Inspection on 16/06/05 for Meridian Walk

This inspection was carried out on 16th June 2005.

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

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

Other inspections for this house

Meridian Walk 27/03/09

Meridian Walk 14/06/07

Meridian Walk 18/05/06

Meridian Walk 21/11/05

Meridian Walk 28/10/04

Meridian Walk 06/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 MERIDIAN WALK 80 Meridian Walk Tottenham London N17 8EH Lead Inspector Karen M Malcolm Unannounced 16 June 2005 @ 10:30 am 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. MERIDIAN WALK Version 1.10 Page 3 SERVICE INFORMATION Name of service Meridian Walk Address 80 Meridian Walk, Tottenham, London, N17 8EH 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) 020 8365 0023 020 8885 2954 Meridian.walk@Heritagecare.co.uk Heritage Care Vacant Post PC - Care Home 6 beds Category(ies) of LD, PD registration, with number of places MERIDIAN WALK Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28 September 2004 Brief Description of the Service: Meridian Walk is a purpose built care home in Tottenham North London owned by Metropolitan Housing. The care is provided by Heritage Care based in Loughton Essex who have homes in Newham, Norfolk, Westminster and Hertford. Heritage Care took over the operation of Meridian Walk on the 1st April 2004 from Real Life Options. Heritage Care was formed in 1993 and took its first steps into the voluntary sector as a provider of support services for the people in East London with learning disabilities and mental health support needs and over the time has embarked into supported living and older people services in various setting in the community. Meridian Walk is registered to provide specialist support to six younger adults with profound learning disabilities in a residential setting. The home is very spacious and well equipped. The home is arranged on two floors with a lift for wheelchair users. The service users bedrooms are spacious and all have access to en-suite facilities that are adapted to individuals needs. The lounge, kitchen, dinning room and sensory area is in one vast room, divided into appropriate spaces that are easily identified by the service users who have sensory difficulties. The garden area is paved with raised flowerbeds for wheelchair users. The home has its own transport with a tail lift for the users with mobility problems. The home provides twenty-four hour care and support and access to a range of residential specialist services geared towards meeting individual service users needs irrespective of age, gender, race or dependency. MERIDIAN WALK Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 16th June 2005 from 10am until 4.55 pm. As the inspector arrived two support workers were taking one service user out on activity in the home’s mini bus. Present in the home were the newly appointed manager, a senior support and two support workers and two service users. The manager informed the inspector that two members of staff were completing their shift at 11am that morning and one staff member was on a half-day induction. Two service users were at their allocated day centre and one service user was in hospital and was due to come out that day. The manager has been in post since January 2005. At the time of this inspection the manager’s application for registration was still in the process of being completed. Meridian Walk is home for six younger adults with profound learning disabilities and at the time of the inspection there were no vacancies. The manager informed the inspector that his vision for the home is to develop and ensure effective communication is promoted for the service users, staff and relatives. It was evident during the inspection that the building is in need of redecoration. This has been an on-going issue with the building owner’s Metropolitan Housing Association and has been addressed in the main body of this report. The manager stated that works are to be completed in July 2005 and this has been negotiated with the Housing Association. The manager also stated that the service users would be going on holiday whilst the works are being completed. Apart of the inspection process included examining care plans, policies and procedures, tour of the building, talking to the manager, observing a handover, talk to staff and observing staff interacts with service users. The inspector found the inspection to be positive and open. The inspector was unable to communicate effectively with the service users, due to their communication difficulties. However, the service users reaction and appearance were observed and it was evident that each service users were comfortable and neat in appearance on the day. What the service does well: The home is a purpose built spacious home for six adults with profound physical & learning disabilities who have lived in the home since it opened. Each service user has a bedroom with en-suite facilities. All the service users have the opportunity to attend a day centre daily and on the day they do not in-house activities are planned. The home a mini bus to enable the service users to participate in the community when ever they wish. The home’s policies and procedures are comprehensive and clear giving clear guidance and MERIDIAN WALK Version 1.10 Page 6 advised to staff. The manager is supported by a care service manager with regards to service users and staffing needs. All the service users have communication difficulties and the inspector was unable to obtain feedback during the visit, however, all the users have good family support networks and they advocate on service users behalf if necessary. