Inspection on 12/07/05 for The Melanie Ann Trust

This inspection was carried out on 12th July 2005.

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

Other inspections for this house

The Melanie Ann Trust 17/05/07

The Melanie Ann Trust 08/08/06

The Melanie Ann Trust 03/02/06

The Melanie Ann Trust 13/12/04

The Melanie Ann Trust 05/08/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

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33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 The Melanie Ann Trust (99 Saltings Road) 99 Saltings Road Snodland Kent ME6 5HA Lead Inspector Lynnette Gajjar Unannounced 12 July 2005 10:00 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. The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Melanie Ann Trust (99 Saltings Road) Address 99 Saltings Road Snodland Kent ME6 5HA 01634 243430 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) The Melanie Ann Trust Mrs Jennifer Iris Edwards CRH Care Home 2 Category(ies) of LD Learning Disability (2) registration, with number of places The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13 December 2004 Brief Description of the Service: The Melanie Ann Trust is registered with the Charities Commission and currently has two properties in Snodland. 99 Saltings Road is an end of terrace property close to Snodland town centre, with a small external garden. 99 Saltings Road is registered to provide residential care and accommodation for 2 younger adults with learning disabilities and sensory impairment. Service users are enabled to attend day centres, and also college, which provide a variety of activities. The sister home is close by and provides care for 3 young adults with learning disabilities and sensory impairments. The care staff currently work across both homes. The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2005 to March 31st 2006. This visit took place from 10am until 13.05pm with two inspectors. The home currently has 2 service users who have lived here for a number of years and is running with no vacancies. The visit was spent observing service users through their daily routines and talking to care staff, the registered manager Mrs Jennifer Edwards, responsible individual Mr Edwards Senior. Two relatives were also visiting at the time of visit but were busy decorating their relative’s bedroom, familiar and respectful interaction was observed with staff. Due to the nature of the service and communication limitations, it is difficult to reliably incorporate accurate reflections of the service users in the report. Some judgements about quality of life and choices were taken from direct observation followed by discussion with staff and evidencing records held at the home. A tour of the premises was undertaken. Social Services and the commission gathered further evidence through the adult protection investigation that is currently being monitored. Issues identified through the recent adult protection investigation that the home require changes in culture and working practises to offer a better lifestyle for service users. The commission recognises this will take a longer time to achieve than some of the more tangible requirements made through this report. What the service does well: What has improved since the last inspection? Medication processes have developed to offer some safer working systems. Some staff core training has been undertaken giving staff better awareness of care needs. Staff morale and motivation is developing with more communication between staff. The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 6 New staff have been employed to fill the vacancies occurred in the past month. Staffing levels are maintained currently through the use of core agency staff on fixed contracts whilst new recruitment is achieved. Fire risk assessments have been completed through an external consultant. Recommendations have been completed and approved by the fire officer. Service users have the benefit of a newly installed central heating system. Full health and social care assessments have been undertaken for both service users. The board of trustees and the registered manager have met to discuss the findings of the adult protection investigation and action needed to improve the service provided and look to the future for current service users. Trustees have started to do monthly-unannounced visits from May 2005 to monitor actions agreed and talk with staff and service users. Family members have been approach to join the board of trustees. What they could do better: Service users lifestyles would benefit by the organisation listening to specialist assessments and support from other professionals and implementing good clear guidance and documentation for staff to follow and setting up monitoring systems internally to ensure they are maintained. Service users and staff will continue to benefit from consistent leadership and management who are up to date with the latest guidance and legislation in relation the adult social care. Further robust medication practice and guidelines for PRN medication would greatly improve service uses well - being and safer administration of medication. Continued improvement of consistent working relationships between staff will enhance the communication and care received by service users. Through the refurbishment and repair to the first floor bathroom, service users would be guaranteed a safe and comfortable bathing facility. Service users would be able to move more freely around the home with the installation of automatic fire door closures. Staff would feel more confident in the support they provide for service users through specialist input and guidance in the effective management of current behaviours and sensory impairments. The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 7 Service users and families would benefit from an easy to follow clear service user guide detailing what exactly the home is and is not able to support them with. 