Inspection on 18/05/06 for Meridian Walk

This inspection was carried out on 18th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meridian Walk 27/03/09

Meridian Walk 14/06/07

Meridian Walk 21/11/05

Meridian Walk 16/06/05

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 Malcolm Unannounced Inspection 18th May 2006 09:35 Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Meridian Walk Address 80 Meridian Walk Tottenham London N17 8EH 020 8365 0023 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.heritagecare.co.uk Heritage Care Mr Zaydon Alayasa Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st November 2005 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 (organisation) based in, Loughton Essex and has homes in Newham, Norfolk, Westminster and Hertfordshire. Heritage Care took over the care of the home on the 1st April 2004 from Real Life Options. 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 situated on two floors with a lift for wheelchair users. The service users’ bedrooms are spacious and all has access to en-suite facilities that are adapted to individuals’ needs. The lounge, kitchen, dinning room and sensory area are 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 is quite a distance away from Edmonton Angel, Tottenham and Wood Green shopping areas. The home has its own transport with a tail lift for the service users with mobility problems. The aim of the home is to provide a friendly, warm, relaxing and homely environment striving to preserve and maintain the dignity, individuality and privacy of the service users and remain sensitive to each service users everchanging needs. 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. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager. The current scales of charges are from: - £1201.89 per week. Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 5 There are no other additional charges. Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours. Present were the designated responsible person (DRP), two support workers and four service users. During the inspection one of the four service users was waiting for their bus and escort to arrive and one service user was at their allocated day centre. Since the last main inspection in November 2005 the home has had another inspection in March 2006. It was evident at the March inspection that the home has made a sufficient improvement to ensure all the requirements from the previous inspection had been achieved. The manager was on holiday at the time of this inspection, so records pertaining to care staff were not inspected. The senior support worker was rota’d on shift however was not available also, due to unforeseen circumstances. Meridian Walk is a home for six younger adults with profound learning disabilities and at the time of the inspection there was one vacancy. A part of the inspection process included examining care plans, policies and procedures, tour of the building, talking to the DRP, observing how staff interacts with service users. The Designated Responsible Person (DRP) assisted the inspector throughout the inspection; this was found to be positive and open. The inspector was unable to communicate effectively with the service users, due to their communication difficulties. It was evident that all service users were comfortable and neat in appearance on the day. Feedback was given to the DRP and four support workers after the inspection. Outside of this inspection a brief feedback was given to the manager stating the requirements highlighted in this report. It was discussed that the inspection was positive and the staff were very helpful and optimistic in their approach to care. As stated in the main body of this report the main concerns were around the monitoring and reviewing of certain practices and documents that were being implemented. The findings from this inspection were that a number of requirements from the last two inspection reports were achieved at the time of this inspection. The inspector commended this on the day. The DRP assisted the inspector throughout the inspection process. The inspector would like to thank the DRP the management team, carers, service users and the relative for their time, patience and co-operation during the inspection process, which was positive and open. What the service does well: Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 7 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 has a mini bus to enable the service users to participate in the community whenever they wish. The home’s policies and procedures are comprehensive and give clear guidance and advice to staff. The manager is supported by the 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 of the service 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: This inspection has identified seventeen areas of improvement and eight recommendations. While it is evident that the staff are experienced and Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 8 competent, the home has failed to ensure that service users needs are not consistently being recorded, reviewed, monitored and up-dated appropriately. It is therefore required that the registered person submits an action plan to the Commission for Social Care Inspection (CSCI), which describes how they will address these matters. The findings from this inspection were that the registered person is to have, in place a clear monitoring procedure at night with regards to a specific service user. The medication policy is to be amended to include a section on covert administration of medication. The ‘Day & Night’ daily logs are to be completed after each shift and clear guidance is to be in place for care staff on how the daily logs are to be completed. Records of healthcare appointments and specialist communication