CARE HOME ADULTS 18-65
Perrymans 56a Abbey Road Barkingside Ilford Essex IG2 7NA Lead Inspector
Claire Taylor Unannounced Inspection 25th September 2007 11:45 Perrymans DS0000025917.V353042.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 Perrymans DS0000025917.V353042.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. Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Perrymans Address 56a Abbey Road Barkingside Ilford Essex IG2 7NA 020 8518 1058 020 8518 1058 perrymans@mcch.org.uk www.mcch.co.uk MCCH Society Ltd 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) Mr Robert Richard Mapother Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Clients with learning disabilities and associated physical disabilities. To include one named person over 65 with PD Date of last inspection 27th April 2006 Brief Description of the Service: Perrymans is a home for six adults with severe learning disabilities and some physical disability. People who live in the home have little or no verbal communication skills, and very limited ability to make decisions about their lives. They all need a lot of support from staff for every aspect of their daily life. The home has been purpose-built on one level and is accessible to wheelchair users throughout. The house is in Newbury Park close to bus routes, underground station and local shops. Bathrooms and toilets are adapted to be suitable for people with limited mobility or physical disabilities. Each person has their own bedroom that is decorated and personalised according to their preferences. There is a lounge/dining room and a paved garden with an area especially designed for people who have sensory impairments. Four ladies and two men were living at the home with one person in hospital at the time of this visit. MCCH declined to provide details of the fees for individual occupancy. MCCH state that they are contracted with Redbridge local authority and would only take referrals from them. Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Time was spent meeting with the people who live in the home, staff and the manager, Bob Mapother who facilitated most of the inspection. Various records were looked at in relation to care planning, staffing and the general operation of the home. There was also a walk round the premises. People living in the home do not have the capacity to share their views regarding their care. In order to make judgements about the care that service users receive, observations of care practices and interactions with staff took place. All registered adult services are now required to to fill in an annual quality assurance assessment. (AQAA) It is a self-assessment that the provider (owner) must complete every year. The completed assessment is used to show how well the service is delivering good outcomes for the people using it. The AQAA also provides the CSCI with statistical information about the individual service and trends and patterns in social care. Some information from the AQAA is included in this report. Prior to this visit, the home also had an additional random inspection in March of this year and again, some of the findings are included. Feedback from the written comment cards returned by four staff and one relative also informed this inspection. All those who took part are thanked for their time. What the service does well:
Perrymans accommodates people who have both physical and learning disabilities, some of whom have highly dependent needs and limited communication abilities. Appropriate care and support is dependent upon the home having sufficiently experienced and skilled staff who have developed a working knowledge of the behaviours, moods, signals and temperaments of the service users. The home was once again able to demonstrate an ability to meet their specialist needs with service users benefiting from a stable and familiar staff team. The manager has been in post for several years and continues to demonstrate good management practice. Written feedback included, “ we have a fantastic manager who listens and supports staff and looks after the interests of the service users.” The staff closely monitor the health and wellbeing of the people and there are good links with other healthcare professionals. Any changes in individual needs are acted upon and adjustments to their care and support are put in place. The owning organisation, MCCH provide good training opportunities for the staff which means that they keep their knowledge and skills up to date. Staff feedback reflected this; “excellent training potential” and “trains support staff to improve service provision” Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Each person living in the home must have an up to date and relevant contract. This will help them and/ or their representatives to have a better understanding of the care that is promised and likewise the home’s duty of care to them. Following the installation of a new bath, the risk assessment for moving and handling one service user now needs review. This is to ensure that staff have clear guidance on what action to take to support their mobility needs and minimise the risk of injury or harm. Personal risk plans for some service users also need to be reviewed so that they reflect current needs. Further activities are needed within the home to provide service users with a more stimulating and fulfilling lifestyle that also meets their social needs. Some minor improvements are required with medication practices. Discontinued or excess medication must be returned to the pharmacy more frequently. Where medication is prescribed on an as required basis, then staff need only sign for the times it is actually given. This will enhance accuracy and minimise the risk of error.
Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 7 An annual quality assurance plan needs to be put in place. This will further show how the views of the service users, their relatives, the staff and other interested parties influence the running of the home and what follow up action has been taken to improve the quality of care. Good practice areas for the home to consider are outlined as follows. The manager should consider allocating one or two staff to take responsibility for organising activities for the service users in the home. MCCH could produce a newsletter to further improve communication between the home and relatives or other representatives e.g. that they are kept updated on staff recruitment issues and informed about any other relevant issues concerning the home’s operation. Staff should receive training on the Mental Capacity Act so that they are up to date with new legislation which is applicable to their work. The specific needs of each service user should be included in the home’s induction pack. Both new and agency staff should sign the form in acknowledgment once they are familiar with the information. The names of staff and service users should be recorded when fire evacuation drills are carried out. 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. Perrymans DS0000025917.V353042.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 Perrymans DS0000025917.V353042.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): 2 and 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Detailed assessments are completed to ensure that the home can meet the needs of service users. Contracts need to be rewritten so that each service user and/or their representative have up to date information about the facilities and services they can expect to receive. EVIDENCE: The same group of people have lived at Perrymans for a number of years and there have been no new admissions to the home. Suitable policies are in place however to ensure that the home would only admit people whose needs can be met. The home ‘s needs assessment plan is detailed and covers all areas to ensure that any new service user’s needs would be fully assessed prior to their admission. This covers all aspects of the person’s life, including individual strengths, hobbies, social/ cultural needs, dietary preferences, medical history and personal care needs. Copies of these assessments were in place for the four files seen as well as detailed needs assessments completed by the service users placing authority. I.e. undertaken by their care managers. The individual contracts for each service user are now in need of review as they were dated 1999. All service users must have an up to date and relevant Individual Service Agreement. This will help them and/ or their representatives Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 10 to have a better understanding of the care that is promised and likewise the home’s duty of care to them. Perrymans DS0000025917.V353042.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 This judgement has been made using available evidence including a visit to this service. Care planning is organised well and regular informal reviews ensure that staff are aware of each service user’s needs and any changes. Good, clear guidance supports staff in providing consistent care for the people living in the home. Some risk assessments are in need of review to fully safeguard individual service users from potential harm. For one individual, a moving and handling risk plan needs review as the home has a new rise and fall bath. EVIDENCE: Four of the service users’ care and support plans were looked at. Reviews are held at least six monthly and involve the service user, their relatives/ representatives and Care Manager wherever possible. Plans are well written which helps ensure consistent guidance and practice so that individuals have the right therapeutic support and treatment to meet their needs. Each person also has a communication passport that guides staff on how to understand their individual means of expression. I.e. communicating through body language, gestures or behaviours. Individual diaries are used daily and records
Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 12 seen were thorough, relevant, and also gave a sense of that person’s experience of their day. Since the last inspection, person centred planning has recently begun and records were seen for one service user. The groundwork for creating their plan had been completed with involvement of the family. It included information about the person’s preferred routines, activities, likes and dislikes and social links. The plan also outlines how the staff should best support them to achieve their personal goals. The home intends to develop a PCP for each person within the next twelve months. Pictures and photos are included making the support plan more meaningful to them and valuing their input to it. Discussion with the manager and staff showed that they clearly know each service user’s needs, likes and dislikes. They were seen to be caring and sensitive in their approach and support individuals with dignity and respect. Relevant risk assessments are in place to ensure that activities people take part in, do not put them at unnecessary risk of harm, whilst protecting their individual rights and choice. Examples seen included personal hygiene, eating and drinking, mobility, accessing the home / wider community and using the home’s vehicle. One person’s risk plans were in need of review however as they were out of date. Following a complaint made by a relative, the personal risk plans for one service user were appropriately reviewed and an additional risk assessment was completed. Perrymans DS0000025917.V353042.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): 12,13, 14, 15, 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are provided with opportunities for recreational and social activity although more could be done to increase the day-to-day activities when at home. Appropriate contact between service users and their families and friends is encouraged to help them maintain relationships. Dietary needs are catered for and a well balanced diet is provided, to ensure health and enjoyment of food. EVIDENCE: Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 14 People living in the home have highly dependent needs including physical disabilities and limited communication skills. Staff therefore tend to organise activities based upon each individual’s assessed needs and knowledge of service users’ preferences. Some of the service users attend a local day centre on a sessional basis and two people returned from the centre during the afternoon. One person attends a blind association centre twice a month. An aromatherapist visits the home on a regular basis and records indicated that service users enjoy the sessions. Relatives are