Inspection on 12/07/05 for Middlefield Manor Residential Home

This inspection was carried out on 12th July 2005.

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

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

Other inspections for this house

Middlefield Manor Residential... 29/04/08

Middlefield Manor Residential... 04/05/07

Middlefield Manor Residential... 11/10/06

Middlefield Manor Residential... 23/05/06

Middlefield Manor Residential... 08/12/05

Middlefield Manor Residential... 17/11/04

Middlefield Manor Residential... 15/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Middle Field Manor Residential Home The Street Barton Mills Bury St. Edmunds, Suffolk IP28 6AW Lead Inspector Claire Hutton Debbie Sedden Announced July 12th 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Middle Field Manor Residential Home Address The Street, Barton Mills, Bury St. Edmunds, Suffolk, IP28 6AW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01638 716910 01638 510925 National Autistic Society Mrs Sara Anderson Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 17th November 2005 Brief Description of the Service: Middlefield Manor is owned by the National Autistic Society (NAS) and is registered to provide personal care for up to fifteen younger adults with a learning disability, specifically, autistic spectrum disorder. The building is a large Georgian detached house set in four acres of grounds, located at the end of a private driveway in the centre of the village of Barton Mills. The home is divided into two separate units; Norfolk House and Cambridge House, each having their own separate enclosed garden and separate staff team. All the home’s bedrooms are single with one bedroom benefiting from en-suite facilities. There is no passenger lift to the first floor and no resident accommodated had mobility problems. The Second floor of the home is offices used by The National Autistic Society and not accessed by residents at the home. There is adequate car parking space to the front. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on a midweek day in July and lasted 8 hours. Claire Hutton, Inspector spent time in Cambridge House and Debbie Sedden, Inspector spent time in Norfolk House. All residents were met and some spoken with. Ten staff were met and some spoken with in private. One relative was spoken with on the day and feedback via eight comment cards from relatives was also available. The registered manager Sarah Anderson and a newly appointed coordinator were available all day and were supportive and helpful during the inspection. Records inspected included: care plans for three residents, medication records and records relating to staffing. What the service does well: What has improved since the last inspection? The home has appointed two new full time coordinators, one for each house. Staff spoken with felt this was a positive move. There have been developments in the activities on offer to residents with courses offered now being full time two days a week – this will lessen the need to transport residents to and from Middlefield for lunch. Also there are new groups and courses on offer in an evening. Environmentally, the second floor of the home now is to be vacated by administration staff and there are plans to look into having a family area created. The recommendation from the previous report to ensure that Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 6 Cambridge House keeps up with modern environmental thinking has further been explored. Staff were aware of the plans to remodel the kitchen, dining area and provide a suitable laundry and residents toilet. These plans have yet to be agreed. A new philosophy and approach is currently being explored at Middlefield. The theory of ‘person centred approach’ is being explored and hopefully will be adopted as a new way of working with the residents. What they could do better: 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. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,4 and 5 People who use this service can expect to have information available that will enable them to know what is offered and what to expect from the service. EVIDENCE: The Statement of Purpose and Service Users Guide was previously examined and met the Regulations, no changes to this document have been made. No new residents have moved into Middlefield Manor since the last inspection when the process of assessment and introduction to the home was assessed fully and found to be met. Resident trial periods could last up to 6 months and were based around individual circumstances. This home does not accept any emergency admissions due to the nature of the resident group and any introduction to the home has been seen to be well planned. A variety of professional assessments were seen to be in place in one person’s file, these were from both neurologists and behavioural specialist. A general assessment or annual reassessment from a placing social worker was not seen, therefore this will be clarified at the next inspection. Each resident has a contract on the file, which has been designed with symbols and pictures informing them of their contract with the home, including the additional costs outside of their fees. The individual signed this. A parent spoken with was unclear about what was included in a contract, citing holidays in particular. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 and 10. Residents can expect to have their needs known and their choices respected, thereby as far as possible achieving an independent lifestyle. However, those wishing to access their records may have difficulty. EVIDENCE: Two of the residents care plans from Norfolk House and one from Cambridge House were inspected; these contained a lot of very detailed information. The plans are divided into ten sections covering the identified needs of each resident. Although the care plans held a lot of information, much of it in Norfolk House was repeated and had not been reviewed or updated making it difficult to follow the residents care needs. However, the behavioural support plans were well documented to reflect the individual’s likes and dislikes and the triggers that affect the residents behaviour. Detailed risk assessments and a protocol supported the plans for all staff to follow thereby providing a consistent approach. This was evidenced throughout the inspection, with an example being, the support offered to one resident who had chosen to stay at the home rather than accompany the other residents and staff on a trip out. The resident was anxious, needing reassurance that they would be staying at the home that night. To reassure them the member of staff discussed what they would be having for the evening meal; the Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 10 resident showed the inspector the gammon steaks in the fridge and appeared to understand the significance of the meal and remaining at the home. Risk assessments had been completed for holidays from the home. The care plans had a section identifying the objectives of each resident. The format listed each objective with guidance for staff to follow to support the resident to meet the objective, evidence seen showed that these were regularly monitored and a record made daily. The objective for one resident was to be more involved in making decisions about their daily life. The resident demonstrated their ability to make choices using a communication aid, called a TEACCH board, which consisted of a series of symbols and pictures that the individual pointed at making their choices. This method of communication was seen on more that one occasion in both houses. All residents care plans was kept securely and treated confidentially. In the last inspection report the matter of recording and ensuring, how an individual could access personal information without compromising the confidentiality of others was made a requirement. The general communication book was inspected and once again mixed recording of resident information was seen. Also a communal weight record book was kept. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14, 15 and 17 Middlefield Manor enables residents to maintain appropriate and fulfilling lifestyles in and outside the home. However there is no assurance that every resident has a healthy diet. EVIDENCE: A day centre is situated locally, which is run by the national autistic society (NAS) and is used by Middlefield Manor. Community based training is available for the residents, which includes a sensory integration class, cooking and shopping. A club is held on a Tuesday night, which can include residents going out for a meal. A senior member of staff who works mainly at the day centre visits the home every Tuesday for an activity. On this particular day, arrangements were being made for residents to go cycling, however, an issue with one of the residents’ not finding their safety hat was causing problems. The group went for a walk instead. The member of staff’s knowledge and awareness of the residents’ behaviour diverted a potential situation and minimised the residents’ distress. A resident in both houses was supported to remain in the home whilst others were out on the activities; another resident was enjoying time in the summer Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 12 house with a puzzle and another was being supported on a one to one basis to use the paddling pool. Residents are encouraged to be involved in the choice of meal and preparation. One service user showed the inspector food in the fridge ready for the evening supper, there was a tray of thick gammon steaks, also fresh vegetables and salad. All items were stored correctly in line with food hygiene requirements. The butcher was observed delivering fresh meat to the home. The menus and meals were discussed with the manager. An 8 week plan had been developed with the University of Birmingham. This was based upon healthy eating and research that is the importance of fish oil and a vegetarian option in the diet. The manager explained this was not stuck to rigidly but was used as a guideline for staff and residents to follow. Staff had recipes that they could follow. In Cambridge House there was a choice night once a week. This was when residents could choose a take away option. There was a record of food eaten kept in individuals records. However there were too many gaps to work out how frequently take-aways were eaten. One parent had been concerned that this option was offered too frequently. One resident spoken with told the inspector they were “happy living at the home, no problems”. They were very keen to show the inspector a collection of fans housed in a shed for which they held the key. The resident also has a ride on Honda lawn mower, which was partly funded by the home and the resident as they cut all the grass within the grounds. They demonstrated their skill at cutting the grass and spoke of maintaining the mower. Their knowledge of the mechanics of the mower was excellent. A separate shed had been made available to house the mower. The resident spoke of a recent holiday with a relative and described enjoying a visit to the local pub the Rose & Crown for a pint and for a Sunday roast, which was their favourite meal. The senior activities co-ordinator confirmed that the home had established good links with a couple of local pubs and that they had helped another resident find employment during the summer months on a dairy farm feeding the calves. They were also in the process of arranging for the residents to attend a disco especially designed to cater for people with learning difficulties held in Cambridge on a three monthly basis. From the 8 replies from the relatives questionnaires returned, one relative did not feel welcome at any time, one person felt they could not visit in private and all the other replies were positive. Three relatives felt they were neither kept informed or consulted about decisions, whereas 5 relatives felt they were. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 20 People who use this service can expect to receive appropriate personal support that meets their needs. However they cannot be assured that medication is handled and administered safely and in line with policy and procedure. EVIDENCE: It was evident during the inspection that residents were supported according to the individual’s needs and behaviour plan, however a relative of a resident was present on the day of the inspection felt that their should be more consistency amongst the staff when dealing with residents that have profound needs. However, they commented that the resident “was extremely settled at the home” and that they “had the best key worker we’ve ever had, knows the resident through and through” They also commented “the staff are extremely nice” They also spoke of the person centred planning approach being adopted by the home, and expressed their concerns that all though in principle the plan was a good idea, they felt that some staff were taking the ethos of the approach too liberally. For example, by giving the residents too much choice over whether they wish to wash and shave or if they choose to spend all their time in bed and that this was to the detriment of the residents hygiene and care. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 14 Through discussions with the relative and staff there appears to be a lack of communication as to how the person centred planning is being implemented causing speculation of the benefits to the residents. From 8 parents who returned a questionnaire to the CSCI 5 were satisfied with the overall care and 3 were not. One resident spoken with in Cambridge House said the home was ‘nice’. Staff spoken with demonstrated that they knew the residents well and recording of personal care given was appropriate. The home uses the Boots monitored dosage system (MDS). Medication was stored in a locked cupboard, the senior carer held the keys. A photograph was displayed on the medication administration record (MAR) sheet for clear identification of each resident. The senior staff member on duty was responsible for the ordering and monitoring of the medication for Norfolk house. The prescriptions are made up by Boots, who deliver the medication to the home, the senior checks in amount of medication, records the date and signs. Any medication that is not used by the home is returned to Boots, and the returns book is stamped, dated and initialled. The returns book was unavailable, as the senior had returned medication to Boots on their way home from work and had left the book at home. This is not good practice as the home’s records should be available at all times. No residents were prescribed controlled drugs at the time of the inspection. However, a separate lockable storage cupboard was available within the locked cupboard, which contained a box of paracetamol, which was being used for communal use for the residents in Norfolk house. The senior carer was informed that this was not good practice and that residents should be prescribed their own as and when required (prn) medication and this should be recorded on the MAR sheet and a record kept of why and when administered. Medication in Cambridge House was also assessed. There had been an incident on 07/07/05 in relation to one person’s medication where staff had not followed the agreed procedure on administering and recording medication. The medication had been signed for but not given. Any event such as this must be clearly recorded on the MAR sheet. In addition in Cambridge House, the medicine cabinet contained medication that was not correctly labelled in terms of the dispensing chemist or who the medication was for and in what quantities. This made auditing medication impossible. An immediate requirement was left with the home to ensure unlabelled medication was returned to the chemist and an audit completed to determine if medication was correctly handled. The CSCI received information on 28th July confirming action taken. The audit by the home revealed 10 tablets unaccounted for. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 15 A resident in Norfolk House was returning from a home visit and the senior member of staff was observed booking in the returned medication. The resident had attended an appointment to their consultant psychiatrist during their home visit and had had changes made to reduce their medication. They made the relevant changes to the MAR chart and assured the inspector that these changes would be countersigned by the general practitioner (GP) as seen on another MAR chart. They also recorded the changes in a communication book held in the drug cupboard for the oncoming senior to read what changes had occurred prior to administering the residents morning medication. Only one resident was currently prescribed a prn medication, Lorazepam. A protocol had been written setting out a clear rationale for the reason medication should be administered and dosage. A record of when a dose was administered, the amount, and a signature is backed up by an incident report and passed to the manager. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Complaints cannot be effectively listened to if adequate information is not available. The home cannot assure a consistent approach on protection or managing challenging behaviour as not all staff have training. EVIDENCE: The complaint procedure for the home was displayed around the home. The complaints procedure produced by the national autistic society needs updating with the correct name and address for the Commission for Social Care Inspection (CSCI) instead of the national care standards commission (NCSC) as in some places it was not correct. Three parents surveys stated they were unaware of the complaints procedure at the home. From the six parents aware four had had cause to make a complaint. The manager gave evidence that twenty-three staff at the home had undertaken training in protection of vulnerable adults since last year. The information supplied shows 8 staff have yet to undertake this training. The manager at the home is aware of the local procedures to be followed and has in the past triggered a referral and is aware of processes to be followed. The manager provided evidence that twenty-four staff had undertaken training with Studio 3 for working with people who display challenging behaviour. From this evidence eleven people required training or refresher training as previous training was 2003. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 28 and 30 Middlefield Manor layout and facilities could be further enhanced to meet the lifestyle of the resident group. EVIDENCE: Middlefield accommodates 14 residents but is registered for 15; the home is divided into two houses Norfolk and Cambridge House each currently provides accommodation for 7 residents. Norfolk house consists of a range of communal areas, a lounge looking out into a lovely spacious garden, a dinning area and a separate smaller eating area and a kitchen, which are all accessible by the residents. Residents are encouraged to use the kitchen facilities, supervised by a member of staff. One resident was observed making a cup of tea for themselves and the carer. The house is nicely presented and decorated. Three of the residents spoken to showed the inspector their bedrooms in Norfolk House, each room was nicely decorated and personalised to the individual’s taste. Following the previous visit from CSCI recommendations were made to make changes to the layout of Cambridge house, in particular the kitchen and lounge area and access to a ground floor toilet. Plans have been drawn up to make these alterations however; the manager was not convinced that these plans Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 18 would meet the needs of the residents. This recommendation is repeated and a recent visit from the environmental health department supports the view of changing access to the toilet. The lounge in Cambridge House was due to have new carpet and curtains. This was needed as a hole was seen in the carpet near the window and the window blind was hanging off. All residents bedrooms in Cambridge House were visited, some showed a very personal, individual room that was said to be the responsibility of the keyworker. Others rooms were not as personalised. Small areas of repair were needed in some bedrooms. One resident had a broken draw another had a hole in their wall. The toilet through the laundry room was not accessible to residents, the door had been locked as the washing machine door had been smashed. An assurance was given that this would be promptly repaired. One of the new senior co-coordinators was present on the day of the inspection and informed the inspectors that the administration office is to move off site to create space for a family room. The administrator was in the process of undertaking a full audit of all files prior to the move. They also explained that there are plans to turn an outside building, which has light and heating already in place into a craft area, for residents to be involved in painting, papier-mâché and other types of arts and crafts. All areas of the home visited were clean and without odour. Evidence of cleaning rotas were seen in Cambridge House. All bathrooms and toilets in Cambridge House were seen to have liquid soap, paper towels and toilet paper. Two parents had said they regularly found no toilet paper in resident’s toilets. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 35 and 36 Residents can expect to have sufficient friendly and competent staff on duty to meet their needs. Staff may not always be assured of regular formal supervision. EVIDENCE: Two new senior co-ordinator posts have recently been created to manage Cambridge and Norfolk house to provide a consistency, however, feedback from staff is that these posts have only recently been appointed and due to resident and staffing holidays have not been properly implemented. Staff were hopeful about these appointments. Ten members of staff were spoken with during the inspection. They had a range of experience. Staff spoke of their experience of working at the home, they felt they were well supported and the training was excellent although they would like to have more supervision and staff meetings. This was particularly expressed as required after an incident of challenging behaviour, when staff felt support from managers in debriefing was needed. Staff were said to receive Studio 3 training as part of their induction process. This training taught them the different techniques for dealing with residents on a daily basis; the training is designed to lower the resident’s anxiety/arousal instead of restraint. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 20 Staff spoken to describe staffing levels to be adequate, mostly worked with 3 staff on shift in each house with an additional member of staff when an activity has been arranged to support residents whom wish to stay behind. At night there was a waking night person in each house and care staff confirmed there was always a manager on call if needed and they would attend the home if needed. Relief workers are used, and were described as being very good. Observation of three relief worker on duty during the day confirmed this. One parent felt that too many relief staff were employed. Recruitment records for 3 staff were examined. All were appropriately recruited except for one person who did not have a POVA first check and was working on a CRB from a previous employer. An immediate requirement was left and confirmation of a POVA first was received on 28th July 2005. This was confirmed as all clear. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 and 42. The home cannot be assured of effective leadership relating to communication and consultation and speculation has been resorted to. The lack of risk assessment around health and safety cannot promote and safeguard the health, safety and welfare of people who use the service. EVIDENCE: Throughout the National Autistic Society (NAS), each home was said to be encouraged to undertake a new project. Middlefield are making changes to meet the individual needs and choices of residents by undertaking training in person centred planning. A parent and carer partnership day was held and a trainer from a company called Paradine was invited to the home to introduce the principles behind person centred planning. A service user accompanied the trainer on the visit to the home to explain their experience, and how they made a transition from hospital to independent living. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 22 Parents have requested another meeting to further explore possibilities of using the person centred planning approach at Middlefield. Through discussion with relatives and staff there are concerns around a lack of communication and consultation about the running of the home with the current management structure. There was a strong feeling that residents and relatives are not consulted on changes. One parent has written on the feedback card ‘If you don’t ask you’re not told’. An inspection from the local council in relation to food hygiene and health and safety was conducted on 01/07/05. A copy of the report was given to the CSCI at this inspection. The report contained several matters relating to risk assessments and the environment that must be promptly addressed. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 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 3 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x x 2 Standard No 31 32 33 34 35 36 Score x 3 x 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Middle Field Manor Residential Home Score 3 x 1 x Standard No 37 38 39 40 41 42 43 Score x 3 x x x x x I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 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 6 Regulation 15 (2)(b) Requirement Evidence must be available to demonstrate that information in care plans is up to date and currently relevant Written communication books must comply to the homes policy on written procedure, confidentiality and data protection. (this is a repeat requirement from 18/11/04) Records must be kept in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise. There must be suitable and adequate arrangements in place for recording, handling and safe administration of medication. (elements repeated from 18/11/04) The complaints procedure must contain the correct details of the Commission for Social Care Inspection, including, name, address and telephone number. A copy of the complaints procedure must be supplied to any person acting on behalf of a Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 25 Timescale for action immediate 2. 10 17 immediate 3. 17 17 (2) shedule 4.13 immediate 4. 20 13 (2) immediate and ongoing. 5. 22 22 (7) immediate resident. 6. 23 and 35 18 (1) and 19 (5)(b) 23 (2)(b) 18 (2) 13 (4) The home must ensure residents are safeguarded and train all staff in the protection of vulnerable adults and how to deal with challenging behaviour. All parts of the home must be kept in good a good sate of repair. Staff must receive support and supervision to carry out their job on a formal basis. All action requested by the recent health and safety inspection must be promptly actioned. immediate 7. 8. 9. 24 36 43 immediate immediate immediate. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard 5 6 15 26 24 27 38 Good Practice Recommendations Uncertainty about holiday arrangements should be clarified with parents. Care plans should be streamlined to make them more easily accessible (especially to relief staff)with key information prominent. Family should be welcomed, and their involvement in daily routines and activities encouraged, with the residents agreement. All residents should be enabled to personalise their rooms. There must be a planned approach to modernisation and keeping up with current thinking relating to the environment in Cambridge House. Access and suitability of the downsatirs toilet in Cambridge House should be reviewed. The management approach at the home should create an open, positive, inclusive atmosphere with a clear sense of direction and communication. Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 26 Commission for Social Care Inspection St Vincent House Cutler Street Ipswich, Suffolk IP1 1UQ 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 Middle Field Manor Residential Home I54-I04 S24447 Middlefield Manor V230899 050712 Stage 2.doc Version 1.40 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!