Inspection on 10/04/06 for Ronak Home

This inspection was carried out on 10th April 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ronak Home 14/01/09

Ronak Home 01/07/08

Ronak Home 17/07/07

Ronak Home 11/08/05

Ronak Home 14/04/05

Ronak Home 15/10/04

Ronak Home 10/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Ronak Home 120 Alderman`s Hill London N13 4PT Lead Inspector Jane Ray Unannounced Inspection 10th April 2006 09:30 Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 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 Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 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. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ronak Home Address 120 Alderman`s Hill London N13 4PT 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) 020 8882 3586 020 8447 9105 MHJ Crausaz Ltd Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11th August 2005 Brief Description of the Service: Ronak Home is operated by MHJ Crausaz Ltd. This company has other homes locally. This home is registered for ten adults, aged between 18 and 65 years, who have a learning disability. The majority of current service users are non-verbal and a number have a diagnosis of autism. The home is a semi-detached three-storey house with a garden. There are ten single bedrooms, of which eight are en-suite. The home is situated close to the facilities of Palmers Green and is opposite a large park. There are good public transport services locally. High staffing levels and some day services are provided by the company in line with the service users individual needs. The homes stated aims are to provide care and support to ten younger adults who have learning disabilities. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 10 April 2006 and was unannounced. The inspection took place throughout the whole day and was the main inspection for the year looking at all the key National Minimum Standards for Younger Adults. The inspector was able to meet and spend time talking to and observing five of the six current service users. The inspector was also assisted by the recently appointed manager and was able to speak to the staff working throughout the day. As part of the inspection the inspector toured the property and also looked at relevant records and policies including service user case notes, staff files and health and safety records. The inspector was supported very positively throughout the day by the manager and staff. The registered provider joined the feedback session at the end of the inspection. What the service does well: What has improved since the last inspection? The last inspection took place in August 2005 and this made 13 requirements and 4 recommendations of action that needed to take place in order to meet the National Minimum Standards for Younger Adults and the associated regulations. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 6 Of these 9 requirements and all the recommendations were fully met and the remaining four requirements had been partly but not fully met. Two of the requirements for staff to have two written references and to complete their induction training plan are immediate requirements at this inspection as they have been restated from two previous inspections although the inspector recognised that significant progress had been made already towards completing this work. Progress that has been made since the last inspection includes the completion of monthly registered provider visits, the manager has applied to be registered, service users have individual guidelines where they have PRN medication, service users have risk assessments to promote their independent living, medication administration records are completed correctly, there are no unpleasant odours in the home and no mattresses on bedroom floors, all staff have a CRB disclosure, the manager is being regularly supervised, fire safety measures have improved including the testing of the fire alarm and emergency lighting. 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. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 The service users would benefit from having comprehensive up to date assessments prepared by the home so that their individual needs can be clearly identified. The service users also need to have accurate and up to date contracts with the home. EVIDENCE: Four service user case notes were inspected. They each contained a pen picture of the service user and most of these were very brief and contained limited information. It was not possible to find a document that clearly assessed all the service users needs reflecting their physical, social, cultural and emotional needs. This document would then act as a basis for the individual care plans. The four service user case notes all contained an individual contract between the home and the service user. This needed to be amended for the two service users who have recently moved from St Georges to Ronak. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 and 9 Service users are supported in the home by the availability of care plans that have been regularly reviewed and reflect their individual needs. Service users need to be supported to access the records of their most recent review meeting with their care manager to ensure that any actions from the meeting are incorporated into their care plans. They also need to have their risk assessments reviewed. EVIDENCE: Four service user case notes were inspected. They all contained individual care plans that reflected the needs of the individual service users and their complex needs. These had all been reviewed in the last six months. The risk assessments were also in place and these looked at activities that promote the independence of the service users and how these can take place as safely as possible. Risk assessments for two service users who had recently moved to the home had not been updated in the last six months. Each of the service users had behavioural guidelines in place either as a separate document or as part of their care plans and risk assessments. These all suggested appropriate ways of supporting the service users if their Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 10 behaviour became more challenging. The language used in these documents was clear and easy for staff to follow. The service users had each had a care plan review meeting in the last twelve months and for three service users the record of this meeting was available in their case notes and the actions were reflected in their care plans. One service user had no record of the review meeting in his case notes. The home needs to obtain a record of this meeting from social services and ensure the actions from