involved in social events and functions. A barbecue was held in the summer for service users and their relatives. The home has entertainment facilities including television, videos/ DVDs, music system, art and craft activities and some sensory equipment specific to service users preferences. Some improvements to community activities have taken place since the last inspection. Records showed that individual service users have been on outings to the cinema, theatre and pantomime. Staff have also supported people to go out for a social lunch, individual shopping trips and visits to church. Within the home however, more could be done to provide stimulating activities for service users. During this inspection, three service users were at home for the day and although they were provided with some sensory equipment, they were not occupied with any specific activities. It is acknowledged that one of the three people was unwell with a chest infection. Planned activity timetables are in place for each service user but daily records showed that they were not always followed. More activities are therefore needed for when service users are at home so that their social needs are met and they can experience a more fulfilling lifestyle. The manager should consider allocating one or two staff to take responsibility for organising activities in the home. Family, friends and guests are welcome at the home and the manager upholds good communication links with the service users’ respective families. Two service users have regular contact with their families with one person meeting up with family every weekend. The other person’s mother visits for lunch and staff also support them to visit her at home each week. Menus seen indicated that people living in the home are provided with a variety of nutritious foods and balanced diet. Menus are based on staff knowledge of individuals’ likes and dislikes. One person’s family have been consulted about their preferred foods. One of the service user’s receives their food daily through a “PEG” feeding tube and staff have been trained to do this. Two other people require liquidised food and clear instructions on how to prepare their meals is available to staff. I.e. Each item should be liquidised separately so that service users can experience the different food tastes. Perrymans DS0000025917.V353042.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 good This judgement has been made using available evidence including a visit to this service. Clear guidance and the knowledge of experienced staff helps to ensure that individuals receive support in ways that they are familiar with and comfortable with. Promotion of health is well observed and suitable arrangements are in place to ensure that the service users’ physical, healthcare and emotional needs are met. The home’s medication practices are generally well organised although some improvements will ensure better safety and consistent treatment for each service user. EVIDENCE: People who live in the home depend on staff to fully support them with their personal care needs. Where support is required with personal physical care, this is identified and guidance is available on how specific tasks should be undertaken whilst also maintaining privacy and dignity. Consistency and continuity is achieved through each service user having a designated key worker. Staff were able to demonstrate their knowledge and were observed undertaking a variety of care activities competently. Staff were seen to manage the many and varied tasks required to promote individuals well-being
Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 16 and safety, such as manipulation, and correct resting positions for one individual who is wheelchair bound. Records seen confirmed that arrangements are in place for meeting healthcare needs. Service users are supported to access a range of NHS facilities e.g. GP, Consultant, dental, chiropodist, optician and community nurses for one individual. Information about health conditions such as epilepsy is available in the home. Staff have received training on epilepsy to enable them to fully support those service users with such specialist needs. Entries in sampled files showed that potential complications and problems are identified and dealt with through prompt referrals to the appropriate health professional. An example was seen for one individual who has a history of recurrent episodes of chest infections. There had been some recent deterioration in their health. Records showed that their condition was being monitored closely with support from the GP as well as ongoing visits to other NHS services. One other service user was in hospital at the time of this visit. The AQAA identified that there are plans to instigate health action plans for each service user. None of the people who live in the home are able to self medicate. Certificates showed that sufficient staff are trained to administer medication. The organisations procedure requires that a second member of staff witness medication administration. Previous concerns around medication practices have been addressed although some record keeping is still in need of improvement and discontinued medication must be returned more frequently. A large supply of excess syrup medication had not been returned. Aside from this, medication was stored correctly with records kept for its receipt and disposal. Guidelines are in place to specify what medication must be given when required and the reasons for prescription. The home was using coding systems introduced by their pharmacist that did not accurately reflect actual practice. For as required medication, staff enter a code daily to denote that it was not administered. If medication is prescribed as and when needed then staff need only sign for the times it is actually given. Medicine administration charts were otherwise in good order and accurate. Perrymans DS0000025917.V353042.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Good practices and policies are in place to enable concerns to be raised and responded to. Arrangements for protection from abuse are well managed and help ensure that service users are safe. EVIDENCE: The home has a complaints policy that provides clear details of how concerns would be listened to and acted upon. The current group of service users living at the home would need total support to make a complaint and would rely on a relative, staff or other people to raise a concern on their behalf. For some individuals, their relatives are very proactive in promoting their welfare and well-being. For others, they do not have a family member to represent them. To address this, the home plans to arrange for each service user to have an independent advocate. This was identified on the completed AQAA. Staff feedback also supported the need for advocates. There is a complaints book and two complaints have been made since the last inspection. The registered provider MCCH dealt with both. Records clearly showed what action had been taken and that the views of family members are taken seriously by the home and organisation. Since the last inspection, an allegation of suspected abuse was reported to the local office of the Commission for Social Care Inspection. An investigation was carried out under the remit of adult protection. This was dealt with appropriately by the home and the Commission were notified promptly of action taken. Following a thorough investigation in accordance with both the home’s policy and local authority procedures on safeguarding vulnerable adults, the allegation was unsubstantiated. There are systems in
Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 18 place regarding the protection of vulnerable adults and relevant policies to safeguard the service users welfare. E.g. a whistle blowing policy to state what action to take should staff suspect anything untoward. Records confirmed that staff are properly inducted on abuse awareness and have received training on safeguarding vulnerable adults. People living in the home need full support with their finances and are reliant on staff or family to manage their monies. Appropriate documentation was in place with regard to income/expenditure made on their behalf as well as policies to safeguard their personal interests. Records are kept of financial transactions and daily checks are made at the staff handover to ensure that these are correct. A representative from MCCH was routinely checking finances at the time of this inspection as part of a regular audit. Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 19 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, 29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Extensive refurbishment has taken place meaning that service users live in more welcoming and homely surroundings. Bedrooms have been redecorated and continue to reflect people’s personal identities as well as being designed to meet their individual needs. Specialist equipment is available to enhance people’s independence. The home is clean, hygienic and kept in a good state of repair. EVIDENCE: The organisation has worked hard to address the previous requirements concerning the redecoration and refurbishment of the premises. A new rise and fall bath has been installed that is more suitable to meet individual needs. The bathroom has been retiled and new flooring fitted. The loose tiles in the shower room have been replaced. The lounge and hallways have been redecorated and recarpeted throughout. Service users’ bedrooms have been redecorated and fitted with new carpets. New furniture has been purchased for some of the bedrooms. One individual was supported to choose their own pink paint for
Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 20 their room. The staff have ensured that each service user’s bedroom reflects their interests, hobbies and personal identities. New kitchen equipment has been purchased including modified bowls and cutlery that meet the service users’ specialist needs. There is now a sensory area in the garden with a water feature for the benefit of those individuals with sensory impairments. This was made possible following a donation by one of the service user’s relatives. The home appeared very clean and free from malodour with good standards of hygiene practice in place. The laundry facilities are suitable to meet the service users current needs. There are policies and procedures in place regarding hygiene and the control of infection. Protective clothing is available and appropriate arrangements in place for the safe storage and disposal of clinical waste such as incontinence aids. Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 21 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 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from a competent and knowledgeable staff team, who are provided with the necessary training and guidance to support their needs. Good recruitment practices ensure that staff are vetted correctly so that service users are safeguarded from people who should not be working there. EVIDENCE: The staff team remain largely unchanged with low turnover. This enables consistency and familiarity for the people who live there. Service users appeared comfortable and relaxed and observations showed that staff respect their individuality as well as demonstrate an understanding of their specific needs. The home’s allocation allows for a minimum of three staff on each morning shift, two in the afternoon with one staff on a flexi shift from 3pm to 7.30pm. The main purpose of the flexi shift is to support the service users with eating their meals. There is one waking night staff with an additional staff who sleeps on the premises in the event of an emergency. Rotas were examined and showed that adequate numbers of staff are in place for meeting service users current needs. In addition, staff allocation is adjusted where necessary to meet individual needs i.e. extra staff support for one service user during a
Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 22 stay in hospital and for planned outings or trips. The manager advised that there was one staff vacancy to be filled. Regular bank staff from other MCCH homes and some agency staff are used to cover vacancies. Staffing levels must be kept under close review however given the age of some service users and their fluctuating health conditions. Staff are provided with good support and the necessary training to meet the service users collective and individual needs. Examples include training in the management of epilepsy and PEG feeding. Records and observation showed that good communication processes are upheld in this home. Regular staff meetings are held on a monthly basis and in depth consultations about the home’s care practices and service users needs are routinely discussed. Some staff feedback comments included, “all staff work as a team” and “there is total support”. A wide range of training opportunities are available to staff at all levels. Feedback from staff comment cards indicated that training was given high priority by MCCH. New staff complete an induction process whereby an experienced staff supervises and supports the new worker. This was confirmed during the visit as a new staff member was on duty. Induction learning topics include the worker’s role in the home, general principles of care and some basic information about organisational policies. It would better if the specific needs of each service user were included in the induction and that new staff sign the form in acknowledgment. The home uses regular agency staff on occasions and again, these staff should also sign confirmation that they have completed their induction. Following new legislation it would be beneficial for staff to receive training on the Mental Capacity Act. The home’s recruitment procedures are thorough to ensure that staff are vetted correctly and service users are safeguarded. The main staff records are held centrally at the organisations head office in line with an agreement made with the Commission. In the home, a record is kept to evidence that appropriate recruitment checks have been carried out by MCCH. Two files were checked and contained all the correct documentation. Records were not available for the newest member of staff although an email was sent by MCCH to verify that they had a completed CRB and POVA check. Perrymans DS0000025917.V353042.