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. MERIDIAN WALK Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection MERIDIAN WALK Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Service users know that their assessed needs had been addressed prior to moving into the home. Therefore, the staff supporting service users on a daily basis addresses individual care needs appropriately. EVIDENCE: All the service users have lived at the home since it opened. All referrals are from local authority and are accompanied by a comprehensive community care assessment. The manager and another staff member will undertake their own assessment involving the prospective service user their representative and other involved professionals. MERIDIAN WALK Version 1.10 Page 9 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 Service users have in place care plans, which address their assessed and any changes to their needs. However, this is not consistently up-dated, therefore service users are potentially at risk with regards to their continuing caring needs not being appropriately addressed by the staff supporting. EVIDENCE: Each service users has a care plan in place. At the previous inspection it was required that the care plans risk assessments are up-dated regularly and any changes to individual health or care needs are recorded. A number of care plans were sampled and it was evident that care plan had not been updated. Since the previous inspection there have been a number of changes within the staff team the main change has been with the management structure. A number of areas for improvement have not been met due to these changes these included, updating service users care plans. The manager was aware of this and ensured the inspector that is will be completed soon. Each service users has a named key worker. Apart of the strategy meetings held in the beginning of the year, it was recommendation that the placing authority completes all the service users reviews. The manager stated that this was completed in March 2005. However, copies of the reviews were not MERIDIAN WALK Version 1.10 Page 10 present on file. This was addressed with the manager and advised that it is the responsibility of the manager to ensure that copies of reviews completed are present on individual’s files. Person centred planning (PCP) format were present on some individuals files, however these were not been completed. The manager stated that all the care staff have recently undertaken training on PCP and will start implementing this programme soon for their key clients. The manager also stated that apart of the PCP format will involve multi media CD and the home is in the process of purchasing a computer for service users to enable them to access information via the computer with minimum support. The daily progress forms examined have been updated. The old format were also good, however, the previous manager did not monitor these appropriately. It was advised the new forms must be monitored regularly or the same situation will arise. Care plans sampled, it was evident that risk assessments were not updated. This was an area for improvement from the previous inspection, this is has been restated. It was recommended at the previous inspection by the inspector that the registered manager should seek external professional help to enable the service users in the home to communicate in their own way and to enable each user to express their own choices within the home. Accessing an advocate for the service users has been proved difficult. The manager stated since he has recently become employed, one of the areas he will be tackling is around advocacy. The organisation has a clear & comprehensive policy on advocacy and the organisation does ensure that service users are involved in the recruitment of staff within the organisation. This recommendation is restated. MERIDIAN WALK Version 1.10 Page 11 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 &17 Service users are given the opportunity to develop, participate in the local community and appropriate leisure activities. Service users maintain contact with family, friends and have personal relationship if they so wish. The meals provided to the service users met their dietary and nutritious needs. EVIDENCE: All service users attend a day centre weekly and each day one service user stays at home. All the service users have various educational and training programmes which they carry out daily. The manager stated that every week the home employs activity workers to ensure weekly activities are supported appropriately, this was evident on the rota shown. MERIDIAN WALK Version 1.10 Page 12 At the previous inspection it was required that the registered repairs the old and broken sensory equipment in the home and having in place a clear sensory programme for each service user, giving care staff guidance on how to support individuals in the home. During the tour of the building it was evident that a number of the sensory equipment had been changed, however, guidelines were not in place. The level of the service users disabilities does not enable them to undertake employment. Service users do participate in college and day centre activities where they are properly supported. Service users go out on different activities in