Inspection on 03/02/06 for The Melanie Ann Trust

This inspection was carried out on 3rd February 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 8 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 12/07/05

The Melanie Ann Trust 13/12/04

The Melanie Ann Trust 05/08/04

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Insight - Eastchurch

Southfields

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Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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 Snodland Kent ME6 5HA Lead Inspector Marion Weller Unannounced Inspection 3rd February 2006 09:30 The Melanie Ann Trust DS0000023847.V277481.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 The Melanie Ann Trust DS0000023847.V277481.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. The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Melanie Ann Trust Address 99 Saltings Road Snodland Kent ME6 5HA 01634 243430 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) The Melanie Ann Trust Mrs Jennifer Iris Edwards Care Home 2 Category(ies) of Learning disability (2) registration, with number of places The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2005 Brief Description of the Service: The Melanie Ann Trust is registered with the Charities Commission and currently has two properties based in Snodland. 99 Saltings Road is a small end of terrace property with a garden situated close to Snodland town centre. The home is registered to provide residential care and accommodation for 2 adults with learning disabilities who also have additional sensory impairments. The Trusts sister home is very close by and provides care for 3 young adults with learning disabilities, sensory impairments and behaviours that may challenge. The Trusts care staff currently work across both homes. The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Regulatory Inspectors Marion Weller and Lynnette Gajjar carried out an unannounced inspection of 99 Saltings Road from 9:30 am until 1:00 pm. During that time the inspectors observed and spoke with service users and care staff. Due to the nature of the service and communication limitations, it is difficult to reliably incorporate accurate reflections of service users in the report. Some judgements about quality of life and choices were taken from direct observation followed by discussion with staff and evidence seen in records and care plans maintained at the home. Parts of the premises were seen and progress made since the last inspection was discussed. The home currently has 2 service users who have lived at 99 Saltings Road for a number of years. The home is running with no vacancies. The staff gave their full cooperation throughout the inspection. What the service does well: What has improved since the last inspection? The home has assisted care managers and health specialists to undertake full reviews of the care provided and the records maintained for service users. As a result of the recent adult protection investigation, the home is now more aware of the change in culture and working practices that needs to take place to ensure a better lifestyle for service users and continues to focus on this work. The adult protection investigation has now been completed and closed. There have been improvements in medication administration from recommendations made, including medication training for staff. Comprehensive care plans have been completed for service users with evidence that these are being regularly reviewed. Specialist risk assessment management protocols have been completed to further protect service users safety. The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 6 Fire doors have been completed to a satisfactory standard and full certification received from the Fire Officer. Staffing levels are currently being maintained to the benefit of service users. Recruitment to establish a fully substantive staff group for the home continues. Recent training and development opportunities have benefited and guided the staff’s work with service users. Appropriate training events are being booked for this year and staff have been identified to attend. Staff continue work to prove competence for NVQ awards in care at level 2 and 3. A new carpet has been laid in one service user bedroom and the room redecorated. New carpet has been laid in the hall. Radiator covers have been fitted to all areas of the home to which service users have access. The trustees of the home are now undertaking regular provider visits and written reports on their findings are shared with the manager and the CSCI. What they could do better: The manager needs to review and revise the homes statement of purpose and service user guide. Personal information relating to individual service users must be removed from the documents. This work is now a priority. Service users contracts should be revised and produced in a format that is easy to understand and is user friendly. Daily record sheets need to accurately and comprehensively reflect care plan demands and evidence that the homes practices are in line with individual plans of care. Attention to the content and detail of records maintained would further enable the home to evidence improvements to daily practice. The terminology used in service user records requires careful prior consideration to ensure that entries made protect service users dignity and status as adults. The home must clearly differentiate between care plans and information kept in service user files. Service users would benefit from the reorganisation of files and the regular archiving of documents once superseded to ensure staff have ease of access to current up to date information. The bathroom should be refurbished as previously stated to ensure service users enjoy a safe and comfortable bathing facility. The mat by the back door needs to be replaced; the curling edges are a slip/ trip hazard. Replacement should be of the non-slip variety to secure staff and service users safe exit and entry. The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 7 The use of “hold open” fire door guards recommended by the Fire Officer would give individuals with sensory loss a greater ease of access to all parts of the home without fear of injury or sense of restraint. The manager should complete work to gain the Registered Managers Award qualification within the agreed timescale. 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 to adult social care. Infection control procedures would be further enhanced by consideration being given to the use of dispersible plastic laundry bags for transporting soiled linen to the washing machine sited in the homes kitchen. Attention to detail regarding basic food hygiene requirements and correct storage of food would benefit service users health and safety. Prescribed medications for service users must be stored safely between uses. The homes records as to staff trained to assist with specialist medication administration must be kept updated. 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 DS0000023847.V277481.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 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 the following standard(s): 15 Current information provided to service users and their representatives is not sufficiently clear to enable them to make a decision about the services the home provides or whether the home is suitable to meet their needs. EVIDENCE: The homes statement of purpose and service users guide is incorporated into one large document for both of the homes owned by the trust. The document includes policies, procedures and personal information relating to current service users. It is a cumbersome document that provides a lot of information but uses out of date professional language, is repetitive, difficult to read and produced in a format that will not assist service users or their representatives to make an informed choice as to whether the home can best meet their identified needs. Care managers from service users placing authority were found to be unaware of the homes statement of purpose or its contents. The manger has requested further time from the CSCI to fulfil the intention of comprehensively revising the document. The home has purchased Mulberry House CD to assist them to customise both the statement of purpose and service user guide. The manager spoke of her awareness that resolution of this issue is now a priority. Due to the nature of service users care needs individual experience and involvement in assessments undertaken before their admission would be The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 