Inspection on 12/03/08 for Monro Avenue (54)

This inspection was carried out on 12th March 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Monro Avenue (54) 18/02/09

Monro Avenue (54) 01/08/06

Monro Avenue (54) 03/01/06

Monro Avenue (54) 31/03/05

Monro Avenue (54) 01/11/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Monro Avenue (54) 54 Monro Avenue Crownhill Milton Keynes Bucks MK8 0BL Lead Inspector Jane Handscombe Unannounced Inspection 12 March 2008 10:30 th Monro Avenue (54) DS0000015064.V359599.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 Monro Avenue (54) DS0000015064.V359599.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. Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Monro Avenue (54) Address 54 Monro Avenue Crownhill Milton Keynes Bucks MK8 0BL 01908 269116 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.macintyrecharity.org MacIntyre Care Miss Nicole Jose Croucher Care Home 6 Category(ies) of Learning disability (7) registration, with number of places Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the maximum registered number of service users is temporarily increased by one (1) from the 1st of March 2004 until the 1st of September 2004. It is a condition of registration that the maximum number of service users registered will be increased from six (6) to seven (7) for this sixmonth period. The maximum registered number of service users will return to six (6) once this six-month period has elapsed. 1st August 2006 Date of last inspection Brief Description of the Service: 54 Monro Avenue is a care home managed by MacIntyre Care and provides personal care and accommodation for six adults with a learning disability. The building is a two storey residential house built in the style of the surrounding properties. The home is situated in a residential area of Milton Keynes and is within walking distance of the local shops, church and local pubs. The home has six single bedrooms on the ground and upper floor and has a secure maintained garden that is accessible to all service users. Access to the upper floor is via stairs or a stair lift. The centre of Milton Keynes is close by offering a large shopping centre, cinema, a range of restaurants and recreational activities, cycle tracks and many other attractions. Fees range from Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes This was an unannounced inspection, which took place over one day on 12th March 2008. The purpose of the visit was to see how the home is meeting the National Minimum Standards. The home currently provides support to 6 service users. All of these users were sent questionnaires in order to ascertain their views upon the support they receive, responses were received from all 6. Results of this inspection report are derived from feedback gained from the service users, discussions with staff during the visit, viewing client’s records held within the service, viewing policies and procedures, staff personnel files, general observation throughout the day, along with any information that CSCI has received about the service in order to gain an understanding of how the services provided by the agency meet the service users’ needs, and impact upon their lives. The inspector would like to thank all those who gave their time during the inspection process. What the service does well: The home deals with a number of diverse care needs and always ensures to offer a very personalised service to meet the needs of those using the service. There is a very real commitment to ensure that all users of the service, however diverse their needs may be, receive a person-centred package of care which meets their needs appropriately. The home is committed to providing staff with ongoing training, to ensure they have the relevant knowledge and skills to address their clients diverse needs and to allow for personal development. Comments received from service user surveys were all very positive and included: ‘I am very happy in my home, I have a lovely bedroom. I go to day services 4 days a week, I do lots of activities’ before moving in ‘I used to visit for tea one evening a week’ Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 6 I was shown around the area and saw my house being built. I had a lot of input for my room and other rooms, so yes I did get enough information about the home before I moved in’ All six of the service users who responded inform us that the staff treat them well. What has improved since the last inspection? What they could do better: Whilst the service generally provides good outcomes for service users, there are eight areas for which requirements and recommendations have been made within this report to address shortcomings in the health safety and welfare of those using the service which are as follows: Ensure systems are in place to ensure accurate record keeping and risk assessment when medicines are away from the home to ensure the health, safety and welfare of those using the service and to ensure that there is no mishandling of medication Appropriate risk assessments must be undertaken in relation to medication leaving the home to ensure the health, safety and welfare of those using the service Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 7 Further work needs to be undertaken on service user plans to ensure that all their health care needs are fully documented, kept up to date and met appropriately. Ensure to gain a full employment history, together with a satisfactory written explanation of any gaps in employment prior to employing a person to work at the care home. It is recommended that the registered manager consider providing information in audio format for those whose needs require. Consult with the appropriate health care professionals for advice and guidance in implementing a nationally validated nutritional screening tool that is completed shortly after admission and reviewed at appropriate intervals thereafter, where this is identified. It is good practice to seek the service users/representatives signature evidencing they have been consulted with in the care planning and review process and agree to the contents of the care plan. It is a good practice that CRB clearances are renewed on a three yearly basis. 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. The summary of this inspection report can be made available in other formats on request. Monro Avenue (54) DS0000015064.V359599.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 Monro Avenue (54) DS0000015064.V359599.