the community such as cinema, swimming, bowling, the park, restaurants, shopping for toiletries or other personal shopping such as for clothes. The home has now introduced a detailed daily diary log, which is filled in by care staf. The new format gives a full and clear account of the day of an individual. All the service users maintain family links and friendships inside and outside of the home. The inspector spoke with the senior support worker with regards to communication with service users in the home. Staff were very aware of the non-verbal communication used by the service users. Records of menus are recorded in individual’s service users plans. A menu plan is available and it was evident that service users are provided with a varied, balanced diet weekly. MERIDIAN WALK Version 1.10 Page 13 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 & 20 The standard of care in the home is good service users are treated with respect and dignity they prefer. Service users health needs and the system of administration of medication are met by the home. However, this is not consistent monitored, therefore potentially leaving service users at risk. All service users are treated with the respect and dignity and the inspector observed this on the day. The home has appropriate specialist support and advice as needed from physiotherapists and occupational therapists, all equipment used in the home had been serviced within the last 12 months. The staff group reflected service users ethnicity, culture and gender. MERIDIAN WALK Version 1.10 Page 14 At the previous inspection two areas of improvement were made requiring the registered person ensure all copies of Regulation 37 reports are kept on file in the office and are available for care staff and the inspector to access at any time. The second area was to ensure that the accident book is available at all times in the home. Copies of Regulation 37 reports have been submitted to the Commission and the accident book was visible in the office. The manager informed the inspector that one service user was in hospital and during the course of the inspection the service user returned back to the home. Whilst the service user was in hospital the home supported the service user daily with his care needs. The inspector reminded the manager that he must ensure the service user’s risk assessment is up-dated to reflect the user’s current needs since arriving home. Five Medication Administration Records (MAR) chart were sampled. One service has oxygen prescribed when needed, another user uses nebuliser daily and two service users are prescribed thickener to aid with their digestion and eating. It was evident that healthcare records are not recorded separately on individual’s files, this was included in daily records log. It was advised that the manager should ensure that this information is recorded separately, because since the previous inspection a number of service users’ healthcare needs have changed. The suggested format should include: • The name of the service user • The reason for the healthcare appointment or treatment • A detailed outcome of appointment or the treatment • Any follow-up information • Sign & dated by the staff supporting the service user Healthcare must include, optician, dentist, GP visits, chiropodist and any consultant assessment or treatments. The organisation has in place a comprehensive medication policy, however, the policy does not include a section on covert medication and guidance for support staff with regards to supporting a service user to use a nebulizer and oxygen. Boots the Chemist supplies the home their medication monthly. A new cabinet is now in place MERIDIAN WALK Version 1.10 Page 15 At the previous inspection it was required that the registered person is to complete a thorough investigation with regards to the gaps found on SW’s MAR chart on 21st, 22nd & 23rd September 2004 for Phyllocontin 225mg tablets one to be taken twice a day and 30g Miconasole Nitrate 2 cream apply twice a day, no signatures found. An action plan was submitted to the Commission prior to this inspection. At this inspection the Medication Administration Record (MAR) chart were examined these were found to be in good order. The manager stated that he monitors the MAR charts weekly to ensure that any discrepancies will be addressed immediately. It was also required that all care staff who have undertaken medication training is listed clearly on the front of the MAR file with the dates when training was undertaken. Prior to this inspection the care service manager submitted an action plan, which detailed how the investigation took place and what procedures were now in place to monitor the medication procedures. A list of support staff who undertaken the medication training was on file, however, the list did not include when the training was undertaken by care staff. It was also advised that the list is to include training for the nebulizer and oxygen training undertook by support staff recently. MERIDIAN WALK Version 1.10 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 The home has a good complaints procedure with some evidence that service users feel that their views are listened to and acted on. Service users are protected from abuse neglect and self-harm. Therefore service users feel safe living at Meridian Walk. EVIDENCE: The organisation has an impressive comments and complaints leaflet that is in a pictorial format, for service users within the organisation who have