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 Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,4,5 Information provided by the home does not enable service users and representatives to make informed decisions as to whether the home can meet their individual needs. EVIDENCE: The statement of purpose and service users guide is currently put together into one large booklet for both homes in the trust including policies and procedures. This is being fully reviewed and designed with the support of Croner and Mulberry House guidance purchased by the trust since the last inspection at the sister home in May 2005. Due to the service users care needs; their involvement in the assessment process would be difficult to reflect with them directly. Mrs Edwards confirmed trial visits and assessments did take place with their representatives / placing authority or advocates / relatives. Both service users are local authority funded and have service agreements between the LA and the trust. Contracts are held in service users care plans; these are detailed and large documents. They would not be understood or followed by the current service users and would require representatives signing on their behalf. Those seen did not cover all areas required in standard 5. All service users have had full contractual and funding re assessments by their placing authorities as part of an adult protection investigation with ongoing reviews. The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 10 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) 6,7,8,9,10 Care plan records currently do not offer clear and concise information to the home to meet the needs of current service users. Risk assessments and guidelines are not detailed enough to ensure consistent approaches by staff. EVIDENCE: Care managers and health specialists have undertaken full reviews of the care provided and records held through the adult protection investigations. The home has all assessments to work from. Risk assessment training has been booked for August 2005 for senior staff and will form the basis of the care plan development. The current format is difficult to follow and requires updating. The trust has purchased a care plan format that they agreed to have fully competed and in working practice by 30th November 2005 as part of their agreed action plan with the commission. Some records seen today were not signed on completion; duplication of records was also evident. Staff are exploring development of visual and tactile object referencing to involve service users as best they can. The registered manager and senior staff are motivated to develop care plans further to be more photographic and object reference formats understood by the individual. Files are stored in locked filing cabinet. Appointeeship has been transferred for one service user to local authority representatives and the other is in hand. Direct observation showed service users instigating contact with staff for support in making drinks and The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 11 lunch. Service users responded to staff fondly and with familiarity through relaxed body language and sounds. Service users were seen to clearly make decision of not to do activities or choices in drinks and meals. There is no recorded information of the choice and agreement service users had within the sister home to use their sensory room. Mrs Edwards stated this is still to be addressed with advocates. Environmental risk assessments have been produced but require reviewing in light of the new heating systems and installed radiators. The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 12 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) 12,13,14,15,16,17 Service users have good community links and personal relationships are promoted. Service users can expect good quality fresh food. Service users lifestyles would benefit from staff having training/ skills and awareness of good practices, resources and support techniques in working with the sensory impaired. EVIDENCE: Records seen showed service users attending horse riding, trampoline, gardening, health suite and local adult education services. A service user was supported to go horse-riding this morning and the other went for a walk around the stables whilst there. Staff confirmed taking service users to such activities, on a 1:1 basis. Both service users were supported to make their sandwich lunch with hand on hand guidance. Due to service users level of ability pursuing work or work experience is not within their personal goals. The promotion of individual choices and rights could, and is, easily restricted because of individual capacity to understand and express their wishes to staff and staff ability to read and understand what is being asked of them. Training and assessments are booked from Kent Association for the Blind to support The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 13 and encourage independence for those with a visual impairment. Care plans and guidance must be detailed and clear to ensure consistent approaches by staff. The kitchen was observed to be clean, well – equipped and stocked with fresh produce and meals were served with ample portions. Meals looked wholesome and appetising. The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 14 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 Service users would benefit from staff developing key communication skills and techniques to enable effective and interactive contact. Service users are at risk of incorrect use of PRN medication, as the home has not yet completed clear guidance for staff to follow. EVIDENCE: Full health assessments have taken place with full feedback to Mrs Edwards. Service users have contact with health care professionals. From this referrals to Speech and Language have been made. Including support from local Primary care trust (PCT) Psychologist. A staff member was seen to use basic hand on hand signing communication with one service user. Otherwise vocal, physical direction was used to communicate activities. Service users walked freely around the home accessing the facilities as they wished. Staff were seen to respond and support personal needs. Some actions from the pharmacy inspector’s visit have been implemented but there was still a