and layout of the building the provision of a waking staff may be more appropriate. The home has a stable staff team. Agency staff are not used in the home. Staff meetings do occur but not on a regular basis. The Deputy Manager stated that she hoped to arrange meetings on a more frequent basis. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 22 The files of three members of staff were sampled. These had details of the application form, references, CRB checks and identification details to evidence that residents are protected by the homes robust recruitment procedures. From talking to staff and from sampling staff records the Inspector found that staff generally receive training in relevant areas. Staff receive training in adult protection, health and safety, manual handling, first aid, ‘Safe Handling of Medicines’, food hygiene, fire safety, COSHH and falls awareness. As required at the last inspection the Manager has arranged for staff to receive training in autism. New staff to the home complete the TOPPS induction. Records did not show that staff have received training in managing challenging behaviour, due to the needs of some residents this will need to be arranged for staff. Additionally, refresher training in fire is required. The pre inspection questionnaire records that refresher training in manual handling and health and safety in arranged for October/ November. The home employs twelve care staff, nine (75 ) have achieved an NVQ in care. Discussion with staff and sampling of files indicates that staff receive supervision on a regular basis. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 23 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 41 and 42 Some of the systems in place to promote the health and safety of residents need improvement. EVIDENCE: The pre inspection questionnaire records that the home has an annual development plan for quality assurance, this was not sampled at this visit. Evidence was observed that the home has previously used surveys to seek the views of relatives and health professionals on the homes performance. The Deputy Manager stated that the CSCI inspection reports formed the basis for any improvements the home needed to implement. Throughout the inspection process the Manager presented as open and positive and welcomed the inspection process. Following the inspection the Manager promptly forwarded an action plan detailing the response made to immediate requirements made at the time of the inspection. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 24 Some improvements were required to record keeping practice. Residents records had not been completed on a daily basis or in sufficient detail to show the care offered and provided is in line with the care plan. Often entries recorded that an individual had been unwell but there was no follow up entry to show that the individual had recovered. A record of all accidents is required to be maintained in the home. Unfortunately some pages had been removed from the accident book and were unable to be found. With service user care records it is recommended that the arrangement within the file puts current information in a more easily accessible location, and some of the historical information be archived. The homes fire records were observed, these indicated that regular testing of the alarms and emergency lighting is carried out. Certificates of servicing were available for the fire alarms. Records evidence that a recent fire drill had been conducted. It is an area of good practice that the home has completed individual risk assessments for evacuation in the event of a fire, these are reviewed after a drill has taken place. Records evidence that staff have not received fire training in the last six months, this must be arranged as a priority. Records for the monitoring of water temperatures were dated 2004. This must be done on a regular basis to ensure that the water is at a safe temperature and does not pose a risk of scalding to service users. Current certificates of registration and employers liability insurance were on display. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 3 3 2 2 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 2 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mereside Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x 2 2 x E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 26 YES Are there any outstanding requirements from the last inspection? 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 6 Regulation 12(1) 15 Requirement Care Plans: Ensure all reviews are dated and signed. Review all behaviour management strategies to ensure they include triggers for behaviours, link to the use of any as required medication and detail both pro-active and reactive strategies. Timescale for action 30/10/05 2. 7 17(2) Schedule 4(9) 3. 9 13(4) 4. 9 13(4) Documented agreements must 30/11/05 be in place to demonstrate how each individual contributes to vehicles costs. These must demonstrate that cost is equitable to use and provide value for money for the individual. These should be signed by the service user or their representative. Ensure the PICA of one service 30/10/05 user is risk assessed and satisfactory control measures are in place with regard to access to the bins. Each risk assessment should be 30/10/05 directly cross-referenced to the element(s) of the care plan to which it relates, and vice versa, so that the reader is naturally directed from one to the other. Version 1.40 Page 27 Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc 5. 19 12(1)(a) and 13(1)(b) 12(1)(a) 15 12(1) 6. 19 7. 19 and 42 8. 19 and 42 17(1)(a) schedule 3 13(2) 9. 20 10. 22 22 11. 23 13(6) Accurate care plans and assessments for known care needs (eg epilepsy and insomnia) must be developed for all service users. The Manager needs to consider how health action plans can be introduced in line with the Valuing People white paper. The Manager must ensure service user records detail their general well being, all care offered and response to care. The Manager must ensure accident records are appropriatley recorded and available in the home for inspection. Medication: Effective recording on the use of as required medication is required to establish if the medication is making a difference. Clear protocols on the use of all ‘as required’ medication are required to direct staff as to when they should be given. Photocopies of prescriptions must be retained and non blistered medication subject to regular auditing to ensure stock balances are correct. Staff competence in the administration of stesolid needs to be evidenced in staff training records. The complaint procedure requires ammenment to make it clear that the CSCI can be contacted at any stage with a complaint. The adult protection policy must be amended to ensure that multi-agencies are involved in the investigation of allegations of abuse not solely the manager. Outstanding requirement from inspection on 16/3/05. 30/10/05 30/11/05 15/9/05 Immediate requiremen t 15/9/05 Immediate requiremen t 7/10/05 30/10/05 30/10/05 Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 28 12. 28 13. 29 14. 33 15. 16. 17. 33 35 42 18. 42 Sleep in staff must be provided with satisfactory facilities. The practice of staff sleeping in the lounge must be reviewed. 23(2)(a,n) The provision of call bells in bedrooms needs to be considered given that the home does not provide waking staff at night. 18(1)(a) A full review of the night time staffing arrangements is needed to ensure they are appropriate to the needs of service users. 12(1) The frequency of staff meetings 18(2) must increase to meet the standard of six per year. 18(1)(a) Staff training must be arranged for managing challenging behaviour. 13(4) Staff must receive fire training 23 six monthly. (Managers action plan records that this is arrnaged for October) 13(4) Ensure records of water temperatures are maintained on a regular basis to evidence that water is delivered at a safe temperature. (Managers action plan records that this is being done monthly) 23 (3) (b) 30/11/05 30/10/05 30/10/05 30/10/05 30/12/05 9/10/05 Immediate requiremen t 15/9/0 Immediate requiremen t 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 1 Good Practice Recommendations The Manager will need to consider how the service user guide can be made more accessible to clients living at the home. Consideration should be given to the use of pictures, video or audio as suitable to individual need. It is recommended that the pre-admission questionnaire used by Merside is expanded to include possible risks, behaviours that may challenge the service and night time support needs. E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 29 2. 2 Mereside 3. 4. 5. 6. 6 9 19 42 It is recommended that the Manager introduces a template document with headings to direct staff on what to include in the service user monthly summaries. To enable risk assessments to be located easily it is recommended that a log of assessments is introduced. Introduce an effective monitoring form for the insomnia of one service user. (Action plan from Manager states this has been introduced) With service user care records it is recommended that the arrangement within the file puts current information in a more easily accessible location, and some of the historical information be archived. Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 30 Commission for Social Care Inspection Birmingham & Solihull Local Offce 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mereside E54 S4557 Mereside V243241 080905 AI stage4.doc Version 1.40 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!