communication difficulties. This is impressive. Since the previous inspection there has been two complaints made. One complaint was addressed and one was outstanding. The outstanding complaint was made by a relative with regarding the care of one of the service users. A copy of the letter was on file and the manager explained the outcome of the complaint, which seems to be addressed appropriately. However, there were no records on file referring to the outcome of the complaint made. It was advised that the manager concludes the complaint by writing a letter to the complainant prior to closing the complaint. One area of improvement that was addressed in the previous inspection required was that the registered person was to ensure all care staff undertake training in adult protection procedures and once completed a copy of individual’s certificates must remain on file. The manager stated all the care staff have undertaken adult protection training, which was facilitated by the Adult Protection Co-ordinator for Haringey, however, certificates were not present on individual care staff files when examined. MERIDIAN WALK Version 1.10 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 Meridian Walk is spacious home, however, a number of maintenance areas have not been addressed since the previous inspection. Therefore the registered person has not ensured service users live in a safe, comfortable and pleasant surrounding. EVIDENCE: The home is purpose built. The home has a large kitchen/diner/lounge area. All the shared space examined meets the size requirement of the standard. All the communal areas are adequately furnished, in the lounge there are several armchairs for individual users. In the kitchen there is a large dining table and service users with wheelchairs can fit around it. The home has six large size bedrooms, which are individualised to meet personal styles and tastes. All the rooms are in need of redecorated. Each bedroom has en-suite facilities specific to each service user’s needs and care plan. At the previous inspection there were a number of maintenance issues that needed addressing. This has been an on-going issue with the building owner’s Metropolitan Housing Association. The areas that need addressing is: MERIDIAN WALK Version 1.10 Page 18 The Garden Needs maintaining. The herbal sensory garden area needs maintaining. Lounge area The area must be redecorated The ceiling must be cleaned of cobwebs Carpet needed cleaning Conservatory Area is being used as storage for the hoist and for a number of black bin bags. S bedroom The area must be redecorated A new carpet must be provided The en suite fan must be cleaned B bedroom The lock must be repaired Cracks on the wall need addressing Risk assessments are needed on cot sides Ceiling hoist in the middle of the room, bed in the corner, bed needs to be repositioned Ants found in the bathroom The en suite fan must be cleaned and tiles missing from the wall D bedroom Bedroom furniture is falling apart The area must be redecorated The en suite fan must be cleaned Sleeping-in room A new carpet must be provided. The area must be redecorated S bedroom The en-suite fan must be cleaned N bedroom Baby alarm in place – not to be used An appropriate call system is to be installed, that meets the needs of the uses disabilities in the home. The area must be redecorated Laundry Room Still very damp due to the dryer been on. This needs to be addressed. MERIDIAN WALK Version 1.10 Page 19 It was also required that the registered person ensures that the kitchen units are replaced and the cooker is repositioned in the kitchen safely. A risk assessment of the cooker is to be completed. The manager stated that the only area for improvement that had been addressed was the baby alarm in N’s bedroom. This has been replaced with a clocking-in system for night staff near the service users bedroom. This is to ensure that hourly checks are completed at night to ensure the service user is safe at night due to the service user seizure. The manager stated that the clocking-in system is temporary situated. Upon examining the user care plan there was no review dated on the service user’s care plan. It was advised that the registered person must have a review date in place and how the review is going to be actioned and by whom. The other maintenance areas for improvement have not been addressed. The manager stated that apart of the works programme with the housing association the works would be starting July 2005. Whilst the works are being completed the service users will all be taken on their annual holiday during this period. Prior to this report being completed the manager notified the Commission that all the service users were going on holiday to Centre Pacs. As the areas of improvement were not completed at the time of this inspection these areas will be restated in this report. The home was found to be reasonably clean on the day. MERIDIAN WALK Version 1.10 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 34, 35 & 36 Staff morale has improved, resulting in staff working positively with service users to improve their quality of life. Service users also benefit from a competent staff team, however training undertaken by staff is not consistently recorded on individual personnel file. Therefore service users cannot be assured that staff are appropriately trained. The manager has failed to ensure all staff that are vetted to work in the home, have in place all the correct documents needed for