number to be completed within the agreed timescales. Mrs Edwards has met with the G.P to request clear guidance for PRN medication and he was stated to be writing to her regarding this. Staff have received training in administering of medication. Medication was stored in separate containers for internal and external medication. This working area is very cramped and in a corridor restricting access. The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 15 The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 16 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 The lack of up to date knowledge and guidance means service users are at risk of being supported inappropriately. EVIDENCE: The home has a written complaint procedure, which is in the written format. Other formats are now being explored but not yet implemented. Mrs Edwards has investigated two formal complaints received from other representatives in the local community. Care staff and management have undertaken adult protection training over the past 6 months. Language and techniques seen in previous records did not promote good practice in managing challenging behaviours. Staff have undertaken a one day training in behaviour management through Studio 3. Staff will also be seeking support and advice through the referral to the Primary Care Trust Behavioural therapist in developing good practice guidelines and monitoring methods. Care plans and behaviour management guidelines are currently being reviewed and new care plans will be devised by 30th November 2005 following the full risk assessment process. A senior carer who had completed the diploma in Challenging Behaviour left the service in October 2004. There is currently an adult protection alert being monitored through Kent and Medway Adult protection protocols. The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 17 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) 24,25,26,27,28,29,30 Service users would benefit further from a living environment, designed, decorated and equipped to promote their personal independence. That is safe and promotes individual care needs in relation to their sensory and hearing impairments. EVIDENCE: 99 Saltings Road is a small-adapted four-bedroom property located within walking distance to Snodland high street and shops. There is a sleep-in room. Two service users bedrooms are single and of comfortable size to meet the needs of current tenants. The third bedroom has been converted into a sensory lights and sound rooms for relaxation. A service users family are currently redecorating their relatives’ bedroom. There is an open planed kitchen and dining area leading to a small terraced garden, with railed steps to the back entrance. Staff stated service users rarely used this entrance. Kent Association for the Blind are due to undertake a full assessment of the environment and make recommendations. Areas such as lighting, colour coordination of decoration and such items as crockery/ plates/ tablecloths etc would be beneficial to promote a safe home and independence for those with a sensory loss. Also highlighting step edges and railings in the garden. The lounge is small but meets the needs of two service users. The toilet and The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 18 bathroom will require upgrading and redecoration in the near future. No taps including the bath have thermostatically controlled mixer valves. Staff state temperatures are taken prior to a bath and record seen to support this at safe temperatures. Toilet seats here was broken and on this visit had been removed. Fire doors and frames have been completed and approved by the fire dept. Further recommendation for automatic door closures remains outstanding from their recommendations. Despite this work the home was clean but redecoration through out is now required. The doorbell fitted has visual and sound triggers. Service users have lived here for a number of years and appear to have adapted to the current environment but were observed to require staff guidance and direction to such hazards around the home. Laundry facilities are located in the kitchen. The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 19 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) ,32,33,35,36 The standard and consistency of care service users are offered has improved. There is a definite willingness and motivation to improve the service provided and work as a team, to do the best for service users. EVIDENCE: The care staff team work in both homes managed by the trust. Rosters are colour coded but difficult to follow. The home has experienced a number of staffing issues to manage through staff leaving over the past 12 month. Three further permanent staff has left since June 2005. Mrs Edwards has been covering hours through the use of two agencies and core named staff. A senior agency worker has been employed for 3 months to assist in the development of paperwork and care plans. Two new permanent staff have been employed. One was on duty today and evidenced good recruitment process and having already attended training course in health and safety issues and was very impressed with the support and induction they have so far received. Conflicts identified in previous inspection appear to have decreased due to turnover of staff but not yet fully resolved. Training records evidence more core health and safety training taking place since January 2005 with further training being booked in coming weeks. ‘six training days in six months that better than an where else I have worked’. There are still some gaps in core induction training before moving into foundation recommendations. Current staff with NVQ 2 in care or equivalent is 5. Two staff is currently undertaking this with a further staff member is waiting to The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 20 register. Staff confirmed formal and informal time was spent with the manager. Since the commission intervention through the adult protection investigation staff have had a team meeting to discuss way forward and areas that require addressing. The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 