CARE HOME ADULTS 18-65 RONAK 120 Aldermans Hill Palmers Green London N13 4PT
Lead Inspector Rebecca Bauers Announced 14 April 2005 at 09.50am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. RONAK Version 1.10 Page 3 SERVICE INFORMATION
Name of service Ronak Address 120 Aldermans Hill, Palmers Green, London N13 4PT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8882 3586 Michael Brausaz of MHJ Crausaz Ltd Vacant Post PC Care Only only 10 Category(ies) of LD Learning Disability registration, with number of places RONAK Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 13 January 2005 Brief Description of the Service: Ronak Home is operated by MHJ Crausaz Ltd. This company has two 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. The homes stated aims are to provide care and support to ten younger adults who have learning disabilities. RONAK Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection took place on the 14th of April as part of the annual inspection programme. The inspection took seven hours to complete. The home had an additional visit on the 13/1/05 to follow up on requirements made during the inspection on the 15th of October 2004. The announced inspection involved a tour of Ronak, a group conversation with four service users and six staff. No relatives had requested to speak with the inspector. The acting manager and two deputy managers were present throughout the inspection. The newly appointed operations manager was present for four hours. The pre-inspection questionnaire was not completed or returned to the CSCI which was disappointing and three comment cards were received, one from a relative; one from a care manager and a health professional. What the service does well:
Family and friends contact is good and promoted by the home. Service users rights are respected and a good selection of healthy, culturally appropriate food is provided in the home, which the service users enjoy. Service users indicated using makaton that they liked the food provided. The health needs of service users are well met with evidence of multidisciplinary working. Personal care needs are carried out in preferred ways promoting respect and dignity. Staff are according to the homes recent quality assurance summary ‘kind and caring’. The inspector did observe positive interactions between service users and staff during the inspection, service users seemed generally relaxed RONAK Version 1.10 Page 6 What has improved since the last inspection?
The registered provider has appointed a new operations manager, which, should enable full support through regular supervision to be given to the acting manager. The operations manager described some specific changes that she wished to implement to improve the continuity of the service provided to service users. These included recruitment, regular management meetings, review of the organisational policies and procedures and the general development of good practice within all of the homes. Eleven of the twenty three requirements made at the last unannounced inspection on the 15th of October had been met during the additional visit on the 13th of January 2005. At this inspection five of the eleven requirements had been met and six requirements had not been met. Following an immediate requirement issued on the 13/1/05 staff have been issued with new revised job descriptions (residential support workers) and contracts to reflect this, which has proved a positive experience for most of the staff spoken to. Staff are receiving regular supervision. Staff have received appropriate training in the administration of medication, rectal diazepam and manual handling and lifting. Following an immediate requirement issued. The homes quality assurance system has been implemented giving a clear indication of service users, staff and relatives thoughts with regard to service provision this will be of benefit to enable further service development to meet the needs of the service users living in the home at Ronak. Monitoring visits are being carried out more frequently although they have not been happening every month as required. The registered person has now referred a staff member to POVA and had complied with the recommendations made from strategy meetings and a subsequent adult protection investigation carried out by a placing authority in July 2004. RONAK Version 1.10 Page 7 What they could do better:
Fifteen requirements have been made at this inspection six are restated and one recommendation has been made. The staff files are still incomplete and need two references; the CRB checks that were present at the last inspection must be found and put back in staff files immediately. Staff files must contain a record of completed induction training undertaken and staff must enrol to do NVQ level 2 or 3 in care to ensure a level of competence within the staff team. Regulation 26 visits must be carried out every month. Service users have not all had an annual review, this is required. Service users individual plans still do not contain detailed information with regard to their autistic support needs and behaviours relating to autism. Risk assessments need to be updated. Medication PRN guidelines must be more specific to the individual to safeguard against over administration of a PRN. Authorisation records for the administration of medication by trained staff must be updated. The recommendations made following an O.T assessment for one service user must be complied with in order to meet the physical needs of the service user and to ensure staff safety when supporting her with personal care. Service users are still not receiving their benefits via their own savings account; benefits are being paid into a pooled account for all the service users. A requirement is made for the registered person to