employment. EVIDENCE: At present there is a manager, senior support worker, four full-time support workers and three part-time support workers. The manager stated that there are two full-time and one-night support worker vacancies. The rota was shown and it was evident that the shifts are adequately managed. At the previous inspection it was required that the registered person has in place a copy of all training undertaken by care staff on file and to ensure that staff supervision meetings are carried out at least six times a year with a senior/manager, in addition to regular contact on day-to-day practice. The manager stated that all support workers have undertaken a number of training, however, he had not written up the supervision notes. It was advised that evidence of these records must be on individual’s files. MERIDIAN WALK Version 1.10 Page 21 Support workers Criminal Records Bureau (CRB) checks are kept at head office. However, other staffing information was on file but not all the information required under Regulation 19 Schedule 2 was available. It was advised that all the records regarding support worker personnel information must be kept in the office. Staff morale has improved since the previous inspection. Evidence of this was observed, during the afternoon handover staff seemed to be more aware of their responsibilities and roles. The daily logs handed over were examined and it was evident that these were more detailed and clear with regards to individual service users care. The manager stated that the support workers have not undertaken team building training, this was due to changes within the management team since November 2005. Two members of staff have been disciplined since the previous inspection. One has left the organisation and the other was moved to another home. One support worker on duty was on a half a-day induction. The manager also stated from time-to-time student nurse complete a number of weeks placement in the home. It was advised that all staff whether student or volunteers must have completed satisfactory enhanced Criminal Records certificate (CRB) in place prior to completing a placement in the home. MERIDIAN WALK Version 1.10 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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) 37 & 42 The manager has a clear development plan and vision for the home, which he has effectively communicated to the service users, staff and relatives. Service users are assured that their health and safety is promoted and protected. However, this is not constantly reviewed by the home, therefore service users health, safety and welfare is not promoted and protected. EVIDENCE: Since the last inspection the previous manager has left. The current manager has been in post since January 2005. At the time of this inspection the manager informed the inspector that he has not completed or submitted his application to the Commission and was in the process of completing this. Staff spoken to stated that the manager is works alongside the team and is clearly a hands-on manager. It was also required at the previous inspection that the registered person ensures all care staff including the manager undertake a team building MERIDIAN WALK Version 1.10 Page 23 training, facilitated by an outside trainer. A copy of the team building agenda is to be submitted to the CSCI along with the action plan and timescales set to review the actions taken. The manager stated that they will be undertaken this training soon. Copies of the home’s Person in Control visits have been completed. Number of Health and Safety certificates were not in place this included the gas, electrical installation, legionella lasted serviced 21/04/05, hoist service and portable appliance testing (PAT). A requirement regarding these certificates has been made. It was evident at this inspection that all Controls of Substances Hazard to Health (COSHH) were stored appropriately. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 3 x x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No MERIDIAN WALK Score Standard No 24 25 26 27 Version 1.10 Score 2 x 2 x Page 24 6 7 8 9 10 LIFESTYLES 2 3 x 2 x Score 28 29 30 STAFFING 2 x 3 Standard No 11 12 13 14 15 16 17 2 3 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score X 3 3 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X Standard No 37 38 39 40 41 42 43 Score 2 x x x x 2 x MERIDIAN WALK Version 1.10 Page 25 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 9 Regulation 14(1)(d) Requirement The registered manager must ensure all service users risk assessments are up-dated regularly; any changes to their health or care needs must be recorded on file. (Previous timescale of 30th November 2004 was not met.) The registered person must ensure that service user’s plans are reviewed six-monthly and a copy of the minutes kept on file. (Previous timescale of 30th November 2005 was not met.) The registered person must have in place a clear sensory programme for each service user, giving care staff guidance on how to support individuals in the home. (Timescale of 30th December 2005 was not met.) The registered person must keep a list of all care staff that have undertaken the medication training on the front of the medication file with the date and the staff members usual signature and initials as recorded Version 1.10 Timescale for action 30th August 2005 And from then on 2. 6 15(2)(b) 30th August 2005 And from then on 3. 11 16(m) 30th August 2005 And from then on 4. 