21 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) 37,38,39,40,42 There is better leadership; training systems in place to enable the management of the service to develop and grow into new and current good care practice, and so beginning to reduce the potential risk to service users. EVIDENCE: Mrs Edwards was last year on long-term sick leave but returned to work early following the resignation of the team leader. The team leader was managing the home during the sick leave. Mrs Edwards holds a current registration for Nursing for learning disability level 2. Mrs Edwards has undertaken one-day training courses since January 2005. Mrs Edwards last undertook ‘behaviour modification’ training in 1982. Mrs Edwards is currently registered to undertake her Registered Managers Award NVQ 4. Mrs Edwards and Mr Edwards SNR and JNR are becoming more aware of current legislation and guidance on changing social care for adults but this will take time to implement within the homes policies and procedures. The trust has invested in the Croner Management guide to assist with meeting the National Minimum Standards. Quality assurance systems are to be developed but not yet in place. The Melanie Ann Trust has four trustees; families have been approached to become The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 22 trustee members. Trustees meet twice a year with Mrs Edwards. Trustees have started to do unannounced visits to the home to monitor care; records, finance and staff practice including the manager. This is a new task and in it’s infancy requiring development of skills and knowledge of the service and report records. The family as founders of the trust have strong personal ties to the homes, all in daily contact and working within the homes. Full financial audits were undertaken as part of the adult protection process and assessed as on the whole satisfactory, good practice recommendations were made. The trust is currently looking at a developmental plan for the service, evaluation of appropriateness of current service and properties to meet the needs of current or new service users. Fire safety has been approved by the fire office with recommendation of the installation of automatic door closures on all doors. Further staff has and are doing their first aide appointee training. Accident records were seen and records are now compliant with data protection. Formal auditing systems are yet to be introduced. The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x 3 2 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 2 1 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 2 3 2 2 Standard No 11 12 13 14 15 16 17 x 2 2 2 3 3 3 Standard No 31 32 33 34 35 36 Score x 2 2 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Melanie Ann Trust (99 Saltings Road) Score 2 2 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x 2 x H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 6 Requirement Timescale for action 30th November 2005 2. YA7 15(1) The registered person shall keep under review and where appropriate, revise the statement of purpose and the service users guide and notify the commission and service users of any such revision with in 28n days.By ensuring information held is accurate and reflects the services provided to include all that is required under schedule one. By removing unnecessary information and policies. This is carried over from the previous inspection on 13th December 2004 Unless it is impracticable to carry 30th out such a consultation the November registered person shall after 2005 consultation with the service user or representative of his prepare a written plan (“the service users plan”) as to how the service users needs in respect of his health and welfare, are to be met.In that care plan are reviewed within the multi disciplinary process to ensure all assessments, aspirations and care/ behaviour strategies are clear and agreed, current with Version 1.40 Page 25 The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc 3. (YA9 13(4) 4. YA 20 13(2) 5. YA 24 23(2)(a)( b)(f(n)(o) latest legislation and promote good practice and protect service users from potential risk of harm.Not met from previous inspection December 2004. This is carried over from the previous inspection on 13th December 2004. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. In that environmental risk assessments are reveiwed and appropriate action taken, particularly with regard to the steps, radiators and individual risk assessments be expanded upon in scope. This is carried over from the previous inspection on 13th December 2004 It is required that specific instructions be recorded and agreed with the GP (wherever possible) for the administration of PRN medicines, particularly sedatives, and other medicines of this type. This is carried over from the previous inspection by the pharmacy inspector in January 2005 The registered person shall having regard to the number and needs of service users ensure that:Ø The physical design and layout of the premises to be used as a care home meet the needs of the service usersØThe premises to be used as a care home are of sound construction and kept in good state of repair externally and internally.Suitable adaptations are made and such support, equipment and facilities are provided for service users who are physically disabled 30th November 2005 30th November 2005 30th September 2005 The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 26 6. YA32 &35 18(1)(a) 7. YA37 12(1)(a)( b)) 8. YA39 26 (sensory impaired)Ø EXternal grounds, which are suitable for, safe for use by, service users, are provided This is carried over from the previous inspection on 13th December 2004. The registered person shall having regard to the size of the care home, the statement of purpose and number and needs of service users:Ø Ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users.In that all care and management staff have undertaken core and foundation training and assessed competent by accredited trainers. Clear evidence is in place of courses attended. Implementing practice will now be monitored. This is carried over from the previous inspection on 13th December 2004 The registered manager shall ensure that the care home is conducted so as:Ø To promote and make the proper provision for the health and welfare of service users.