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is an established manager who has relevant qualifications and a good leadership approach to run the home in the best interests of the service users. Some minor improvements are needed with the quality assurance systems to ensure that quality of care is regularly appraised and the home is meeting its objectives. Good systems are in place to promote and protect the health, safety and welfare of people living and working in the home. EVIDENCE: The manager Bob Mapother has worked in the home for many years and continues to demonstrate good management practice. He has valuable experience in working with people who have learning disabilities. Discussions and observation confirmed that he is knowledgeable about each service user’s specific needs and has periodically attended various training courses to keep
Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 24 his skills up to date. A range of quality assurance systems are used to measure the success of how the home is achieving its aims and serve the best interests of the people who live there. Examples include care plan reviews, meetings, monthly visits from the registered provider and some satisfaction questionnaires. Although the home does have systems in place, an annual quality assurance plan needs to be drawn up and implemented. This will further show how the views of the service users, their relatives, the staff and other interested parties influence the running of the home and what action has been taken to improve the quality of care. Comments from a relative indicated that communication could be improved with regards to staff changes and general information about the home. In response, the organisation could consider publishing a newsletter to inform service users relatives or other interested parties about significant issues or changes related to the home’s operation. The completed AQAA stated that all relevant safety checks were up-to-date. Some health and safety records were sampled including fire safety and general risk assessments. Fire drills are held at correct intervals although it would be better if the names of staff and service users taking part were recorded. Risk assessments are in place for safe working practices and had been reviewed. As discussed earlier in the report, a risk assessment for using the new assisted bath must be rewritten. Accurate records are kept for accident and incident reporting and the home keeps the Commission informed of any significant events that affect the well being of the service users. Key health and safety training for staff is organised and planned so that staff update their skills and knowledge at appropriate intervals. Certificates showed that training undertaken since the last inspection has included infection control, moving and handling, food hygiene, medication and some first aid. Perrymans DS0000025917.V353042.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 X 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 3 25 3 26 3 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X 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 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes-1 although this has been partly met 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 YA5 Regulation 5(1b&c) Requirement An up to date contract must be provided for each service user so that they or their representative are given full information about the service that is being arranged. Following the installation of a new bath, the risk assessment for moving and handling one service user now needs review. This is to ensure that staff have clear guidance on what action to take to support their mobility needs and minimise the risk of injury or harm. Risk assessments for some service users need updating so that they reflect current needs and potential risks to service users and staff are identified and minimised. Suitable activities must be provided in the home and residents must be supported to participate in a range of activities in the community. Timescale for action 31/01/08 2 YA9 13(4)(5) 30/11/07 3 YA9 13(4)(5) 30/11/07 4 YA14 12 16(2 n) 30/11/07 Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 27 (Date for compliance set at previous inspection 30/09/06) Partly met- Timescale extended. 25/09/07- Further activities are needed within the home to provide service users with a more stimulating and fulfilling lifestyle that also meets their social needs. 5 YA20 13(2) Where medication is prescribed for service users as required, then staff need only sign for the times it is actually given. This will enhance accuracy and minimise the risk of error. Any excess or discontinued medication must be returned to the pharmacy A written annual quality assurance plan needs to be developed for the home. This will show how the views of service users, their representatives, the staff and other relevant parties influence the running of the home and what action has been taken to improve the quality of care. 30/11/07 6 YA20 13(2) 30/11/07 7 YA39 24 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA14 Good Practice Recommendations The manager should consider allocating one or two staff to take responsibility for organising activities for the service users in the home.
DS0000025917.V353042.R01.S.doc Version 5.2 Page 28 Perrymans 2 YA39 MCCH organisation could produce a newsletter to further improve communication between the home and relatives or other representatives e.g. that they are kept updated on staff recruitment issues and informed about any other relevant issues concerning the home’s operation. Staff should receive training on the Mental Capacity Act so that they are up to date with new legislation which is applicable to their work. The specific needs of each service user should be included in the home’s induction pack. Both new and agency staff should sign the form in acknowledgment once they are familiar with the information. The names of staff and service users should be recorded when fire evacuation drills are carried out. 3 YA35 4 YA35 5 YA42 Perrymans DS0000025917.V353042.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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
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