needs of service users and methods of communication are to be recorded clearly on each service user’s file. Service users with communication difficulties are to be given informed choices at mealtimes. Service users’ care plans are to have a section that relates to financial arrangements. Support workers are to undertake training in working with service users with learning and communication difficulties, bereavement & loss, team building and monitoring and reviewing how this is implemented. Menu plans are to be completed for individual service users’. The manager is to seek professional advice and guidance with regards to service users accessing proper support with regards to sensitive healthcare issues. The manager is to have in place clear guidance notes for staff with regards to specific service users’ with swallowing difficulties. The registered person to seek advice and support for service users and staff with regards to bereavement and each shift there is to be a qualified first aider. Any documents relating to the home’s vehicles must be kept securely. The recommendations addressed in the table at the back of this report are deemed good practice. 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. Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using evidence including a visit to this service. The home continues to ensure 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. Since the previous inspections one service user has died. At present there is one vacancy, but in discussion with one of the support workers it was evident that a referral has been made to the home via the placing authority. Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. While care plans are in place these are not consistently monitored or reviewed. Therefore the information recorded is likely to be inadequate and may not reflect the current care or support needs of the individual living at the home. Therefore service users may not be receiving appropriate care. EVIDENCE: Three care plans examined. Service users care plans are now in place. These were deemed good by the inspector, as the information recorded covers individuals’ holistic care needs. Some areas such as personal care are written from the service user’s perspective on how they would like to be supported. However, there were some gaps identified, regarding no evidence of reviews taken place with the placing authority and no agreement from the specific service users or their representative on their behalf of what has been recorded. This was discussed with the service manager on the phone. It was evident that obtaining reviews with the placing authority was proved difficult. The service manager stated a Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 12 meeting has been arranged this week to discuss the matter further. Prior to this inspection the service manager and the manager has kept the Commission informed with any correspondence sent to the placing authority regarding reviews. All service users have communication difficulties. Service users mainly use non-verbal communication, through gestures, actions, body language and facial expression. The staff are in tuned to individuals’ care and support needs. Staff spoken to state service users’ choices are decided on a daily basis. However, evidence of how this has taken place is not recorded clearly, such as breakfast routines and on how individuals choose want they want to eat. It was advised that any appropriate input or specialist communication aids used to support individuals’ with their communication needs must be recorded. The service users ‘My Day & Night’ (daily logs) are set out in an individual format of how each service user spent their day. Each section is set out in a question form scenario for support workers to fill in. At the previous inspection the inspector was impressed by the format, however it was expressed clearly to the manager that the format must be monitored and reviewed regularly and to ensure that staff completes the document appropriately. A requirement was made at the time with regards to a number of omissions found. At this inspection, it was evident that not only were omissions found, but also the format was being partially used and a different format was in place alongside of the current format. In discussion with the support workers, they were all in agreement that the format is good, however, when introduced to the team, the purpose of the format was not explained or shown. Blank copies were not always available therefore other formats were being used. It is the view of the inspector that there has been some miscommunication on how ‘My Day & Night’ format is implemented. Another area of concern was the communication book. Messages are recorded however, there is no monitoring process in place on whether individuals had read the information, understood or acted on the action asked. Therefore the system is not fully workable and good ideas and practices implemented may become lost. Therefore the registered person must have in place clear and precise guidance notes on how ‘My Day & Night’ (daily log) are to be completed. This format is to be monitored and reviewed regularly. It is deemed good practice that the registered manager has a team-building day or a meeting to discuss ‘My Day & Night’ (daily log) and the communication systems within the home. All the service users’ have some form of communication difficulties. Therefore it is not always possible for the staff to ensure that the service user’s rights to make decisions are upheld. Staff state they are aware of individual wants and dislikes due to their actions, which is non-verbal. However, it was not evident on individuals’ care plan how this non-verbal communication is shared with other staff and how service users can make proper informed