provide confirmation of progress made so far to enable service users to have their benefits paid into their own accounts, to access, save and spend their own money. Pooled accounts are an example of poor practice and must be rectified so that service users can rightfully access what they are entitled to when they wish. Maintenance issues are itemised in the relevant section of the report. These must be addressed for the safety and comfort of the service users at both sites. Staff must be recruited to the current vacancy that is currently being covered by agency staff to enable continuity in service delivery for the service users. Service users autistic needs benefit from continuity in care and established agreed routines. Improved Communication across the organisation is not yet evident however it is hoped that progress will be made with the recent appointment of the new operations manager and so is restated and as ongoing commitment to promote open communication. RONAK Version 1.10 Page 8 The registered person still has not recruited a manager to put forward to the CSCI to apply to become registered. This must be worked toward and achieved as a priority to promote clear direction and leadership within the home. Comments obtained from comment cards were non-committal and the health professional’s comments referred to the lack of leadership and staff incompetence to follow instruction and recommendations made. It is recommended that the home has a designated driver to facilitate service users access to the community. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. RONAK Version 1.10 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection RONAK Version 1.10 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Service users individual aspirations and needs are assessed. EVIDENCE: There have been no new admissions since the last inspection. The home conducts a thorough assessment of prospective service users. There was also evidence of care manager assessments in service user files. One service user may be moving out from the home in the next month due to her changing needs. The acting manager stated that she would inform the Commission when this happens. RONAK Version 1.10 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9 Service users assessed needs are not fully documented, changing needs have been reflected in the individual plans, although service users are not having annual reviews with other professionals, which may lead to non-identification of changing needs and limitation to the resources they require to meet the service users needs. Service users are supported to take risks although these are not being satisfactorily reviewed. EVIDENCE: Some progress has been made with the restated requirement made at the last additional visit for the service user individual plans to reflect the autistic needs of service users. However they still do not specify the actual autistic needs exhibited and the type of consistent support that is needed from staff. This must be included in the individual plans to ensure that a clear distinction is made between autistic needs and challenging behaviour needs. Service user individual plans are detailed and most have been reviewed on a six monthly basis. Three service users annual reviews involving a multidisciplinary input were overdue and in some cases the review notes were not
RONAK Version 1.10 Page 12 held on file for those who had had an annual review. It is essential that reviews occur annually and that records of these are held on file in order to up date individual plans to specify support needs that may have changed and goals for service users. Risk assessments are reviewed annually and require more frequent reviews due to the high and changing needs of the service users. Contact sheets are held on individual files to keep a record of all contact made with other health professionals and care managers. RONAK Version 1.10 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15,16,17 Service users do take appropriate activities although these can sometimes be restricted by the lack of a designated driver. Contact with family and friends are good. Service users rights are respected and a good selection of healthy, culturally appropriate food is provided in the home, which the service users enjoy. EVIDENCE: Service users do undertake a variety of activities although these can be reduced when the home does not have a ‘designated driver’ to drive the homes vehicle. Some service users attend day centres; others access activities in the local community. Some service users have recently returned from a holiday in Torquay, which they very much enjoyed. Service users are encouraged to maintain regular contact with family and friends. Service users summary from the quality assurance tool stated clearly that staff respect their rights, privacy and dignity and that there are enough
RONAK Version 1.10 Page 14 opportunities for them to get ‘out and about if they want to’ and that ‘cultural and religious beliefs are observed’. According to the quality assurance summary service users felt that the food ‘is nice and that it is presented in an appealing and appetizing manner’. Food provided in the home meets the cultural needs of the service users. Food stocks contained halal meat which is specific to some of the service users cultural needs. RONAK Version 1.10 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 The management of medication is good however there is a need to develop the PRN guidelines to safeguard the service users fully. The health needs of service users are well met with evidence of good multidisciplinary working. The physical needs of service users are not being fully met and this specifically puts one service user and the staff at risk. Personal support is offered in such a way to ensure service users privacy and dignity. EVIDENCE: Staff are following the homes medication policies and procedures for the administration and storage of medication. The good management of the medication promotes the good health of the service users. The staff signatures in the front of the medication file which stipulates who has been trained to administer medication had not been up-dated since the recent medication training, this record must be updated. PRN guidelines are in place but need to be developed to include the specific behaviours exhibited prior to the administration of the PRN to safe guard service users from over administration. Service users personal care needs and preferences are well documented in their individual plans. Service users now have annual health checks and benefit