20 13(2) 30th August 2005 And from then on MERIDIAN WALK Page 26 5. 20, 23 & 35 17 6. 20 13(2) & 17 7. 19 12(1) 8. 22 on the MAR sheets. This must be up-dated accordingly. This must also include training undertaken for oxygen or nebulizer. Evidence of this must be available for the purpose of inspection. (Previous Timescale of 30th November 2005 was partially met.) The registered person must have in place a record of all training undertaken by care staff with copies of relevant certificate kept on file. Evidence of this must be available for the purpose of inspection. (Previous timescale of 30th December 2005 not met.) The registered person must amend the medication policy to include sections on covert medication, oxygen & nebuliser guidance. Evidence of this must be available for the purpose of inspection. The registered person must ensure that healthcare needs for service users are addressed and recognised. Records of all healthcare needs are to be recorded on individual’s care plan file. This information recorded is to include • The name of the service user • The reason for the healthcare appointment or treatment • A detailed outcome of appointment or the treatment • Any follow-up information • Sign & dated by the staff supporting the service user The registered person must ensure that the outstanding complaint from a service user’s relative is addressed fully. A Version 1.10 30th August 2005 And from then on 30th September 2005 30th August 2005 And from then on 30th August 2005 And from then on Page 27 MERIDIAN WALK 9. 24, 26 & 28 23(2)(c) (b) 10 24 14(2) 11. 24 23(2)(b) 13(4) 12. 36 18(2) record of the outcome is to be kept on file. Evidence of this must be available for the purpose of inspection. The registered person must ensure all the areas highlighted and described under ’Environment’ in the main body of this report are addressed. An action plan must be in place, this is to include consultations letters to service users, staff, relatives and friends of when the works are starting, completing and what action is being put in place to minimize effect on the day-today running of the home during this period. (Previous timescale of 28th February 2005 not met.) The registered person must have in place on the specific service user’s care plan the reason why the clocking- in system is in place, with guidance notes of when this is to be reviewed and by whom. The registered person must ensure that the kitchen units are replaced and the cooker is repositioned in the kitchen safely. A risk assessment of the cooker is to be completed and evidence of this must be available for the purpose of inspection. (Previous timescale of 28th February 2005 not met.) The registered manager must ensure that staff supervision meetings are carried out at least six times a year with a senior/manager, in addition to regular contact on day-to-day practice. Evidence of this must be available for the purpose of inspection. (Previous timescale of 30th Version 1.10 30th September 2005 30th August 2005 And from then on 30th September 2005 30th August 2005 And from then on MERIDIAN WALK Page 28 November 2004 not met.) 13. 42 13(4) The registered person must ensure that the health and safety of service users and staff includes regular servicing of the gas boiler, hoist, legionella and the Portable Appliance Testing (PAT), these are completed yearly. The electrical installation must also be completed and this covers the home for five years. Copies of all Health and Safety certificates are to be on file. Evidence of these must be available for the purpose of inspection. The registered person must submit an application form to the CSCI with regards to registering the new manager for Meridian Walk. The registered person must ensure all care staff personnel records kept must contain all information as set out in the National Minimum Standards and as required by the regulation. The registered person must ensure all staff employed, volunteers or student on placement have in place before commencing work in the home an satisfactory enhanced CRB check that has been completed by the home or if completed by an agency a verification record stating the individual’s CRB number, the date applied for, the individual’s date of birth and any conviction/s that appears on the CRB form. A record of this is to be kept on file. 30th September 2005 14. 37 7&8 30th August 2005 And from then on 30th August 2005 And from then on 30th August 2005 15. 34 17(2) Schedule 4 16. 34 19 Schedule 2.7 MERIDIAN WALK Version 1.10 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 32 7 Good Practice Recommendations The registered person must undertake appropriate steps to meet this requirement by 2005 50 of the staff team NVQ level 2 trained. It is recommended that the registered manager should seek professional advice with regards to ensuring that service users’ rights to make decisions are upheld in the home. It is recommended that the registered person is to ensure that the manager undertakes his registered manager’s qualification in NVQ level 4 in management and care by the end of 2005 as to comply with the National Minimum Standard. 3. 37 MERIDIAN WALK Version 1.10 Page 30 Commission for Social Care Inspection North London Area Office Solar House, 1st Floor 282 Chase Road, Southgate London N14 6HA 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 MERIDIAN WALK Version 1.10 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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