Inspection on 21/11/05 for Meridian Walk

This inspection was carried out on 21st November 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 24 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 18/05/06

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 9.30 21 November 2005 st Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 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.V259078.R01.S.doc Version 5.0 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.V259078.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Meridian Walk Address 80 Meridian Walk Tottenham London N17 8EH 020 8365 0023 020 8 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) Heritage Care Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th June 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 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 DS0000060937.V259078.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five and half hours. Present was the manager and three support workers. One service user was in the home, one service user was in hospital and four service users were at their allocated day centre. The manager has been appointed as the manager since January 2005. The manager informed the inspector that his registration interview with the Commission is scheduled for 24th November 2005. 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. Apart of the inspection process included examining care plans, policies and procedures, tour of the building, talking to the manager, 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. It was also evident at this inspection that the communal areas have now been addressed by the housing association and the remaining works to be completed are the service users bedrooms, and the garden area. 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 advised 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 the users have good family support networks and they advocate on service users behalf if necessary. Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: This inspection has identified twenty-four areas of improvement. Four of which are Immediate Requirements that was issued on the day of the inspection and seven of which have been restated from the previous inspection report. The four Immediate Requirements relate mainly to one specific service user’s care needs. The manager is to submit to the Commission copy of Regulation 37 report regarding one specific service user who has admitted into hospital over the weekend. The manager is to ensure care staff have undertaken oxygen and nebuliser training a copy of the day of the training is to be submitted and the registered person is to complete at least weekly Regulation 26 visits copy to be submitted to the Commission. The other areas of improvement relate to the registered person to submit an action plan to the Commission for Social Care Inspection (CSCI), which describes how they will address these matters. The action plan must describe how the registered person ensures: • That guidance are in place regarding one specific service user’s nighttime routine and how this is monitoring. • Six monthly reviews are to be completed and kept on file. • Copies of the service users placing authority’s reviews must be obtained and kept on file. • The outstanding environmental works must be completed. • Supervision must be carried out and notes maintained on individual’s staff personnel files. • Portable Appliance Testing (PAT) certificate must be in place and then completed annually. • Criminal Records Bureau (CRB) for agency staff must be either obtained or verified prior to support worker starting employment in the care home. • All service users care plans must be securely maintained. Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 7 • • • • • • • • • • The registered person must give notice to the Commission of any allegation of misconduct by any person who works at the home. A copy of the local adults protections procedures must be obtained and kept in the home. The fridge and freezers must be defrosted. No homely remedies are to store in the first aid box and the first aid box must be maintained. Staffing levels to be reviewed Risk assessment to be complete and updated regularly when any changes occur to an individual service user’s health or care needs. When medication is administered by a support worker to a service users the Medication Administration Records (MAR) chart must be completed with the appropriate signature or code The gas boiler must be serviced. All documents must be accessible at all times. And the daily diaries for each service users are to be completed after each shift. This must be monitored and reviewed by the manager. The three recommendations are seen as good practice and should be given serious consideration. Recommendations are seen as good practice and should be given serious consideration. 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.V259078.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 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 the following 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 DS0000060937.V259078.