Ø To make proper provision for the care and where appropriate treatment, education and supervision of service users. This is carried over from the previous inspection on 13th December 2004 Where the registered provider is an organisation or partnership, the care home shall be visited in accordance with this regulation by – (c) An employee of the organisation or the partnership 30th November 2005 30th November 2005 30th September 2005 The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 27 9. YA39 24(1) that is not directly concerned with the conduct of the care home.Visits under paragraph (1) or (2) shall take place at least once a month and shall be unannounced.The person carrying out the visit shall - (a) Interview, with their consent and in private, such of the Service Users and their representatives and persons working at the care home as appears necessary in order to form an opinion of the standard of care provided in the care home;(b) inspect the premises of the care home, its record of events and records of any complaints; and(c) prepare a written report on the conduct of the care home.Submit a copy of the report to the manager and commission This is carried over from the previous inspection on 13th December 2004 The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. This is carried over from the previous inspection on 13th December 2004 30th September 2005 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 YA1 Good Practice Recommendations It is recommended that the service users guide be devised into a format that is easily understood by service users. This is carried over from the previous inspection on 13th December 2004 It is recommended that service users be supported by H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 28 2. YA5 The Melanie Ann Trust (99 Saltings Road) 3. YA6 4. YA6 5. 6. YA6 YA7 7. YA7 8. YA7&23 9. YA10 10. YA11 family, friends and/or advocate (care manager) as appropriate when drawing up the contract with the home. Where the service user is unable to understand the contract, this is explained and signed on their behalf by family, friends and/or advocate (care manager) as appropriateThis is carried over from the previous inspection on 13th December 2004Contract should be written as guided by the office of fair-trading. This highlights that prospective residents should have straightforward, written contracts in clear, easy to understand language, and in a suitable format, such as large print. http:/www.oft.gov.uk/news/press releases/2004/1204.htm It is strongly recommended that the care plan establish individualised procedures for service users likely to be aggressive or cause harm or self-harm, focusing on positive behaviour, ability and willingness through current dept of health guidance and legislation. It is recommended that the care plan is made available in a language and format the service user can understand (e.g. visual, graphic, simple printed English, deaf. blind manual, explanation, British sign language video, audio tape). It is recommended that all entries made to the care plan are signed. It is recommended that staff and management demonstrate how individual choices have been made and record instances when decisions are made by others and why. It is strongly recommended that where limitations on facilities, choice or human rights to prevent self harm or self neglect or abuse or harm to others are made only in the persons best interest, consistent with the purpose of the service and the homes duties and responsibilities under the law. It is strongly recommended that where a Works and Pensions appointee or other agent is necessary, the appointee/agent is independent to the service. This is carried over from the previous inspection on 13th December 2004 It is recommended that personal information regarding service users must be removed from open documents such as statement of purpose, service user guide and daily communication books /records. It is recommended that service users with multiple disabilities are offered specialist interventions and opportunities by trained staff. H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 29 The Melanie Ann Trust (99 Saltings Road) 11. YA18 12. YA20 13. YA22 14. YA23 15. YA24 16. YA26 17. YA27 18. YA29 It is recommended that service users have the technical aides and equipment they need for maximum independence (which staff are trained to operate as needed), determined by professional assessment, reviewed and changed or replaced promptly as the service users needs change and are regularly serviced. It is strongly recommended that the home obtains a copy of the BNF in relation to information, contradictions and side effects of medication currently supplied to service users and this is updated every six months. It is recommended that the homes complaint procedure is explained or devised into a format easily understood and followed by service users.A record is kept of all issues raised or complaints made, details of any investigation, action taken and outcome, and this record is checked at least 3 monthly It is strongly recommended that physical and verbal aggression by a service user is understood and dealt with appropriately, and physical intervention is used only as a last resort by trained staff in accordance with Dept of Health guidance, protects the rights and best interests of the service user, and is the minimum consistent with safety. It is recommended that the home meet the requirement of the local environmental health dept, health and safety and buildings act and regulations and from 1st April 2004 the Disability Discrimination Act 1995 Part 3. This is carried over from the previous inspection on 13th December 2004 Service users bedrooms should include (unless otherwise agreed in the persons individual plan, or being identified as in their best interests) the items documented in standard 26.2. This is carried over from the previous inspection on 13th December 2004 It is recommended that the bathroom be upgraded as part of the homes redecoration programme to ensure facilities are maintained to good standards and promote infection control management. This is carried over from the previous inspection on 13th December 2004 It is strongly recommended that registered person ensures the provision of the environmental adaptations and disability equipment necessary to meet the homes stated purpose and the individual assessed needs of all service users.Home s offering a service to the sensory impaired provide specialist aides and adaptations as needed to include for example:Ø Loops/microphones/mimcoms/textphones/videophon eØ Additional and/or antiglare lighting, colour contrastingØ Tactile symbols, objects of reference, H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 30 The Melanie Ann Trust (99 Saltings Road) 19. YA30 20. YA30 21. YA31 22. YA32 23. 