Inspection on 23/05/06 for Middlefield Manor Residential Home

This inspection was carried out on 23rd May 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

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... 08/12/05

Middlefield Manor Residential... 12/07/05

Middlefield Manor Residential... 17/11/04

Middlefield Manor Residential... 15/06/04

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Coopers Mill Ltd

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Paradise Lodge

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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 Middlefield Manor Residential Home The Street Barton Mills Bury St Edmunds Suffolk IP28 6AW Lead Inspector Mike Usher Key Unannounced Inspection 23rd May 2006 11:00 Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 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 Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 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. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Middlefield Manor Residential Home Address The Street Barton Mills Bury St Edmunds Suffolk IP28 6AW 01638 583549 01638 583540 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) Vanessahalfacre@nas.org.uk National Autistic Society Post Vacant Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th December 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 homes 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 used by the NAS as offices and not accessed by residents at the home. There is adequate car parking space to the front. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two inspectors, and focused on previous requirements and recommendations, recent developments, and looked at all the key National Minimum Standards. The inspection used a variety of methods to assess the operation of the service, including consultation with staff, management, service users, and relatives, examination of records and other documentation, observation, and documentation provided prior to the inspection by the National Autistic Society (NAS). Survey forms were distributed to all service users and their families. The responses received prior to the completion of this report are incorporated into the text. The inspection was carried out against a background of serious concern that the service was suffering from major failings, and was in crisis. There has been a history of worrying incidents involving service users, complaints from their parents, ineffective management, and staffing problems. A separate inspection of the medication arrangements was carried out by a specialist Pharmacy Inspector on 22/03/06. The requirements and recommendations arising from that inspection were addressed by the NAS in the action plan received by the Commission on 25/04/06, and referred to in the body of this report. Immediately prior to the current inspection, a meeting was held between the Commission and senior managers of the NAS to discuss the concerns. The NAS managers were open in acknowledging the depth of the problems, and were able to provide details of actions already taken, and outline the plans in hand, to address all the issues raised. Clear and confident undertakings were given by the NAS that the service would continue to improve, and that any investment of resources required would be provided. There was a strong commitment to the home, and to providing a high standard of care to the service users. The inspection found that the home was achieving a good level of service, with many standards examined being fully met, and where shortfalls were identified these were all considered to be minor, and did not impact unduly on the wellbeing of service users. It is clear that the home has made a very significant improvement in the quality of care provided, and that the strong commitment demonstrated by managers and staff is very positive. Further progress is required, but the service has reached a standard that is deemed adequate. One of the matters needing to be resolved involves the continuing concerns expressed by some parents of service users, with communication between themselves and the NAS being a key issue. It is clear that many parents maintain a strong involvement in the daily life of the home, and this can lead to tensions between themselves and the home’s staff. The complex and sensitive nature of these relationships is acknowledged, and both Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 6 parties will be encouraged to resolve any issues directly, in the best interests of all concerned. What the service does well: What has improved since the last inspection? The management have introduced a number of measures designed to improve the overall performance of the service, including more effective external monitoring. Daily routines have been reviewed to ensure that they promote independence, choice, and respect. Recording systems have been strengthened, and medication arrangements brought up to satisfactory standards. Staffing levels have been improved, and new staff recruited. They are currently awaiting starting dates, or are being inducted. Once they are able to take up their full duties the home should be able to cease its dependency on agency staff. During recent months, the NAS has been able to use many of the agency workers consistently, providing some continuity to residents. Staff continue to receive appropriate training and supervision, with refresher training and in-house sessions held recently. The number of incidents involving service users has reduced, and risk assessments have been reviewed following all such events. Care planning has been further developed to focus on person centred planning, and all care plans brought up to date. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 7 The accommodation has been refurbished to provide a more comfortable and pleasant environment for service users. 