RONAK Version 1.10 Page 16 from regular input from health professionals such as occupational therapists, psychologists and psychiatrists. One service user had an O.T assessment on the 23/12/04, which stipulates various recommendations that range from the need for adaptations such as a hoist to use her en-suite bathroom to finding an alternative placement with aids and adaptations already in place to meet her needs. The recommendations stipulated by the O.T must be acted upon for the health and safety of the service users and staff. The quality assurance summary outcome was low for the question ‘ the home is suitably adapted and equipped for my needs’. Accidents and incidents have been recorded appropriately since the additional visit on the 13/1/05. RONAK Version 1.10 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Adult protection procedures are good. Staff now have a clearer understanding and knowledge to protect service users from abuse, neglect and self-harm. The homes grievance procedure is not being utilised by staff. The complaints procedure is accessible to service users and visitors, service users views are listened to and acted upon. Continued poor practice with regard to the pooling of service users monies is not acceptable and a breach of the service users rights. EVIDENCE: Little progress has been made with regard to the requirement made concerning the registered person providing clarity and evidence of how service users, receive, access, save and spend their own money. The registered provider did however confirm in a meeting on the 24/3/05 that this is being looked into but no indication or confirmation of when this process will be complete has been given so far. The arrangements for service users to access their money through their own savings accounts instead of through a pooled account must be confirmed in writing to the Commission. The support required for service users to manage their own money had been documented in the individual plans since the last inspection and included the name of the appointee. Progress had been made with regard to a restated requirement made during the additional visit on the 13/1/05 for the registered person to comply with the recommendations and actions stipulated during a strategy meeting on the 25/6/04 and a subsequent investigation carried out on the 16/7/04 by Hackney, the service users placing authority. The homes adult protection
RONAK Version 1.10 Page 18 procedures have been amended following an immediate requirement issued on the 15/10/04 to reflect the appropriate reporting procedures and to promote the welfare and protection of service users. The member of staff who had been dismissed as a result of an investigation carried out by the home has now been referred to POVA as per the recommendation made during the strategy meeting. This was confirmed by the registered provider during a meeting on the 24/3/05. Staff have undertaken POVA training on 3/2/05 and are now knowledgeable with regard to the reporting procedures to follow to safeguard service users. The complaints records have been amended prior to the additional visit to include if a complaint is substantiated or not. There have been no complaints since the last inspection according to records. Service users said on their quality assurance questionnaires that they felt confident that complaints would be listened to, taken seriously and acted upon. In contrast the Commission have received many phone calls from staff at all levels with queries and concerns with regard to practice and working conditions during the period in which there has been no operations manager to address these issues. The Commission had disclosed some of these issues to the registered provider during a meeting on the 24/3/05. The registered provider had not received any of these concerns through the organisations grievance procedures. RONAK Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,30 Service users are benefiting from the recent investment in the replacement of furnishings and the re-decoration of some of their own bedrooms, which has created a more comfortable and safe environment. The home is clean and hygienic. Further maintenance work is needed to improve standards. EVIDENCE: The environmental conditions of the home have been improved since the last inspection all requirements had been met and in addition the home had replaced the flooring in the dining area with a wooden floor and an additional sofa had been provided. All radiators have been fitted with decorative covers, which now need painting. Two of the service users bedrooms have been recently decorated to their own preferences making them bright and homely. A new fridge and freezer has been purchased since the last inspection. Further maintenance issues are as follows: One of the sofas in the lounge has broken and needs to be repaired. The mattress in bedroom number 7 smells of urine and needs replacing. The headboard in bedroom 3 is stained and torn and must be replaced.