choices. It was therefore recommended that the manager should seek external professional Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 13 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. At the previous inspection it was required that the registered person has in place clear monitoring procedures at night with regards to a specific service user’s care needs that needs monitoring carefully through the night. It was evident that the new monitoring system was in place, however the guidance notes were not in place. Therefore this requirement is restated in this report. It was also advised that support workers must undertake training around working with service users who have non-verbal communication. In the last Regulation 26 report it was stated that the registered manager is the home’s Champion Person Centred Planner. It was evident that service users care plans are kept securely. On each file there was a financial information section. However, the information recorded was brief and only contained individual bank statements. There was no information on what type of benefits individuals’ can receive, who is their trustee or guardian and placement fee charges. It was advised that this information must be recorded clearly on individuals’ file. Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using evidence including a visit to this service. Service users are given the opportunity to develop, and participate in the local community and are appropriately supported to do so. Service users maintain their family contact. The meals in the home are good offering both choice and variety. Therefore service users cultural needs are being appropriately met by the home, in terms of their dietary 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 DRP stated that each week the service users go out on different activities in the community such as cinema, swimming, bowling, the park, restaurants and shopping. Recently service users went on a holiday to Centre Parc, whilst the communal areas were being redecorated. It was observed by the inspector that the atmosphere in the home was good. The music playing in the lounge was deemed appropriate. The interaction with Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 15 staff and service users was positive. Two service users and two support workers during the inspection went out lunch. The missing person file was in place and found to be impressive. It was evident on each service user’s file examined that information held with regards to family contacts is properly recorded. The DRP stated that the service users families are very much a part of the home. The service users ethnic group is varied and the staff team supported compliments this. The menu plan examined showed that the meals provided by the home are varied, nutritious and balanced. The service users individual menu plans are combine with the My Day & Night daily notes. It was evident that these are not completed daily or the information record is brief such as ‘takeaway.’ Therefore it was not clear as to whether service users were provided with a balanced diet daily. It was discussed with staff in the feedback session at the end of the inspection. It was also discussed that the specific service user who has a puree diet due their swallowing difficulties must recorded information of what their dietary intake is. The cultural diversity of the service users is very varied and this is reflected in the staff team supporting them. One specific service user cultural needs are being met by the support and advice given to the service user’s relative. This specific service user goes home regularly and the family ensures that the individual’s cultural identity is upheld positively. . Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 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 the following standard(s): 18, 19, 20 & 21 Quality in this outcome area is adequate. This judgement has been made using evidence including a visit to this service. The home has improved on their procedures in recording and promoting good health and wellbeing. However, these records of procedures need to be consistently monitored, otherwise service users healthcare needs may not be met appropriately as the information recorded may not correct. Service users know that they are safeguarded by the policies and procedures for dealing with medicines. Therefore medication procedures are wellmanaged promoting good health. EVIDENCE: Staff provide sensitive, flexible and personal support to maximise service users’ privacy, dignity and independence. Service users’ preference about how they are guided, moved supported and transferred are complied with, and reasons for doing so are explained and recorded in their care plans. Heath care information is recorded. However, it was evident from the discussion with support workers and looking through the service users care plan that the information recorded around healthcare is recorded in different places. Therefore the inspector could not track the information presented on whether or not the service users health needs was being properly managed Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 17 and monitored. It was also evident that there were no records of whether service users had dental, optician or chiropody appointment in the last year. The question of smear test, breast and prostate examination was also discussed with support workers around how this is being addressed appropriately and in a sensitive manner. Due to individuals’ service users communication difficulties, this subject is usually either ignored, pushed aside or not addressed properly. It was advised that this must be discussed fully and the manager is to obtain professional advice and support to enable support workers to support service users appropriately. It