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 Quality in this outcome area is good. Prospective users of the service are provided with comprehensive information and an assessment of their needs, along with visits to the home, to enable them to make an informed choice about where to live and be assured that their needs can be met appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection undertaken in August 2006, there have been no new admissions to the home, all users of the service have been living in the home for a number of years, and so direct evidence of the management of new admissions was not available for scrutiny. However, we were informed that the manager of the service ensures to visit all prospective users of the service and undertake an assessment of their needs to ensure that their needs can be met at 54 Monroe Avenue appropriately. Prospective service users are provided with information about the service in the form of a service users guide and statement of purpose. The service users guide has recently been produced in picture format and it is anticipated that the statement of purpose will also be provided in picture format. Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 10 It was noted that whilst the Commissions contact details were included in these documents, a named inspector is also included. It is not good practice to include a named inspector as the allocation to services changeable and can result in service users and their representatives being provided with out of date information. The Commission’s telephone number needs updating to reflect the recent change. In addition to the provision of information, people looking to consider 54 Monroe Avenue are invited to visit the home on a number of occasions to include taking meals, day, overnight, weekend and weekly visits enabling them to spend time meeting with staff and fellow users to gain an all round picture of the home and the people they will be living with prior to making their final decision. The service deals with a number of diverse care needs and always ensures to offer a personalised service to meet all the needs of their clients. There is a very real commitment to ensure that all clients, however diverse their needs may be, receive a person-centred package of care and support, which meets their needs appropriately. From the evidence seen by the inspector and information provided prior to this visit, the inspector considers that this service is able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Monro Avenue (54) DS0000015064.V359599.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. All those using the service have an individualised plan of care and support which details their assessed needs and personal goals and documents how these needs and goals are to be met, however these are not always updated appropriately This judgement has been made using available evidence including a visit to this service. EVIDENCE: All users of the service have an individualised plan of care drawn up from an assessment of needs. Service users and their representatives are involved in the care planning and review process, however it is recommended that evidence of their involvement and agreement to the contents of the care plan is documented within their files. Three service users files were viewed during this visit and were found to be individualised, contain detailed information on the users individual health, social and personal care needs and preferences and how these needs are to be Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 12 addressed, although care needs to be taken to ensure that these are updated where necessary. Within each service users plan of care are detailed risk assessments detailing any risks and how these are to be minimised whilst retaining each users independence. Recent changes have taken place to enable service users to contribute to their review of care in a more personalised way. Reviews of care have involved those using the service using DVD format to present what they have achieved since their last review in a visual format. One service user spoken to during this visit clearly enjoyed taking part in her review in this innovative way. Communication systems within the home have been developed to ensure that those using the service are provided with information that is more accessible to their individual needs and to allow for more involvement, choice and opportunities. People using the service are more actively involved in the meal planning through the use of pictorial cards enabling them to choose their preferred choice of meals. Likewise, the daily menu is displayed in the home in pictorial format also. Service users were asked if they make decisions about what they do each day, of the 6 who responded, four said they always made decisions about what they do each day and two said sometimes. One commented that ‘when I am home I can do what I want. When at day services it is more structured but I don’t have to take part if I don’t want to.’ Monro Avenue (54) DS0000015064.V359599.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Opportunities and support is provided for people to access the local community and develop their life skills. Service users are enabled to keep in contact with family and friends, to maintain important social contacts. Meal times are well managed with different food options available, to provide service users with a varied and wholesome diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident has an individual activities plan, which details their regular scheduled activities such as day services and other planned events. People using the service are encouraged to engage in activities both within and outside of the home. On the day this visit took place some residents were Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 14 attending a day centre in the local community and two were being supported in attending a swimming session during the morning. Those using the service are supported and assisted to undertake opportunities which allows for their personal development where required. This was clearly evidenced with one service user, who has become very interested and involved with a local communication strategy group and has shown an interest in developing her involvement further. With support, she is in the process of putting herself forward for the communication steering group and to attend the partnership board meetings to voice and share information being discussed at the communication group she presently attends. The manager informs us that Macintyre have implemented computers and internet systems within the service to aid service users in communication and will also support staff with new e-learning training that has been adopted within the service. Users of the service are provided with a healthy diet with all meals provided at the home being freshly cooked on the premises. There is a visual food rota, which was designed through service users choices, and enables service users to be actively involved in planning the meals for the week. The inspector joined two service users and staff members for lunch and observed the evening meal. It was evident that the meals provided at the home are enjoyed and staff assists in a sensitive manner where necessary. Service users are actively involved in the planning and choices of the daily menus. Families and friends are welcomed into the home and are involved in daily routines and activities. Service users can choose whom they see and can see visitors in their own rooms, in private, if they wish. There are no restrictions about family and friends visiting. Monro Avenue (54) DS0000015064.V359599.