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 & 10 There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. Service user are not confident that information about them is handed appropriately and that their confidences are kept. EVIDENCE: At the previous inspection it was required that the manager ensures all service users care plans are reviewed six-monthly and risk assessments are up-dated. The manager stated at the previous inspection that these documents would be completed and update within the specified timescale set. It was evident at this inspection that firstly the manager was unable to locate the current risk assessment file and six monthly reviews had not been completed. From a strategy meeting held earlier this year the placing authority action was to undertake all the reviews for service users. The manager stated this has been undertaken, however, copies of reviews completed have not been submitted to the manager. It was advised that the manager must obtain copies of the reviews reports to ensure any actions that need addressing for specific service users are addressed. Therefore these requirements are all restated in this report. It was evident that all service users care plans were not kept securely in the home. Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 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 the following standard(s): 11, 14 & 17 Service users are given the opportunity to develop, participate in the local community and appropriate leisure activities. However, records in place do not evidence this on a daily basis therefore it is not evident if service users social and leisure needs are appropriately being supported by the home. 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. At the previous inspection it was required that the manager has in place a clear sensory programme for each service user, giving care staff guidance on how to support individual appropriately. It was evident that each service user has in place a pictorial sensory programme. Each activity has clear guidance for care staff to support individuals appropriately. The sensory room has now been revamped and various sensory equipments are now in place. The sensory programme provided included, pampering that includes hand massage Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 12 and nail care, foot spa, aromatherapy, bath time and walking using a frame. Records of activities participated are on file. This was impressive and commended by the inspector. Two of the service users have a puree diet due their swallowing difficulties. One service user is prone to chest infection. On the Saturday prior to the inspection the specific service user who has is prone to chest infection was admitted into hospital with a chest infection. The manager stated that as the incident happened over the weekend he was unable to submit a Regulation 37 to the Commission. However, on the specific service users daily care notes examined their was no records made indicating the service user had been admitted into hospital on 19th November, 2005 in the afternoon. The last recorded entry made was the morning of the 19th November 2005 that stated that the specific service user was ‘given their PRN medication and was fine relaxing in the lounge.’ The afternoon section was blank. It was evident in all the diaries examined that there was a number of unrecorded days. This was addressed with the manager. An Immediate Requirement regarding the registered person to completed weekly Regulation 26 visits to the home was issued on the day. The Regulation 26 visits are to be unannounced and the service users care plans are to be examined during each visit. Copies of the reports completed are to be submitted to the Commission. Since the previous inspection all the service users have been on holiday whilst the redecorating of the communal areas were completed. Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 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 the following standard(s): 18 & 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. EVIDENCE: Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 14 At the previous inspection a requirement was made relating to healthcare needs of service users to be recorded separately and to ensure that the appropriate care and support is supported by the home for individuals. The suggested format to be used was: • 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 manager showed the inspector the new healthcare, which was clearly set out in the format suggested. Appointments and treatments were on recorded. The inspector commended this. One service user was admitted into hospital over the weekend with a chest infection, this has been addressed in the previous section under ‘Lifestyle.’ It was evident from the discussion with the manager that the service user has had a number of hospital admissions within the current year. Relating to same health problems. The specific service user has also been prescribed Oxygen and a Nebulizer. At the previous inspection it was required that the registered person ensures that all care staff undertakes training in Oxygen and Nebuliser administration. It was evident that the care staff within the team have not undertaken this training. This was concerning and the issue was discussed with the manager at length, especially as the specific service user is now in hospital with a chest infection. An Immediate Requirement was issued regarding Oxygen and Nebuliser training. It was also advised that all care staff undertaken medication, Oxygen and Nebulizer training was to be listed on the front of the medication file, with dates and to be reviewed accordingly. 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. Medication Administration Records (MAR) charts was examined. It was evident that there was two gaps found in one-service users MAR charts. Therefore it was not evident whether the medication was administered or refused. It was evident that in two previous inspection reports the home was issued a Statutory Notice regarding gap found in medication charts. It is therefore reminded that any further non-compliance regarding gaps in the medication administration records (MAR) further action would be taken. Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 15 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 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, however, service users are not confident that these are in line with the local procedures. Therefore service users can be potentially placed at risk. 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. The outstanding complaint from the previous inspection has now been addressed and evidence of this was on file. The manager stated that there is another complaint being managed by the service manager regarding the same complainant. Adult protection was discussed with the manager and it was evident that the home does not have in place a copy of the local authority’s adult protection procedures in place. Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 16 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, 27 & 30 Meridian Walk is spacious home, however, a number of maintenance areas have been addressed since the previous inspection and a number remain outstanding. 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. Sensory room off the lounge/dining/kitchen areas has been refurbished. It was evident at that the main communal areas had been redecorated, however, the service users bedrooms had not been completed. The kitchen units have been replaced and the cooker is now fitted appropriately. Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 17 The other outstanding areas found were: All six bedrooms are in need of redecorating. The garden – needs maintaining and the sensory garden is over grown. Lounge area The carpet is in need of a thorough deep cleaning or replacing The sofas are worn and need replacing Kitchen area The fridge and freezers need defrosting An open tin of condensed milk was found in the fridge this must be removed Conservatory This area is being used as storage for the hoist and for a number of black bin bags. S bedroom A new carpet must be provided Wardrobe draws broken and need replacing or repaired B bedroom The door lock must be repaired Cracks on the wall need addressing Risk assessments are needed on file with regards to the cot sides D bedroom Bedroom furniture is falling apart Sleeping-in room A new carpet must be provided. The area must be redecorated N bedroom Kylie sheets in place must be replace Laundry Room Door found to be wedged open There remain a number of areas that need addressing from the previous inspection as addressed above. During the inspection a contractor from Metropolitan Housing Association visited and completed an estimate of all the outstanding works that needed completing. Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 18 This requirement relating to the outstanding maintenance of the home has been restated in four previous inspections. It is therefore a matter of concern that there is continued failure to ensure that an appropriate works are completed. Any further failure may result in the Commission taking appropriate enforcement action. The clocking-in system positioned outside a specific service user’s bedroom is still in place. However, the manager stated this is now longer in operation. The care plan examined did not indicate that this has now been discontinued, however, the specific service user still night time needs must be monitored appropriately. It was advised that the manager has in place a clear and concise monitoring system to demonstrate that the night care staff is monitoring the specific service user. The home was found to be clean and tidy on the day. Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34 & 36 A staff team supports the service users, however, the manager has failed to ensure all staff that are vetted to work in the home, having in place all the correct documents needed for employment. The staffing levels in the home needs to reviewed to ensure service users needs are appropriately addressed. The manager completes supervisions, however, records are not maintained accurately, therefore it is not evident whether or not supervisions are monitored and reviewed appropriately by the manager. EVIDENCE: Staffing levels was discussed with the manager. On shift were two agency staff, one bank staff and the manager. Over the weekend when the specific service user was taken to hospital two agency staff were on shift and the shift leader was out shopping with another service user. This was concerning and was discussed with the manager. The manager stated that three new members of staff have been employed and will be starting soon. Staffing records are kept at the organisation’s head office. It was advised that these records would be examined at the following inspection. In discussion with the manager it was evident that a number of agency workers are employed by the home. It was also evident that the manager does not check with the agencies the care workers Criminal Records Bureau (CRB) checks. At the previous inspection CRBs was addressed for students Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 20 and volunteers. But it was advised this practice must apply to all person who assists the service users in the home with personal care. Therefore this requirement is restated and amended in this report. The manager informed the inspector that since the previous inspection there has been one senior staff member dismissed and at