this are incorporated into the care plan. All the service users had a key worker. The inspector spoke to two staff who act as a key worker and they both had a good understanding of the practical and emotional responsibilities of being a key worker. The inspector was also able to verbally communicate with one service user and he also had a good understanding of who acted as his key worker and how they would provide him with the necessary support. The inspector was able to see the service users expressing their views and making decisions about their daily lives in the home through a range of communication. This included choices about food, drinks, where they wished to spend their time and whether they wanted to go out. The staff explained that none of the service users currently accesses an advocacy service. The care plans that were inspected for four service users all stated whether the service user needed assistance with their personal finances and how this was arranged. One service user explained that they had monthly service user meetings and were able to discuss food, holidays and activities. The record of these meetings was also inspected. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16 and 17 The service users are supported to access a range of activities many of which are community based. Contact with family and friends is promoted. The service users are supported to eat a healthy diet but the recording of what they do actually eat needs to be improved. EVIDENCE: The manager explained that one service user attends a full time day service. Two of the service users access colleges, one for gardening and the other to attend a music therapy session. Five of the service users attend a multisensory session at Chase Farm Hospital. Four of the service users choose to attend church on a regular basis. It was seen in the service user case notes that each service user has an individual activity programme based on their individual interests. These include using local community resources including swimming, snooker, shopping and local walks. The home also has access to a driver who works between two homes and during the inspection he took out two service users with staff support. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 12 Last year the service users enjoyed a holiday in Torquay and this year a holiday is being planned in Wales. The inspector spoke to one service user who was able to describe all the activities he undertakes and he said how much he enjoys these activities and how the staff are available to support him with this programme as necessary. The inspector looked at the case notes and at present the activities are just recorded as part of the daily logs and there is no record available of why planned activities do not always take place. It is recommended that there is a clear record for each service user of what activities they have undertaken and if an activity needs to be cancelled the reasons for this. During the inspection the lunch took place and the evening meal was prepared. The menu was also inspected. The food served corresponded with the menu and promoted a healthy and balanced diet. The staff were observed at lunchtime sitting with the service users whilst they ate and supporting and prompting them as required. The meal was well presented and took place in a relaxed manner. It is required that a record is kept of the food eaten so that it is possible to monitor the food on the occasions where the menu is not followed. It was observed that some staff bring their own food into the home and store this in the fridge in a labelled bag. It is recommended that a separate small fridge is provided for the staff so that their food can be kept separate from the service users. It was observed during the inspection that all the service users were dressed in a manner that was comfortable and age appropriate. Everyone was well groomed and had been supported to access the hairdressers. One service user explained that he has a key to his own room. He also explained that the staff always pass him his letters and will assist him to read them if he wants some help. Service users were observed choosing where they wished to spend time in the house and this included the communal areas and their bedroom. The manager and staff explained that there is close contact with a few relatives and one has daily contact with the home. The care plans stress the importance of keeping relatives in touch with what is happening where appropriate. One regular visitor came to the home during the inspection and was observed to be welcomed appropriately by the staff. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 The service users are supported with their personal care in a manner that preserves their privacy and dignity. The service users are also accessing the appropriate healthcare input and they are supported to take the correct medication by appropriate medication systems. EVIDENCE: The service users throughout the inspection, were being supported by staff with their personal care. This input happened in a discreet and respectful manner. Personal care took place in the service users bedroom and in most cases they have their own en-suite bathroom, which helps to maintain their privacy. It was observed that routines were flexible according to the needs of the individuals. One service user who had recently been unwell was able to stay in bed later and have a rest in the afternoon. One other service user who has a tendency to go to bed throughout the day was being encouraged to have daytime activities and to establish a more regular sleep pattern. The home has a minimum of two male staff working during the day and one male and one female member of staff working at night. This is because some Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 14 service users specifically respond positively to staff of the same gender and this is accommodated within the service. The healthcare records were inspected for four service users. They had all been supported to attend healthcare appointments including the GP, dentist, optician and chiropodist where needed. In addition they all had ongoing input from the psychiatrist. There was evidence of other input being accessed as necessary including speech therapy and occupational therapy. The medication system was inspected. The home uses the Boots blister pack system. The blister packs and medication administration records were inspected and were satisfactory. There were no gaps in the medication administration records. Medication that is received or returned to the pharmacist is recorded on the medication administration record and this provides an audit trail of the medication. Guidelines are in place for the service users who take PRN medication and these are available in their case notes and with the medication administration records. One service user is given medication in a covert manner and the reasons for this and approval from the psychiatrist are recorded in his medication records. The temperature of the medication is being monitored on a daily basis. The staff training records show that permanent staff who administer medication have received medication training. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users and their relatives can access an appropriate complaints procedure. Adult protection procedures are also in place to safeguard the service users although some staff do need to receive training to enable them to respond appropriately to an adult protection issue. EVIDENCE: The complaints procedure was inspected in the service user case notes. This procedure was available in a user-friendly format. The record of complaints was inspected. There have been no complaints since the last inspection. The service has an adult protection and whistle blowing procedure. The staff training records were inspected for four staff. Two had received training in the last year, one had received training but this had taken place three years ago and one had no record of any training. It is required that all staff have up to date training on adult protection issues. The resident finances were inspected for three service users. Two service users had their building society books at the head office on the day of the inspection as their appointee was arranging for them to withdraw cash. One had their building society book available in the home and this showed that he was receiving the appropriate DSS benefits. The records of cash expenditure for all three service users was inspected and these were all satisfactory and showed appropriate records and receipts. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,29 and 30 The service users are benefiting from living in an environment that offers plenty of space and is clean. The home would benefit from a programme of refurbishment and redecoration. EVIDENCE: The inspector did a tour of the building. The home was clean and tidy. Service users had been supported to personalize their bedrooms. The furniture in the communal areas is designed to meet the needs of the service users by being strong and yet a style that is in keeping with the home. Each service user has a single room. Two service users have a futon bed, one because he had previously wanted to sleep on the floor and has been supported to move onto a low bed and the other because his epilepsy puts him at risk of falling. One service user who has mobility issues has a ground floor bedroom and a bathroom with a shower and shower chair that meets his specific mobility needs. Hygiene is promoted in the home by antibacterial hand wash and disposable hand towels being available in shared bathrooms and toilets. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 17 Some identified maintenance are as follows: The toilet seat in the upstairs bathroom needs to be replaced. Curtains in communal areas need to be provided in a manner that can be reinstated when they have been pulled down. A broken cupboard door in the kitchen needs to be repaired. The damaged electrical fire in the dining room needs to be removed. The broken glass in the French doors leading from the dining room to the garden needs to be repaired. In addition the home needs to have a refurbishment programme for the next 18 months that identifies a timescale for work to be done. This needs to include the refurbishment of windows, replacement of the kitchen and refurbishment of the front entrance hall as well as continuing to decorate throughout the home and replace floorings as appropriate. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 18 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): 32,33,34,35 and 36 The service users are supported by a stable and experienced team of staff. There is however still a need for all staff to have two written references and to complete their induction training programme. A full training audit needs to take place to review what training staff have received and further training that is required and then an ongoing training programme needs to be put into place. EVIDENCE: The manager explained that at the time of the inspection there is a manager, deputy (who was the previous acting manager) and a team of support workers and bank workers employed to work at the home. The current staffing levels are four staff working in the morning, five in the afternoon / evening and two waking staff at night and one member of staff sleeping in. The staff team consists of 11 full-time and 4 four part-time staff as well as some bank staff. Of these staff 8 staff have started the NVQ training at levels 2,3 and 4. This means that just over 50 of the staff team are enrolled for NVQ training in care. The manager explained that there has been very low turnover and no new staff recruited since the previous inspection. This is because of changes that have taken place in another home in the organisation and some staff have Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 19 transferred to Ronak. The rota was inspected and the staff all appeared to be working appropriate numbers of hours. There is some use of agency staff but in the last few weeks the rota indicates that this is limited to between one and three shifts a week. The rota usually showed who was in charge of each shift but this was not recorded for every shift. There was also no record of which member of staff on each shift had a first aid qualification. The record of staff meetings was inspected and these are taking place every two months and are satisfactory. Four staff files were inspected. Each file included an application record, a CRB disclosure, a signed contract giving the member of staff their terms and conditions and appropriate ID. It was noted that one member of staff only had one written reference. There was no record to confirm that CRB disclosures had been checked for agency staff working in the home. The staff training records were inspected for four staff. One member of staff did not have a completed induction training record. Two of the four staff had current epilepsy training, none of the staff had current challenging behaviour training and only two of the four staff had training on autism. The staff supervision records were inspected. All of the staff had been supervised but only one of the staff had a record of receiving supervision every two months. The managers supervision records were also inspected and she had received supervision every two months as appropriate. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 20 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): 37,39 and 42 The service users live in a service with an appropriately qualified manager. The system to seek views on how the service is operating would benefit from including the views of relatives and other care professionals involved with the home. The health, safety and welfare of service users is promoted with improvements needed in fire safety and staff training to ensure they are protected effectively. EVIDENCE: A manager has been recruited to manage the service with the appropriate skills and experience. She has applied to be the registered manager. The manager also explained that she has nearly completed the NVQ level 4 in care management. The registered person monthly monitoring visits to the home have been delegated to other managers and are taking place as required with the reports being sent to the CSCI. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 21 The latest quality assurance information was inspected. This dates back to November 2005. Questionnaires had been completed by staff acting on behalf of the service users and by staff themselves. There was no evidence that the relatives or other care professional views had been sought. The quality assurance system has a scoring system but would benefit from a clear action plan. The health and safety training records were inspected for four staff. Three had food hygiene training, three had infection control training, three had first aid training, four had fire safety training and three had health and safety training. Some of this training had taken place more than two years ago and needs updating. The fire safety measures were inspected. The fire alarm and appliances had been serviced. Weekly fire alarm and emergency light checks and monthly drills are recorded as taking place. The fire door on the first floor was held open by the carpet and needs to be kept shut at all times. A fire safety risk assessment is available. The current certificates are available for the portable electrical appliances and the gas system. The certificate for the electrical installations was not available in the home as the original had been sent to the insurance company. The fridge and freezer temperatures are being checked weekly. Water temperatures are not checked but the showers are fitted with a water temperature control mechanism. The insurance certificate for the home was inspected and was satisfactory. The record of accidents and incidents was inspected and these are all recorded appropriately. Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 22 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 2 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 2 ENVIRONMENT Standard No Score 24 1 25 3 26 x 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 1 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score x 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 x x 1 x Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? YES 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 YA2 Regulation 14(2) Requirement The registered person must ensure that each service user has a comprehensive up to date assessment prepared by the home. The registered person must ensure that all the contracts between the home and the service user are updated. The registered person must ensure that copies of the record of the service users most recent review meeting are available so that the actions agreed at the meeting can be included in the service users care plan. The registered person must ensure that all the service users risk assessments are reviewed regularly. The registered person must ensure that a record is kept of the food consumed by the service users. The registered person must ensure that all staff have received adult protection training and a record of this training is available in their training record. DS0000010634.V287692.R01.S.doc Timescale for action 15/06/06 2 YA5 5(1)(b) 15/06/06 3 YA6 15(2)(b) 31/05/06 4 YA6 14(2)(a) 31/05/06 5 YA17 16(2)(i) 30/04/06 6 YA23 13(6) 15/06/06 Ronak Home Version 5.1 Page 24 7 YA24 8 YA24 9 YA34 10 YA34 11 YA35 12 YA35 13 YA36 14 YA39 23(2)(b)(c) The registered person must ensure that the maintenance issues raised in the relevant section if the report are rectified. 23(2)(b) The registered person must prepare a refurbishment programme for the home for the next 18 months and send this programme to the CSCI. 19(1)(a) The registered person must ensure that each member of staff has two written references and copies of these are placed in their staff file. This requirement is restated from three previous inspections. Timescale for action was 1/10/05. This is an immediate requirement. 13(6) The registered person must check the CRB disclosure for the agency staff working in the home and keep a record that this check has taken place. 18(1)( c) The registered person must (i) ensure that completed induction training is held on all staff files. This requirement is restated from two previous inspections. Timescale for action was 31/10/05. This is an immediate requirement. 18(1)(C) The registered person must ensure that all the staff have received the specific training needed to meet the needs of the service users including training on autism, epilepsy and challenging behaviour. 18(2) The registered person must ensure that all staff receive regular supervision at least every two months. 24(1)-(3) The registered person must ensure the quality assurance exercise seeks the views of relatives and care professionals. DS0000010634.V287692.R01.S.doc 15/06/06 15/05/06 31/05/06 15/05/06 31/05/06 31/07/06 15/05/06 31/07/06 Ronak Home Version 5.1 Page 25 15 YA42 13(4)(a) 16 YA42 13(3)(4) 17 YA42 23(4)(a) The results of this exercise must be collated into an action plan. The registered person must send a copy of the electrical installation certificate to the CSCI. The registered person must ensure that all the staff have received or have updated their health and safety training. This needs to include food hygiene, fire safety, first aid, infection control and health and safety. The registered person must ensure that all the fire doors are kept closed at all times. 30/04/06 31/07/06 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA13 Good Practice Recommendations The registered person should keep a record of each service users daily activities and if an activity needs to be cancelled or changed then there must also be a record of why this change has taken place. The registered provider should provide a separate fridge where staff can keep their food. 2 YA17 Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ronak Home DS0000010634.V287692.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!