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. Further work on service users care plans is needed to ensure that all their health care needs are fully met and documented appropriately. People are supported to access health care services both within the home and in the local community. Poor practices are taking place when medication leaves the home, which need addressing to ensure the health, safety and welfare of those using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 16 In the main, service users are very dependent and staff attempt, through body language and other forms of non verbal communication to determine when service users would like to go to bed, bath, have their meals and take part in other activities. This is recorded in individual care plans. This extends to supporting service users to choose the clothes they wish to wear, hairstyles, make up and general appearance. The care plans set out in detail the service users preferred routines, their likes and dislikes and partnerships with families, friends and relevant professionals outside of the home. Essential information needed by staff to be able to provide personal and health care support was included in residents’ files Whilst viewing the care plans, details within these evidenced that a great deal of work has gone into planning their personal support in such a way that meets their preferred requirements and noting their preferences in the gender of staff when undertaking intimate care. Staffs support people using the service to see their local GP and other community healthcare services when needed, both within the home and in the local community. Care plans viewed during the visit contained evidence of healthcare treatment and intervention. Risk assessments were found within the care plans detailing any identified risks and how the identified risks were to be minimised whilst promoting service user independence. Whilst all the above were found within service users files, of the three viewed, it was noted that monthly weights were not being undertaken regularly. None of the files viewed contained any monitoring of weight this year. One services users file informed us that his/her weight had not been monitored since February 2007, the second file viewed documented the last weight recorded in December 2007 and the third file recorded in July 2007. Furthermore, one of the said service users files contained eating guidelines, which stated “diet to be monitored closely to ensure she keeps a steady weight”. And the lack of monitoring his/her weight appropriately is clearly not meeting his/her health needs appropriately. Whilst the nutritional needs of service users are identified, current good practice recommends that care homes have a procedure for dietary assessment and nutritional screening using a nationally validated screening tool. This should be undertaken on admission and at appropriate intervals thereafter, with a record of nutrition, weight gain or loss and appropriate action taken. A recommendation has been made within this report to consult with the appropriate health care professional for advice and guidance. One of the files viewed highlighted that the service users medication profile had not been filled in and was left blank. When mentioned to the manager, it was seen to during the inspection and completed appropriately. Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 17 A chiropody summary sheet was evidenced, within the same service users file, highlighting that the chiropodist last visited in July 2007 and an entry stating, “ to be reviewed in December”, no evidence of such a review was contained within the file. The manager informed the inspector that the foot clinic is now visiting the home to provide service users with a regular chiropody service where required. A further service users file contained a document entitled ‘About me and how to support me’; it was dated August 2006 with no evidence of any review of the document having taken place. There was evidence that a record of incidents is documented, however, these need to be cross-referenced within service users files. A requirement has been made within this report to ensure that all their health care needs are fully documented, kept up to date and met appropriately to ensure the health and well being of those using the service. Service users have the necessary disability equipment they require to enable them to maintain their independence and robust risk assessments are in place detailing how the care is to be delivered in a safe manner whilst maintaining and promoting the users independence. Of those service users being case tracked during the inspection it was evident that the carers spoken to were aware of their individual needs and had a good understanding of how to address their needs whilst promoting their independence. Whilst the home has robust medication policies and procedures for staff to follow to ensure the health, safety and well being of those who use the service and whilst staff have received medication training to equip them with the necessary skills and knowledge, poor practices were seen to be evident on the day of inspection. Whilst viewing the storage of medication, it was noted that one such medication was contained within the medication cabinet dated 2003. Whilst the inspector was informed that the medication was not in use, such medication should be returned to the pharmacist appropriately. The registered manager assured the inspector that the said medication would be returned to the pharmacist appropriately and the medication returns paperwork was completed during the inspection. Whilst cross checking one service users medication, it was found that the number held within the home did not tally with that documented. Upon discussion with the manager, it was ascertained that the two missing were in fact with the service user who was away from the home for the day although there was no documentation in place to evidence this. Appropriate entries must be made in the homes records detailing any medications that have been taken out of the home. When service users attend local day centres, visit family members or go on holidays and their medication leaves the premises in order Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 18 that it can be administered whilst absent from the home, there is no evidence that a risk assessment has been put in place. A requirement has been made within this report to address these shortfalls and to ensure the health, safety and welfare of those using the service. Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good People using the service and their family/representatives are provided with information on how to make a complaint, which is in a format suitable to their needs. Policies and procedures are in place to safeguard those using the service from any form of abuse and staff are all provided with safeguarding training to ensure they have the appropriate knowledge and skills to recognise and respond to any allegations or incidences This judgement has been made using available evidence including a visit to this service. . EVIDENCE: The complaints procedure is provided in written and pictorial format to meet the varying needs of those using the service. In discussion with the manager, it was acknowledged that information provided to one user of the service did not meet with his/her needs appropriately although staff remind the user how to make a complaint if the need should arise. It was suggested that the information be provided in audio format to meet with the service users needs and the manager agreed that this would be considered. The Commission have received one complaint since the last inspection, which was forwarded to the organisation and dealt with under MacIntyre’s complaints procedure. The service itself has received one complaint, which was dealt with appropriately and resolved within a timely manner. Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 20 All service users are protected form abuse, neglect and self-harm and have all been provided with guidance and support in understanding vulnerable adults issues. All staff are provided with relevant training both in their induction training and regularly thereafter, enabling them to recognise the signs of abuse and how to respond if an allegation or incident is brought to their attention. Those spoken to during this visit were clear on how they would respond to any allegations or incidences of abuse and were all aware of, and would use the whistle-blowing policy where necessary. During the last twelve months, the service have made three safeguarding referrals all of which were dealt with under the local interagency safeguarding policy and procedures. Of the six service users who responded to the surveys sent out prior to this visit, four knew who to speak to if they were not happy and know how to make a complaint. Of the further two neither were aware of who to speak to if they were not happy; both are unable to communicate verbally although one acknowledged that their family knows who to complaint to on their behalf, whilst the other person acknowledged that staff know when he/she is unhappy and know what to do to try to find out why. Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27 and 30 Quality in this outcome area is good The physical design and layout of the home enables people to live in a safe environment. Bedrooms are decorated and personalised to service users choices and are provided with appropriate specialist equipment to meet their needs and maximise independence. People using the service benefit from living in a comfortable, homely environment, which is clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home evidenced that the home was clean and hygienic throughout. The home provides a physical environment, which generally meets the specific needs of those people who live there. There are adequate toilets, shower and Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 22 bathing areas with appropriate aids and adaptations in place to meet the needs of the residents although it was noted that the toilet in the shower room failed to have a retractable safety handrail in place. When mentioned to the registered manager, we were informed that they were awaiting a new one to be fitted and were assured this would be undertaken. The home offers six single bedrooms, each with an individual washbasin. The service users bedrooms were well equipped and highly personalised and reflected the particular likes of the individual service users in their choice of decoration and furnishings. The recent addition of a relaxation area within the home allows for those using the service to retreat to a quiet area to relax and unwind. The service recognises that there is room for improvement and plan to develop this area further. Users of the service have access to a safe well-maintained sensory garden, which they can enjoy during the warmer months. There are plans in place to further enhance the sensory garden to include more visual colours and textures to provide for more stimulation. Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 25 and 36 Quality in this outcome area is good People using the service benefit from having a motivated, well trained and skilled staff team to meet their needs appropriately. There are effective recruitment procedures in place although these could be further enhanced to ensure they are more robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s policies around the recruitment and selection of staff serve to protect service users health and welfare. Application forms are completed, references are collected and a face-to-face interview is undertaken. Relevant POVA (protection of vulnerable adults) and CRB (criminal records bureau) checks are undertaken prior to appointment to ensure the persons suitability with working with vulnerable people. However, whilst viewing four staff personnel files, shortcomings were noted in respect of gaining a full employment history. It was noted that a full employment history was not contained within two of the files and there was no evidence of any documentation explaining the gaps. Whilst looking at the application form, it Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 24 was noted that a full employment history is not asked for and therefore a requirement has been made within this report to address this. It was further noted that one staff members CRB disclosure was almost five years old, another staff members was four years old and a third persons was almost four years old. As a matter of good practice CSCI advises renewal of CRB disclosures every three years. All newly recruited members of staff receive a structured induction training including shadowing more experienced carers until both parties feel confident and comfortable. Staff are provided with mandatory training in core subject areas which is updated accordingly, and undertake ongoing development in order that they are appropriately trained and equipped with the skills to meet the varying personal care needs of the service users, thereby protecting the service users health, well being and safety. Staff training is recorded