present one care staff is suspended pending investigation. It was evident that no notification to the Commission has been made with regards to the staff member who is currently suspended. It was advised that all disciplinary actions with regards to staff must be notified to the Commission under Regulation 37. Supervision was discussed. It was evident that the manager had completed supervision, however, the records kept were kept in an A4 notebook. It was not clear from the notes that were supervised. Supervision was discussed at length and it was recommended that a new format should be devised to ensure that records of supervision is recorded, signed and dated at the time of supervision, rather than being type up weeks after the meeting. Recent training undertook by care staff included fire safety and working with families and the manager has completing person centred planning. Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The management of the home is satisfactory overall but the records are not well managed monitored and reviewed. This practice could potentially place service users at risk. Therefore service users cannot be confident that their health, safety and welfare is being protected, monitored or reviewed appropriately by the home. EVIDENCE: The manager’s registration interview with the Commission is schedule for 24th November 2005. Due to the number of Immediate Requirement relating to a specific service user care and health needs. A Immediate Requirement issued, it is therefore required that the Registered Person complete at least once a week Regulation 26 to ensure service users care needs are being addressed and monitored by the home appropriately. This is to be reviewed on 21st December 2005. It was evident that many records the office area was an untidy and therefore the manager was unable to locate a number of documents required. This was Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 22 discussed with the manager at the time of the inspection. Service users care plans were not stored appropriately. Part of the inspection process included the inspector completing a fire risk assessment whilst touring the building. The purpose of the fire risk assessment was discussed with the manager. It was identified through the fire risk assessment that there were a number of good practices and some areas of concern. All the fire extinguishers are in place and the means of escape is clear all fire door have magnetic door closures in place. It is advised that the manager must complete a environmental and fire risk assessment which is reviewed and monitored annually. At the previous inspection it was required that the registered person ensures that the gas boiler, hoist, legionella, the Portable Appliance Testing (PAT), electrial installation certificates are in place. it was evident that the:The lift last serviced on 27/04/05 The hoist last serviced on 29/03/05 The gas boiler last servced on 26/04/05 The fire extingusher last serviced on 09/05 The legionella water checks are completed monthly It was evident that the Portable Appliance Testing (PAT) was not in place. A requirment is been made regarding this. The first aid box was examined. It was evident that the first aid box needed reviewing and items such as Nurofen must not be kept in the box. During the tour of the building there were two electric fan heaters in the home one was in the lounge and in one of the service user’s bedroom. Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X 2 X X 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 2 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 2 2 X 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Meridian Walk Score 1 X 2 X Standard No 37 38 39 40 41 42 43 Score 1 X X X 2 2 X DS0000060937.V259078.R01.S.doc Version 5.0 Page 24 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 YA37 Regulation 26 Requirement Timescale for action 21/12/05 2. YA18 The registered person must complete at least weekly Regulation 26 for Meridian Walk. This must be completed as an unannounced visit. Copies of the reports are to be submitted to the CSCI. Interview, with consent and in private, such of the service users and their representatives and persons working at the care home and sample of records ascertaining to service users care in order to form an opinion of the standard of care provided in the care home. This is to start immediately and to be reviewed by 21st December 2005. Immediate Requirement 13(2) & The registered person must 16/12/05 18(1)(c)(i) ensure training appropriate to work they are to perform. It is therefore required that the registered person ensures that all care staff have appropriate training in Oxygen and Nebuliser administration and records of the training undertaken must be kept. Al list of all staff that have undertaken this training is to be DS0000060937.V259078.R01.S.doc Version 5.0 Meridian Walk Page 25 3. YA18 4. YA18 placed on the front of the each individual’s personnel file. A list of all who are trained, on the medication administration charts to be in place. a copy of the training organised and proposed date to is to be faxed or posted to the CSCI no later than Friday 16th December 2005. (Previous requirement 30th September 2005 not met.) Immediate Requirement 14(1)(d) & The registered person must 21/12/05 13(1)( consult with the placement authority regarding reviewing the specific service users health needs due to a number to admittances to hospital over the last year. A plan of action on how the specific service user’s health needs are managed must be in placed