RONAK Version 1.10 Page 20 The en-suite toilet seat in bedroom 5 is chipped and needs replacing. The carpet in bedroom 6 is uneven and worn and the headboard on the bed is broken. Both must be replaced. RONAK Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 The staff records are poor and the homes recruitment policy and procedure is not being followed to protect the service users. Staff have received a good level of training to meet the needs of the service users, however they have not completed NVQ Level 2 in care to indicate full competence to meet the needs of service users. Staff receive good support through regular supervision and team meetings from their direct line managers promoting some continuity of service provision and more positive staff morale. Service users benefit from staff being clear about their roles and responsibilities and the sharing of tasks. EVIDENCE: Progress has been made with restated requirement concerning staff training. More than half the staff had received medication administration, manual handling and rectal diazepam training. Staff commented positively that there had been far more training offered since the last inspection. Staff job descriptions have been revised and contracts had been issued to staff providing clarity of role and responsibilities to the ‘residential support workers’. Staff records demonstrated the occurrence of regular supervision, staff spoken to confirmed that they also had monthly team meetings and that they are consulted more regularly which has helped to promote more ‘positive team work and to boost morale’. Service user feedback from the quality assurance
RONAK Version 1.10 Page 22 survey identified that ‘staff show kindness and understanding and know what I like and don’t like’. All staff stated that they now had access to a copy of the General social care councils (GSCC) standards of conduct and practice following a recommendation made at the last inspection. Five staff records examined were found to be incomplete. The restated requirement had been progressed partially by containing recent photo ID however four out of five references were not in the files. There were incomplete or no staff induction on file and the CRB checks that were present at the last inspection were now missing. Only one of the files contained a CRB check. All these documents must be in place to safe guard the service users. Staff have not enrolled to do NVQ level 2. This must be rectified. The acting manager stated that four staff will be booked on NVQ level 3 in care and seven staff will be booked on NVQ level 2 in care. The home has a twenty-four hour a week vacancy, which is currently being covered by agency staff. Staff expressed that agency staff shadow them on duty prior to working independently with service users which means that they can sometimes be stretched to meet the service users needs fully, particularly those with more complex needs. The vacancy must be recruited to permanently to allow continuity of care to meet the service users needs. RONAK Version 1.10 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38,39,42 There is a detailed quality assurance system in place, which has enabled service users to feel confident that their views underpin the self-monitoring and development of the home. Other monitoring systems still need to be progressed. There is potential for the leadership and management of the home to benefit the service users and staff but this is not yet happening. The health, safety and welfare of service users is promoted and protected effectively. EVIDENCE: The immediate requirement made at the last additional visit on the 13/1/05 for the home to have a quality assurance system in place and for it to be implemented had been fully addressed. The complete document with a summary of results was available. The summaries gave a clear indication of where the home needs to make improvements in service delivery for service users. This is a great asset to the home in the development of an improvement plan. RONAK Version 1.10 Page 24 Progress had also been made with the requirement for the registered person to carry out unannounced monthly visits to the home. Three visits had been carried out in the last five months and the reports were available in the home. These must however be carried out every month. The acting manager has recently received supervision from the newly appointed operations manager. This is a positive step in providing support and in the development of the service for the service users. The acting manager will be leaving her post on the 31/5/05. The restated requirement for a manager to be appointed and to apply to the CSCI to become registered has not been progressed and is a matter of urgency. The inspector is hopeful that the requirement made for communication between the staff team, managers and director are professional, open, clear, consistent to ensure the objectives of the home are being worked toward to promote the continuity of care for service users will be addressed fully with the new operations manager in post. The operations manager expressed identified areas for development and continuity to improve overall service provision and the safety of service users. The first joint managers meeting is planned for the 27/4/05. There is now a suggestion box in place in the home. The home maintains all records for the health and safety of service users. Records were seen for fire drills, electrical checks, insurance cover and a detailed work place risk assessment. 