24. YA33 YA33 25. YA35 26. 27. 28. YA35 YA35 YA36 varied textile surfaces.Ø Florescent or padded hazard/obstruction (where they cannot be removed)Ø Computers for personal useØ TV with video/DVD recorder with subtitle or sign language facility.Safety systems and equipment are appropriate for people with sensory problems e.g. flashing light /vibrating fire alarms. It is recommended that dirty / soiled laundry is carried into the kitchen whilst food is being prepared, cooked or eaten.It is recommended that soiled water disposable washing bags is considered to minimise the handling of soiled laundry. It is recommended that carers to manage infection control effectively identify personal toiletries and equipment through clear format/system. (For example list toiletries used by individual service user on inside of bathroom cabinet door and use own designated cupboards only for storage, colour coordinate cups, toothbrushes, flannels, towels etc to limit the use of labelling. It is strongly recommended that detailed job descriptions be devised, and that staff be issued and are familiar with the GSCC code of conduct. This recommendation is carried over from the last inspection on 13th December 2004. It is recommended that staff continue to be facilitated to attain NVQ qualifications as stated in the standard. This is carried over from the previous inspection on 13th December 2004 It is recommended that regular staff meetings take place and are recorded with action taken. It is recommended that there are staff on duty at all times who can communicate with service users in their first language including sign and have the skills in other communication methods relevant to service users needs (block alphabet, finger spelling. Braille, Makaton, total communication, personal symbols) It is recommended that all staff received structured induction training (within six weeks of appointment) and foundation training (within six months of appointment) to Sector Skills Council specification (including training on the principles of care, safe working practices, the organisation and worker role, the experience and particular needs of the service user group and the influences and particular requirements of the service setting) It is recommended that each staff have an individual training and development assessment and profile. It is strongly recommended that staff working in learning disability use LDAF accredited training to provide underpinning knowledge for progress towards NVQ. It is recommended that mechanisms be put into place to H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 31 The Melanie Ann Trust (99 Saltings Road) 29. YA36 30. 31. 32. YA36 YA37 YA37 33. 34. YA38 YA39 35. YA39 36. 37. 38. YA40 YA42 YA42 establish arrangements for the manager and trustees to brief staff and for them to receive direct feedback It is recommended that staff have regular, recorded supervision at least 6 times a year with their senior or manager in addition to regular contact on a day to day practice covering areas detailed in this standard. These records are signed and dated by staff. It is recommended that staff have annual appraisal with their line manager to review performance against the job description and agree career development plans. It is recommended that the Manager have an appropriately detailed job description. This is carried over from the previous inspection on 13th December 2004 It is strongly recommended that the registered manager undertakes updated and current training to develop her knowledge and skills in sensory impairment and challenging behaviour It is strongly recommended that the registered manager undertake updated training and reading in developments in adult social care and relevant guidance and legislation. It is strongly recommended that methods for formal feedback to be collected from staff and service users be devised. It is recommended that there is an annual development plan for the home, based on systematic cycle of planning action, review and reflecting aims and outcomes for service users It is strongly recommended that staff be involved in the drawing up and review of policies, and that policies be reviewed regularly. That staff understand and follow these within their roles and responsibility It is recommended that all polices and procedures codes of practice and records are signed by the registered manager and are dated, monitored, reviewed and amended. It is strongly recommended that thermostatically controlled mixer valves be installed to the bath taps It is strongly recommended that radiator (just installed) are risk assessed to heat discharge and hot surface temperatures and where identified radiator guards installed. (For example the service users bedroom where bed sits up against this and kitchen are were could be used as a support to stand from the table.) 39. The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 32 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT 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 The Melanie Ann Trust (99 Saltings Road) H56-H06 S23847 99 Saltings Road V223181 120705 Stage 4.doc Version 1.40 Page 33 - 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. 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