was also evident that support workers were confused as to what is recorded as healthcare, an incident or an occurrence’. It was advised that guidance must have in place to enable support workers to record the information under the appropriate heading. All the service users have learning difficulties consultant who reviewed service users medication, gave support and guidance with regards service users care needs. The inspector was informed that the consultant has now retired therefore this service is no longer available by the local authority, until a replacement is found. It was advised that the manager should seek advice and guidance from the GP with regards to supporting the home with this additional service. One service user has problems with choking, a referral was made to the speech and language therapist on 18/04/06 and on 17/05/06 a form was introduced on the specific service user’s file. A note was recorded in the communication book. However, there was no guidance on the purpose of the form being introduced. This was discussed at length with the DRP on duty and it was explained that the form was for staff to look at and give comments, as stated above, but this was not stated in the communication book. The medicines policy is complete and there is a general adherence to the policy. There is also a separate policy in pictorial format for service users with communication difficulties. Other service users within the organisation devised this, and it is also available in different languages. The inspector deemed this as excellent and informed the staff on duty of this. The records for the receipt, administration and disposal of medication were satisfactory. There was no evidence in the individual service users’ care plans of their consent to take medication although all the service users were taking medication regularly. The service users are generally protected by the home’s medicines policy and procedures. The staff, however do receive adequate training in all aspects of handling medication. The only area of concern relates to covert medication. A number of the service users have swallowing difficulties and are on thickener to aid their eating and drinking. Due to this, some service users, prescribed medication is disguised in certain food to ensure medication is taken daily. At the previous inspection it was advised that the medication policy is amended to include a section on covert medication as well as, oxygen and nebuliser medication. Although at present there is no service user in the home who Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 18 requires oxygen or nebuliser, as this specific service user died recently, it was advised that this is good practise as in the future the same situation may occur. Since the last inspection one service user had died. From discussion with staff it was evident that no form of counselling or support for service users or staff had been sought by the organisation during this period. It was advised that this was needed, as all the service users had known each other well since moving into the home. An issue was raised in the communication book regarding a specific service users personal care. It was advised that this issue should be discussed, the specific service users risk assessment is to be update along with the individual’s care plan. Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using evidence including a visit to this service. Service users know that their views are listened to, therefore they are confident that their views will be acted on. The home policies and procedures regarding abuse are in place. Service users are confident that these are in line with the local procedures. Therefore service users know that they are protected. 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. Adult protection was discussed with the staff and it was evident that the home does have in place a copy of the local authority’s adult protection procedures. Training is completed by the organisation and a part of individual training includes Adult Protection, which takes into account the local procedures. Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 & 30 Quality in this outcome area is good. This judgement has been made using evidence including a visit to this service. The home’s environment has improved greatly since the last inspection. Therefore the home is now a safe and an inviting place for service users to live. EVIDENCE: The home is purpose built and is very spacious and well equipped. The home is situated 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, dining room and sensory area are 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’s communal areas, individuals’ bedrooms, sofas, lounge/kitchen flooring and the kitchen units have now been either redecorated or replaced. During the tour of the home it was evident that although the bedroom, the hall and landing areas had been redecorated the carpets was not been replaced. The DRP informed the inspector that service users are to pay for their own carpets, but she was unsure about the communal areas. In one bedroom Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 21 there was a mouse bate visible. It was advised for health and safety reason that this must be removed. The home has six large sized bedrooms, which are individualised to meet personal styles and tastes. Each bedroom does reflect individual’s identity and cultural preference. The home has a lift installed and each service users’ has specialist equipment in their bedroom to aid their mobility. At the time of this inspection the lift was out of order. The home was found to be reasonably clean on the day. The laundry room equipment was found to be in good order. Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 35 Quality in this outcome area is adequate. This judgement has been made using evidence including a visit to this service. An effective staff team supports Service users, which are appropriately trained. However, the training programme needs to be reviewed to ensure that the training been provided actual meets the service users specialist needs. EVIDENCE: As the manager was not available on the day of the inspection, staffing records were not examined. Therefore requirements made under this outcome group from the previous inspection are restated in this report. On shift were the DRP and two support workers. The senior support worker was rota’d to work on a flexi-shift, but due to unforeseen circumstance was unable to come in. The DPR was a bank worker, one of the members of staff was from the agency however had worked in the home a number of years. The second member of staff was still in their probation period of employment. It was evident from the rota that there are eight full time members of staff, two part-time members of staff, four bank workers and one agency staff employed by the home on a regular basis. On each shift there is a named designated responsible person (DRP) and each member of staff has a task list of duties to complete before the end of the shift. Staff spoken to state that this was good and felt this was workable. However, it was evident that one of tasks to be completed by staff was to record events in each service users’ My Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 23 Day & Night notes. This has been addressed in this report under the outcome areas group of ‘Individual Needs and Choice’. During the feedback session with staff at the end of the inspection, it was clear that a number of issues were raised with regards to management procedures being followed correctly such as communication, care plans and ‘My Day & Night’. It was the view of the inspector that the registered person needs to ensure support workers undertake a number of training sessions around: • ‘My Day & Night’ daily notes • Communicating with service users with a learning difficulty • Choking & swallowing training • Bereavement & Loss • Team building • Monitoring and reviewing how this is implemented • Key-working roles and responsibilities In discussion with staff it was evident that one member of staff has completed their NVQ level 2, three have completed level 3 and one person is currently undertaking NVQ level 3. The manager is undertaking his Registered Manager’s Award (RMA) at present. Staff meetings were discussed. It was evident from the discussion that agency or bank staff are not always formally invited to the meetings and copies of the minutes are not always shared. It is recommended as good practice for the manager to distribute minutes of staff meetings to all staff who work in the home on a regular basis. Therefore new proposal or changes can be share properly within the team. Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 Quality in this outcome area is adequate. This judgement has been made using evidence including a visit to this service. Service users are confident that the home is run well. Service users health and safety is regularly reviewed and monitored. Therefore, service users are fully protected and safeguarded. EVIDENCE: The ethos in is run well. Staff were positive about the home and service users whom they support. The home is managed to the benefit of the service users and this is evidence in staff work practice observed on the day. Staff were open to discuss constructive issues and seek advice from the inspector on the day. The inspector saw this as positive and this was reiterated to the manager on his return by phone. Service users are kept safe and input from family and friends are positive. The home has two vehicles belonging to service users. The documents pertaining to each vehicle were kept in the office on an open shelf. It was advised that this should be kept in a locked secure place. Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 25 It was evident from the discussion with the DRP that the only two qualified first aiders are the manager and the senior support worker. It was advised that on each shift there must be a qualified first aider and this is to be clearly indicated on the rota. Fire drills have been completed, however, not regularly and it was advised that there must be at least four fire drills a year and good practice is to record all service users and staff who were present on the day. Other documents relating to health and safety were not examined at the time of this inspection. Records in place have much improved since the previous two inspections. However, it is recommended that any implementation of new procedures, documents or monitoring charts should be reviewed and monitored regularly to ensure that the documents in place are workable. Copies of Regulation reports are submitted monthly to the CSCI. Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 2 3 X 3 X 3 2 X Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 27 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 YA6 Regulation 14(2) Requirement Timescale for action 30/07/06 2. YA20 13(2) 3. YA6 17 The registered person must have in place clear monitoring procedures at night with regards to a specific service user’s care needs that needs monitoring carefully through the night. Guidance in place must be on file and this must be monitored and reviewed appropriately. (Previous timescale of 30/04/06 not met.) The registered person must 30/07/06 amend the medication policy and procedure to include a section on covert administration of medication. (This requirement was partially met and amended in this report previous timescale of 30/04/06 not met.) The registered person must 30/07/06 ensure that ‘My Day & Night’ daily logs are completed