and followed and monitored by the registered person by 21st December 2005. Immediate Requirement 17(1)(a) The registered person must 25/11/05 Sch 3(j) record any accident affecting service users in the care home and of any other incident in the care home, which is detrimental to the health and welfare of the service user. The records shall include the nature, date and time of the accident/incident, whether medical treatment was required and the name of the persons who were in charge of the care home and supervising the service user respectively. It is therefore required that the registered person submits, fax or post, to the CSCI, a detailed chronological record of the events prior to SW’s being admitted into hospital along with a chronologically account of SW’s health history not later than Friday 25th November 2005 DS0000060937.V259078.R01.S.doc Version 5.0 Page 26 Meridian Walk Immediate Requirement 5. YA6 15(2)(b) 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 August 2005 was not met.) 30/12/05 6. YA24 23 7. YA27 14(2) 8. YA36 18(2) Copies of service users review meeting held by the placing authority must be kept on file. The registered person must 30/01/06 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 30th September 2005 was partially not met.) The registered person must have 30/12/05 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 30th August 2005 partially met, restated and amended in this report.) The registered manager must 30/12/05 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 DS0000060937.V259078.R01.S.doc Version 5.0 Page 27 Meridian Walk 9. YA42 13(4) 10. YA34 19 Schedule 2.7 11. YA10 17(1)(b) 12. YA33 37(1)(g) 13. 14. YA23 YA17 13(6) 13(4) & 23(2)(c) be available for the purpose of inspection. (Previous timescale of 30th August 2004 not met.) The registered person must have in place a Portable Appliance Testing (PAT) certificate for all electrical equipment present in the home. This must be completed annually. The registered person must ensure all staff employed, agency staff, 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. (Previous timescale of 30th August 2005 not met.) The registered person must ensure all records including service users care plans are kept securely in the care home. The registered person must give notice to the Commission without delay of occurrence of any allegation of misconduct by any person who works at the care home. The registered person must obtain a copy of Haringey’s Adult Protections local procedures. The registered person must ensure no open tins are stored in the fridge. The registered person must ensure that the fridge and freezer is defrosted and records of temperatures for both are 30/12/05 30/12/05 30/12/05 30/12/05 30/01/06 20/01/06 Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 28 maintained. 15. YA38 13(2)(4) The registered person must ensure the first aid box is maintained. The registered person must ensure all homely remedies are kept in medication cabinet not in the first aid box. The registered person must ensure that the portable electrical radiators are removed. The registered person must the gas boiler is serviced. The registered person must ensure all medication administered to service users are signed immediately on the Medication Administration Records (MAR) chart. If not administered then the correct code must be recorded and evidence on the back of the form. The registered person must amend the medication policy to include sections on convert and oxygen and nebulizer administration. The registered person must review the staffing levels in the home. 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 August 2004 was not met.) The registered person must ensure all document required for inspection are accessible. The registered person must complete an environmental risk assessment that includes a fire DS0000060937.V259078.R01.S.doc 30/12/05 16. 17. 18. YA42 YA42 YA20 13(4) 23(2)(c) & 13(4) 13(2) & 17 30/12/05 30/01/06 30/01/06 19. 20. YA33 YA9 18(1) 14(1)(d) 30/01/06 30/01/06 21. 22 YA41 YA42 17 13(4) 30/12/05 28/02/06 Meridian Walk Version 5.0 Page 29 23 YA14 17 24 YA24 13(4) & 23(4) risk assessment. This is to be reivewed annually. The registered person must ensure care staff completed the daily diaries after each shift. This must be montoried and reviewed accordingly. The registered person must ensure that all fire doors are able to effectively self –close at all times and are not wedged open. Magnetic door hold or a release mechanisms must be fitted to any fire doors in the home that young people/staff members routinely prefer to leave open for extended periods of time during the day or night.Alternatively the registered person consult with the London Fire Emergency Planning Authority (LFEPA) fire officer with regards to risk assessment with regards to the safety aspect of having fire doors remaining shut and evidence that LFEPA are schedule leaving the door open. 30/12/05 30/01/06 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 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 manager should organise his filing system within the home to ensure he can find documents for an inspection when needed. It is recommended that a easier supervision format is in DS0000060937.V259078.R01.S.doc Version 5.0 Page 30 2. 3. YA38 YA36 Meridian Walk place. Meridian Walk DS0000060937.V259078.R01.S.doc Version 5.0 Page 31 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.V259078.R01.S.doc Version 5.0 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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