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. Where there is no score against a standard it has not been looked at during this inspection. 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) RONAK Version 1.10 Page 25 “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 1 3 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 2 1 1 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 x Standard No 37 38 39 40 41 42 43 Score x 1 2 x x 3 x RONAK Version 1.10 Page 26 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 15(1) Requirement Timescale for action 31/5/05 2. 38 12(5)(a)( b)21(1) The registered person must ensure that the service users who have been diagnosed as autistic have a service user plan that reflects specific behaviours exhibited which are typical to the individual and their support needs to promote consistency. This requirement is amended and restated from the last three inspections. Timescale for action was 30/11/04 and 13/2/05. Copies of the updated service user plans for four service users must be sent to the CSCI. The registered person must 31/5/05 ensure that communication between the staff team, the managers, operations manager and the director of the organisation are professional, open, clear, consistent and reviewed on a regular basis to ensure that the aims and objectives of the home are being worked toward to promote the continuity of care for service users. This requirement is amended and restated from the last three inspections. Timescale for action was 30/11/04 and
Version 1.10 Page 27 RONAK 30/2/05. 3. 39 26 The registered person must ensure that the monthly visit reports carried out by the registered provider or one of the partners are also kept in the home. This requirement is amended and restated from the last two inspections. Timescale for action was 10/12/04 and 1/2/05. The registered person must supply the CSCI with documentation to clarify the current procedures for service users to receive the appropriate benefits that they are entitled to. Current documented evidence must be provided of how service users receive, access, save and spend their own money. This requirement is restated from the last two inspections. Timescale for action was 15/11/04 and 28/2/05. The arrangements for service users to access their money through their own savings accounts instead of through a pooled account must be confirmed in writing to the Commission. The registered person must ensure that all staff two written references and the copies of the CRB checks that were previously in the staff files must be found and replaced . These must be available for inspection. This requirement is amended and restated from the last inspection. Timescale for action was 1/4/05. The registered person must ensure that the Care Home has a registered manager in post to manage the care home. This requirement is restated from the last inspection timescale for
Version 1.10 1/5/05 4. 23 20(1)(a)( b) 17(2) schedule 4 (9)(a) 30/6/05 5. 34 19(1)(a) Schedule 2 31/5/05 6. 38 9(1)(2) 31/6/05 RONAK Page 28 action was 1/2/05. 7. 6 15(2)(b) The registered person must ensure that service users have annual reviews and that the review notes from the home and the social worker are held on the service users file. The registered person must ensure that service user risk assessments are reviewed at least every six months. The registered person must ensure that the recommendations made in the report following an O.T assessment conducted on the 23/12/04 are complied with. The registered person must ensure that the records in place indicating which staff are authorised and trained to administer medication must be revised and updated. The registered person must ensure that the PRN guidelines specify the specific challenging behaviour exhibited prior to the administration of the PRN. The individual plan must contain this information also. The registered person must ensure that the maintenance issues raised in the relevant section of the report are rectified The registered person must ensure that staff are enrolled on NVQ level 2 or 3 in care. 50 of the staff team have not yet achieved this. The registered person must recruit to the current residential support worker vacancy to aide continuity of care for service users. The registered person must ensure that completed induction training is held on all staff files.
Version 1.10 30/6/05 8. 9 13(4)(c ) 31/5/05 9. 19 23(2)(n) 12(1)(a) 30/6/05 10. 20 13(2) 31/5/05 11. 20 13 (2) 30/6/05 12. 24 23(1)(2) 31/7/05 13. 32 18(1)(a) (c) (i) 30/6/05 14. 33 18(1) (a) 1/7/05 15. 35 18(1)( c) (i) 1/8/05 RONAK Page 29 16. 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 13 Good Practice Recommendations It is recommendaed that the registered person have a designated driver to facilitate service users access to activites wider community. RONAK Version 1.10 Page 30 Commission for Social Care Inspection 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
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