in individual staff files and those viewed demonstrated the home’s commitment to staff development and training. Specific training for individual service users needs, such as autism and epilepsy is provided to ensure that staff has the necessary skills and knowledge. Staff members are encouraged to undertake the National Vocational Qualification (NVQ) in care. Four of the home’s twelve permanent care staff have already obtained an NVQ level 2 or above and a further one is currently undertaking such training. Information provided to us prior to the visit informs us that the manager has recognised this is an area in which they could improve upon and tells us that they plan to enrol all new staff on the NVQ training after completion of their probationary period. Observations of the interactions between staff and residents indicated that staff clearly understood the individual needs of those using the service and showed skill in communicating with them effectively. Staff were seen to spend one-to-one time with individuals as well as interacting with them in groups. Staff spoken to, during this visit, demonstrated an awareness of the individual needs of those using the service and were able to interpret non-verbal signals appropriately. The staffing levels on the day of the visit were effectively meeting the needs of those using the service, some of who have complex needs. Staff spoken to during the visit, confirmed that they feel well supported by management and have the opportunity to express their views in the regular team meetings and in their formal supervision sessions. That they are provided with plenty of training relevant to their roles, which is updated when necessary and should they feel they need training in any particular area, they would only have to ask and it would be arranged. All were observed to understand the needs of those they were supporting and were seen to respect the service users wishes and offer support in a sensitive manner. Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 25 Staff receive regular supervision and an annual appraisal of their work. Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 and 42 Quality in this outcome area is adequate. People using the service are provided with a safe environment in which to live. Evidence of poor procedures taking place namely around record keeping for some of the key document tools such as care plans, risk assessments and medication practices do not serve the service users best interests and could compromise the health safety and welfare of those using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered is currently undertaking her National Vocational Qualification Level 4 in Care, after which it is anticipated that she will undertake the Registered Managers Award to enhance her skills and knowledge. Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 27 The staff on duty at the time of this visit confirmed that the home is well run by a supportive and caring manager who leads by example and that the way in which she runs the home is open and transparent. The Annual Quality Assurance Assessment (AQAA) sent out prior to the inspection was returned within the appropriate timescale and contained detailed information. The AQAA informed us of changes they have made and where they still feel they need to make improvements and detailed how they are going to do this. The data section was accurately and fully completed. The manager obtains feedback from residents and visitors when talking to them in the home, and has an ‘open door’ policy that encourages people to see her without the need to make an appointment. Feedback is sought from relatives and service user representatives in the form of service satisfaction questionnaires as part of their quality assurance and monitoring process. Macintyre Care has an equal opportunities policy in place and this is accessible to all staff. During the visit, we examined a number of health and safety records, which indicated that these undertaken appropriately to ensure the health, safety and welfare of those using the service. All necessary checks and servicing of equipment in relation to fire safety and the maintenance of the water system are routinely undertaken and documented appropriately. Hazardous substances are stored appropriately, and the manager confirmed that COSHH sheets have been reviewed since the last inspection. Evidence of poor practices taking place namely around medication and poor recording procedures, do not serve the service users best interests and could compromise their health, safety and well being. Improvements are needed in record keeping for some of the key document tools such as care plans, risk assessments and medication practices to ensure the health, safety and welfare of those receiving a service. These issues have been identified elsewhere in this report. Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 28 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 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 x 27 3 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 2 x 2 x Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 29 NO 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 YA20 Regulation 13(2) Requirement The registered manager must ensure systems are in place to ensure accurate record keeping and risk assessment when medicines are away from the home to ensure the health, safety and welfare of those using the service and to ensure that there is no mishandling of medication Timescale for action 30/04/08 2 YA6 15 Further work needs to be 30/04/08 undertaken on service user plans to ensure that all their health care needs are fully documented, kept up to date and met appropriately. The registered manager must ensure to gain a full employment history, together with a satisfactory written explanation of any gaps in employment prior to employing a person to work at the care home. 30/04/08 3 YA34 19 Schedule 2 Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA22 Good Practice Recommendations It is recommended that the registered manager consider providing information in audio format for those whose needs require. Consult with the appropriate health care professionals for advice and guidance in implementing a nationally validated nutritional screening tool that is completed shortly after admission and reviewed at appropriate intervals thereafter, where this is identified. It is good practice to seek the service users/representatives signature evidencing they have been consulted with in the care planning and review process and agree to the contents of the care plan. It is a good practice that CRB clearances are renewed on a three yearly basis. YA17 3 YA6 4 YA34 Monro Avenue (54) DS0000015064.V359599.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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