after each shift. These must be monitored and reviewed regularly. Evidence of this must be available for inspection. (Previous timescale of 20/04/06 not met.) DS0000060937.V291208.R01.S.doc Version 5.1 Meridian Walk Page 28 4. YA35 17(1)(a) Sch 3.3m 5. YA18 12(1) 6. YA7 17(1)(a) Sch 3.3(l) The registered person must have in place for all staff clear and precise guidance notes on the ‘My Day & Night’ daily logs on how these are completed and what is a healthcare, occurrence or an incident. This requirement is restated and amended in this report. The registered person must have 30/07/06 in place for all new support workers an induction programme, which is signed and dated accordingly. (Previous timescale of 20/04/06 not met.) The registered person must 30/07/06 ensure individual service users, healthcare appointments such as optician, chiropody; dental and hearing tests are to be clearly recorded on each file. 20/08/06 The registered person must ensure details of any specialist communication needs of the service users and methods of communication that may be appropriate to each service users need. 7. YA7 8. YA7 The registered persons must ensure that service users with communicational difficulties are given informed positive choices at mealtimes. Written step-bystep guidance notes on how this is appropriately communicated to each service user is to be on file. This is to be reviewed and monitored by the registered person. 17(2) Sch The registered person must have 4.8 in place on each service users care plan a section a clear account of individual financial arrangements. 18(1)(c)(i) The registered person must ensure that all support workers DS0000060937.V291208.R01.S.doc 30/08/06 30/08/06 Meridian Walk Version 5.1 Page 29 9. YA17 10. YA18 11. YA18 12. YA21 13. YA24 14. YA24 undertake training around working with service users with learning. and communication difficulties. 17(2) The registered person must 4.13 ensure that each service users daily menu plan is completed. Evidence of this is to ensure that individuals’ are being provided with a balance and nutritious diet. 12(1) The registered person must ensure seek professional advice and guidance with regard to service users accessing and being properly supported with regards to healthcare needs that relate to smear test, breast and prostate examination. (Especially for service users with communication difficulties.) 12(1) & The registered person must have 17(1)(a) in place specific guidance notes for the chart that is in place for Sch 3.3(m) the specific service user who is deemed at high risk of choking. This is to included when the notes are to be reviewed and monitored and by whom. 18(1)(c)(i) The registered person must seek advice and support for service users and support workers with regards to bereavement & loss. 13(4) The registered person must ensure that mouse bate in a specific service user’s bedroom is removed or appropriately placed so that it does not contravene any health and safety legislation. 23(2)(b) The registered person must ensure that the lift is repaired. The registered person must either replace or thoroughly clean individual service users carpets. 18(1)(c)(i) The registered person must DS0000060937.V291208.R01.S.doc 30/07/06 30/08/06 30/08/06 30/08/06 30/06/06 30/06/06 15. YA35 30/08/06 Page 30 Meridian Walk Version 5.1 16. YA42 13(4)(c) 17. YA42 17 ensure that care staff undertake specific training • Swallowing & choking Bereavement & Loss • Team building • Monitoring and reviewing how this is implemented • Key-working roles and responsibilities The registered person must 30/06/06 ensure that on each shift there is a qualified first aider. The named care staff must be indicated clearly on the rota. The registered person must 30/06/06 ensure that all the vehicle documents pertaining to individual service users are kept secure. 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 YA7 Good Practice Recommendations It was therefore recommended that the 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. It is good practice that the registered manager has a team building day or a meeting to discuss ‘My Day & Night’ (daily log) and communication systems within the home. It is good practice that the registered person has guidance in place on how communication with the team in disseminated to staff and how this is monitored. It is recommended that the registered person seek advice and support from the GP about continuing the service obtained by the learning disabilities Consultant that at present is not available. It is good practise to amend the medication policy to include a section on oxygen and neblizer administration of medication. As in the future this may be an issue. DS0000060937.V291208.R01.S.doc Version 5.1 Page 31 2. 3. 4. YA7 YA7 YA18 5. YA20 Meridian Walk 6. YA42 7. 8. YA7 YA39 The registered person should record the names of all service users and staff who were present when a fire drill evacuation practice has taken place. Therefore the registered person will have a clear account of which member of staff over the year have been a part of the fire drill evacution. It is also good practice to complete at least one of the fire evacution drills during the early evening. It is good practice for the manager to ensure that copies of staff meeting are given to staff who are unable to attend as well as bank and agency. It is good practice that the registered manager monitors and reviews all documents implemented to ensure that they are workable and useable. Meridian Walk DS0000060937.V291208.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Southgate 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 DS0000060937.V291208.R01.S.doc Version 5.1 Page 33 - 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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