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. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 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 Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 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): 1, 2, 5 Prospective residents of this service currently may not be provided with sufficient information to make an informed choice about what the home offers, but they can expect to have a full assessment of their needs before moving into the home. EVIDENCE: Two documents were examined. Both were entitled the Statement of Purpose, but the acting manager explained that one of them was the Service Users Guide. Both documents also referred to two other registered premises as well as Middlefield Manor. The Statement of Purpose did not contain the procedure that people should follow in order to raise concerns and complaints. In discussion with the acting manager it was decided that these documents needed further development. The acting manager wanted to use a more appropriate pictorial communication for the Service Users Guide and agreed to define further the description about who the service is intended for, especially relating to an upper age limit. No new residents have been admitted to this home in the past year, the current resident group have been there a number of years therefore there were no assessments before placement available to examine. Discussion was held with the acting manager about how a potential resident would be placed and he was clear about the need to conduct a thorough assessment of need and compatibility with existing residents before a place was offered. His Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 10 experience previously was that this would take some time to put together and he would use the NAS assessment procedure in place. Of the three sets of records examined there was information available that could form part of a contract. This was in pictorial form that set out what a resident can expect to receive from the fees paid. Two of these documents were incomplete and all three contained out of date information. The acting manager stated that the formal contracts were held at the Bristol office. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 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 People who use this service can expect to have a plan in place, including risk assessments, that is accessible to staff and reviewed regularly. EVIDENCE: The care plan and associated records of three service users were examined in detail with some records examined for one other individual. The acting Manager confirmed that all care plans had been rewritten in recent months. This was confirmed on the three plans examined. The records had a more organised feel to them and were able to convey key information about an individual and how to support them effectively. The behavioural support plans and methods of communication along with risk assessments were in place. There were risk assessments completed on a generic level for all individual records examined with specific risk assessments also in place. There was evidence to show that risk assessments had been revised when an incident relating to the risk had occurred. Discussion was held with the acting manager around specific risk assessments when using transport and for certain individuals requiring a harness type seat belt. The acting manager agreed to risk assess this practice of restraint and formalise it in writing within the care plan. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 12 Incident records from January 2006 for three individuals were examined. The forms had been completed by care staff and then passed on the acting manager. The forms were not easy to read as a number codes was used in the text. The manager section was not completely filled in. The acting manager explained that the number code was used to input information on to a computer to analyse the information and that he would in future fully complete the forms used. Using the format adopted by the home, staff were seen to complete daily statements for each resident. The format was four separate records relating to activities, personal care given, meals and nutrition and care support at night. Staff felt everything they wish to say could be found under these headings and were happy with the format. In the plans were evidence of reviews including the resident’s views, the recording of these was extremely good with the action points noted with who was responsible to ensure it happened and by what timescale. These are a recent introduction and are expected to be repeated every three months. There was evidence in one care plan that the action agreed at a review had been completed in the set timescale. A survey from CSCI for the residents to complete had been sent to the home. The acting manager has arranged for these to be completed by residents with the support of an advocate. Results of this survey will be included in the next inspection report. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 13 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, 14, 15, 16, 17 A good variety of activities are provided, and service users supported in developing and maintaining links with the local community and their families. Residents are treated with respect, and encouraged to make positive choices in their daily lives. EVIDENCE: On the morning of inspection all but one of the residents were out at activities. Some residents returned at lunchtime for a meal before going on to a change of venue. Care plans examined clearly set out the activities planned throughout the week for each individual. These were a mixture of Asdan courses, outward enterprises, and activities at the National Autistic Society day service at Kenny Hill called The Old Barns. In terms of social links and community inclusion there was evidence of using a local hairdresser, gym and nightclubs. One resident had just returned from a holiday and two other residents were planning to go on individually chosen holidays. For the resident who had been on holiday, a holiday file had been prepared. This was examined and it had contained relevant information such Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 14 as care needs, risk assessments, staffing levels, holiday details including emergency contact details. A variety of policies and forms should they be needed. Water temperatures of baths taken on the holiday had been recorded and a holiday return report had been completed. In the care plans was a record of all conversations and messages from relatives. A document entitled partnership with parents has been developed. The acting manager confirmed this had been sent out in January 2006 and an updated version was sent to parents in May 2006 along with the latest newsletter. Since the last inspection, when issues of privacy and dignity were raised, all staff have attended Person Centred Development training, and issues of privacy and dignity have been addressed at team meeting sessions, and are actively monitored by senior staff. During the inspection, staff were observed to treat residents sensitively, being supportive, friendly and enabling. Shopping is done at local supermarkets, with service users consulted regarding choice, using discussion and visual aids. Menus are displayed on the kitchen walls and there is always a choice of main courses to suit the individual preferences and dietary needs of residents. Following a recent incident where a service user scalded herself in the kitchen, the decision had been taken to lock kitchens and greatly restrict residents’ access. The reason for this decision is understandable, but should be kept under review to ensure that it does not unnecessarily restrict all residents. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 15 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 Appropriate support is provided to promote service users health and well being. EVIDENCE: In relation to healthcare needs being met there was, on the afternoon of the inspection evidence that an appointment had been made for an individual to see their GP. The carer on shift had ensured that there was a member of staff available who could drive and escort the individual. Care records showed access to chiropody, opticians, GP’s community nurses and specialist consultants for adults with learning disabilities. A new initiative had been accessing well person’s clinics for health check ups. The weight record for two residents was not completed. A previous inspection of the home’s medication arrangements on 22nd March by a specialist Pharmacy Inspector, found that the standards had improved, but still found significant shortfalls in the recording of receipt, administration and disposal of medicines, and in security. Consequently, the current inspection examined the medication arrangements in both houses. The system in operation is a monitored dosage system provided by a local chemist. The storage was appropriate and secure. The key was held by a senior person on duty, who confirmed that the key was handed Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 16 to the next senior at the change of each shift. The staff member also confirmed their training and that they had been supervised and deemed competent to administer medication. Another staff member confirmed that they had completed training but yet had not been deemed competent through supervision, so did not administer medication at this time. Several medications were randomly audited and records and medication held cross-referenced appropriately. The medication administration record (MAR) was suitably completed. This indicated medication in stock, as did the medication returns book. There was evidence of regular audit of medications by the acting manager as his signature was seen on MAR sheets. Staff were observed to support service users in a clear and friendly manner, and in such a manner as to enable them to be informed and make choices. Relationships with staff were warm and there appeared to be a good level of trust between residents and staff. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 17 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 Adequate procedures are in place to deal with complaints, and staff are well trained to safeguard residents. EVIDENCE: The homes complaints procedure is displayed in the homes entrance. The record of complaints was examined. Complaints were logged and the acting manager spoke of action he had taken. The acting manager agreed that the date a complaint was received and by whom should be logged along with a formal response in writing. The general practice was to respond quickly verbally to concerns expressed. The number of reportable incidents at the home in recent months was also discussed. These had reached a level that was of concern to the Commission, and to a number of parents who are closely involved with the day-to-day life of the home. It was confirmed at the inspection that the situation has eased somewhat, and the number of incidents reported has reduced, with a more effective management of outcomes. Staff have recently completed training in Protection Of Vulnerable Adults (POVA) procedures, and adult abuse awareness. In addition, training in dealing with challenging behaviour has also been undertaken. This is in addition to the basic training all staff undertake, which focuses on safety and protection (see section on Staffing). Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 18 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, 27, 28, 30 The environment is much improved, and offers comfortable accommodation to service users, which could be made more homely. EVIDENCE: At the time of the inspection, the home was undergoing an extensive programme of redecoration and refurbishment. Nearly all of the communal areas had been redecorated, and new carpets have been laid in Cambridge House, and will be laid in Norfolk House as soon as that decoration work is completed. Comfortable seating is provided throughout, although the walls were still somewhat bare following redecoration, and could be made more homely. A number of bedrooms were seen during the inspection and these were all nicely personalised by residents. The home was generally clean, tidy and in good order. There are sufficient bathrooms and WC’s, although these are functional and would also benefit from being made more homely. There are some restrictions placed on residents use of communal facilities, for practical reasons, such as the kitchens being locked, and in some WC’s toilet paper is not freely available due to problems with service users blocking Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 19 toilets. In some of the bathrooms the taps have been removed to prevent flooding, whilst others are fitted with push taps, which have to be constantly operated to maintain a flow of water. The use of such measures should be kept under review. The ground floor laundry in Cambridge has been converted into a single WC, following requirements arising from the previous inspection, and this has provided a much-needed facility, although work has not been completed in making the new room more homely. Laundry is now done in Norfolk, which was reported to be an arrangement that worked well. The laundry in Norfolk was somewhat crowded and untidy, due to the room being used by the decorators. Once this work is finished the room should be cleaned and tidied. A strip rug along the floor was removed at the suggestion of the inspection team. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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): 31, 32, 33, 34, 35, 36 Staffing levels are adequate, with new staff being recruited to reduce the previous reliance on agency staff. Staff are well trained and competent, with good levels of supervision. Attention is needed to ensure that staffing records are available and accessible for inspection. EVIDENCE: On the day of the inspection, there were 3 carers on duty in each House, plus a Co-ordinator and Senior carer, the acting manager, and Handyman. In addition, the Area Manager was on site. A number of staff were spoken with, and were generally very positive regarding their work, and were well motivated. An examination of a selection of staff files confirmed that the recruitment process used is satisfactory, with some shortfalls due to current procedures. Specifically, CRB checks were not recorded properly, and staff records relating to supervision and appraisals were kept in sealed envelopes (for reasons of confidentiality). The acting manager’s documents were viewed, and staff confirmed that they received regular supervision and appraisals, and it was accepted that the current arrangements are satisfactory. However, in future, arrangements should be made to store confidential records such that they are Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 21 accessible for the purposes of inspection, to enable the adequacy of the arrangements to be properly assessed. All new staff work shadow shifts as part of their induction, and the essential training that all staff are required to undergo is appropriate, covering Fire Safety, Food Hygiene, First Aid, Basic Health & Safety, Overview of Medication, POVA, and more specialist training for working with people with learning disability. Details of the training programme for all staff were provided, and this included planned training, and identified where individual staff required specific training. Staff spoken with felt that they were adequately trained to carry out their duties, and were pleased with the training opportunities they were offered. They confirmed that they received refresher training on a regular basis for essential subjects, and that they were regularly supervised on an individual basis, and that there are frequent staff meetings. It was also established that agency staff receive essential basic training through their employing agency. One of the criticisms voiced by some concerned parents in recent months related to the use of agency staff, which was seen as excessive, and detrimental to the care of residents due to a lack of continuity of care. This is a valid viewpoint, and is acknowledged by the organisation’s management. There has indeed been a reliance on care staff provided by an agency for an extended period of time. In part this has been a reasonable response to various staffing issues (short and long term sickness, vacancies and cover during staff disciplinary action), but has lasted much longer than is desirable. The management have now taken steps to address these issues. New staff have been appointed and will be starting their inductions in the near future, and existing staff have been working additional hours, with further help from staff at the day centre, and Bank Staff. In the meantime it is expected that the current level of agency staff use will continue whilst new staff are being inducted and staff on sick leave are assessed through the organisation’s occupational health procedures. This should result in a decline in the use of agency staff, and improved continuity of care for service users. On the day of the inspection there were two agency carers on duty, both of whom had worked previously in the home, and so were familiar with the residents. One of them had worked at the home many times for a period of over one year, and was very well known to the residents. It was also noted that both agency carers were articulate, and able to communicate clearly with service users – poor language and communication skills being another criticism. During the inspection, it was clear that the staff team worked well together. Relations between staff members were open and friendly, and the discussions Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 22 and conversations held were supportive and respectful. The agency workers on duty were accepted as part of the team and fitted in well. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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, 38, 41, 42, 43 The management of the home is improving, and previous shortfalls are being addressed. The quality assurance process has been revised and more effective procedures put in place. There are still issues with some parents who feel dissatisfied with the service provided. EVIDENCE: Previously, the internal quality assurance process, based on visits under regulation 26 of the Care Homes Regulations 2001, was considered by the Commission to be ineffective, due to the disparity between those reports and the findings of inspectors, and the concerns and complaints raised by parents. The Commission had cause to investigate some of the more serious concerns when it was deemed that the NAS had not itself adequately investigated complaints. This had been compounded by the fact that many complaints had to be raised by the Commission when the NAS failed to act effectively on issues raised. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 24 Prior to the inspection, a meeting was held with senior managers from the NAS, at which the concerns of the Commission were discussed, and within this context, issues raised by parents. The NAS was able to give firm assurances that past shortcomings were being addressed as a matter of urgency and a number of measures put in place to improve the standards of service. The confirmation of Mr Steward as manager of the home is central to these, and an application from Mr Steward to be registered with the Commission as manager is pending. Mr Steward is currently nearing completion of the NVQ 4 award, after which he will start the Registered Care Managers Award. In addition, visits to the home by another manager, as required by regulation, have been revised to ensure that a thorough audit of the home’s performance is undertaken. A summary report of these visits so far was provided to the Commission. During the inspection, by coincidence, the Appointed Visitor was undertaking an internal inspection visit, and it was possible to talk briefly with him, and it was clear that these visits now reflect an accurate picture of the home’s operation, and record the recent improvements. Prior to the inspection, the Commission undertook a survey of relatives of service users. Thirteen survey forms were sent out, and 9 were returned. Four parents also contacted the inspectors by phone, and others sent in detailed comments. Five of these returns were positive with regard to the standard of service provided, the other four had detailed concerns, centring on communication, staffing, and specific historical issues. Two of those responding expressed very strong feelings of dissatisfaction. Some recognition was given to recent improvements, and it is hoped that the new manager will continue to improve relations with all concerned relatives. Most of the issues raised are addressed elsewhere in this report, and are subject to continuing action by the Commission and the home. On the day of the (unannounced) inspection, an administrative worker was auditing the arrangements for service users’ money handled on their behalf by staff. An examination of the records confirmed that they are satisfactory in accounting for any expenditure and that they are stored securely. Other essential records examined during the day were I good order and being stored securely. It was also confirmed that all the requirements arising from a previous inspection by Environmental Health Services had been completed. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 x 4 x 5 2 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 3 28 3 29 x 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 3 x x 3 3 3 Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 YA1 Regulation 4 Schedule 1 5 13 23 13 19 17 Requirement The Statement of Purpose and Service User Guide must be revised to include the arrangements for dealing with complaints. A copy of the formal contract must be kept in the home, and available for inspection. Risk assessments must cover individual forms of restraint used during transportation. Communal areas, including bathrooms and WC’s need to be made more homely. The laundry room must be cleaned and tidied to ensure good standards of cleanliness. A record must be kept of all CRB checks undertaken, and their result. Evidence of appropriate supervision and appraisal arrangements must be made available for inspection. The new manager must make an application to the Commission to be registered. Timescale for action 23/06/06 2. 3. 4. 5. 6. YA5 YA9 YA24 YA30 YA34 23/06/06 23/05/06 23/07/06 23/06/06 23/05/06 7. YA37 8 23/06/06 Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 27 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. Refer to Standard YA1 YA9 YA19 YA22 Good Practice Recommendations The Service User Guide should be further developed with regard to the use of pictorial aids. Incident forms should be completed, and simplified by using names and specific references. The weight charts in resident’s files should be completed where monitoring of weight would be beneficial to safeguard health. The log of complaint should contain the date and who received complaints. Complaints should be responded to in writing. Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Suffolk Area Office 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 Middlefield Manor Residential Home DS0000024447.V293743.R01.S.doc Version 5.2 Page 29 - 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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