10 difficult to reflect upon with them directly. The manager confirmed that trial visits and assessments did take place with their representatives. Individual contracts are held in service users files. These are detailed, overly large and complex and would not be understood or easily followed by current service users and require representatives signing on their behalf. Placing authorities have reassessed service users contractual and funding arrangements during the recent adult protection process. The investigation following the adult protection alert has now been completed. The adult protection alert has been closed. The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 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 the following standard(s): 6 7 9 10 Improved detail to care plans and risk assessments benefit and protect service users with regard to their individual choices and lifestyles. EVIDENCE: Care managers and health specialists have recently undertaken a full review of the care provided by the home and the records maintained. The home has put a lot of work into revised individual plans of care for the two service users. The care plan format adopted was suggested to the home by a care manager and was further investigated and developed to suit individual service user needs. It is difficult to assess whether service users know or are even interested in the written plan of care or evidence that they agree to goals set. The plans however do now include information from service users involved specialist and local health care professionals, family members, representatives, advocates and staff who know them well. The format is fundamentally visual, graphic and written in simple printed English and contains systems for object reference for service users daily routines. The format greatly benefits staff in that they know exactly how to care for individuals in specific circumstances, service users preferences and the level of support to be given. The attention to detail is commendable. Review sheets are in place and records evidenced The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 12 that review meetings are regularly taking place. Specialist Risk Assessment Management Protocols (RAMP) had been completed for service users. The homes staff have recently attended training sessions held by West Kent Health Authority in specialist risk assessment management. The completed work now forms the basis of the homes care planning process and ensures that service users safety is promoted and protected while undertaking new and wellestablished daily routines. Daily record sheets need to accurately reflect and record care plan demands to evidence that the homes practices are in line with individual plans. Attention to detail regarding daily entries would enhance records maintained and enable the home to further evidence good practice. The terminology used in service user records requires careful prior consideration and monitoring to ensure that entries made, protect service users adult status and dignity. It was seen that service users files are overly large and cumbersome due to the work undertaken with and consequently documented about individuals over the years. The home must now differentiate between care plans and service user files. Service users would benefit from the home organising service user files and the regular archiving of documents once reviewed and superseded to ensure that staff always have ease of access to up to date information. Files are appropriately stored and are secure. Service users personal information remains in the statement of purpose, as mentioned previously. Evidence is in place that the home is working with care management to transfer appointee ship to local authority client finance services for the further protection of service users as required. Staff on duty showed a good understanding of service users individual needs. Service users were seen to respond to staff fondly and with familiarity through relaxed body language and sounds. Service users were seen to clearly make decisions whether or not to do activities. Staffing levels are currently being maintained and were adequately meeting the needs of service users on the day of the inspection. Individuals presented as quite relaxed with the inspectors presence in the home. No adverse behaviours were observed. There is no recorded evidence of the choice and agreement service users have with the sister home to allow service users from that home access and use of their sensory room. The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 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 the following standard(s): 12 13 14 15 16 17 Staff have a good understanding of service users preferred lifestyle. Service users would further benefit from staff and management continuing to access training that will develop and improve awareness of up to date good practice and support techniques. The homes poor management of basic food hygiene potentially places service users at risk of harm. EVIDENCE: Records evidenced service users attending horse riding, trampoline sessions, swimming, dancing, Jacuzzi and health suite stretch and relax sessions, going for meals out in the local community and activities offered through local adult education services. The home has also started to use a mobile service that visits regularly, offering art, craft and sensory sessions. The manager said the service is tailored around the needs of the individual. Staff confirmed taking service users to activities regularly on a 1:1 basis. Service users were observed to engage with music, TV and other appropriate activities during the The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 14 visit. Due to service users level of ability, pursuing work or work experience is not within their personal goals. Kent Association for the Blind have recently completed assessments and provided the home with good practice advice to support and encourage independence for service users with visual impairment. The promotion of service users choices and rights could easily be restricted because of individual service users capacity to understand and express their wishes. There were indicators that the leadership offered by management is improved and monitoring is taking place to ensure that the homes responsibility to promote individual choices and rights, at a level suitable to the individual, is being taken seriously and maintained. Dietary needs of service users are catered for with a generally well-balanced and varied selection of food available that meets service users tastes and choices. The kitchen was seen to be clean and well equipped. Some food stored in the refrigerator was seen to be out of date and stored incorrectly, which compromised basic food hygiene standards, placing service users at potential risk of harm. The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 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 the following standard(s): 18 19 20 The health needs of service users are being met with evidence of good multi disciplinary working taking place on a regular basis. Medication administration would be further improved with better attention to detail regarding effective record keeping and consistent adherence to good practice requirements. EVIDENCE: All service users have had full reassessment from care managers and health professionals during the recent adult protection process. Appropriate referrals had been made to behaviour management, speech and language specialists and to Kent Association For the Blind. Records maintained since the initial referrals were made, show that the home has continued to liaise with specialist and local health care professionals in supporting service users in their health needs. Staff were seen to respond to and support personal needs during the visit. Medication training for the majority of staff has been completed. Competency checks are ongoing in the use of injection pens. The list of staff that have been trained to administer insulin via injection pens was not up to date. MAR sheets were inspected and seen to be in order with no unexplained gaps in the records. Staff dispensing and administering medication to service users were the signatories. The home has now agreed specific instructions with the GP for the administration of ‘when required’ medication. Medication The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 16 records did not evidence the presenting indicators for administering PRN medication to service users and the dose offered to relieve symptoms. To some extent the current MAR sheets do not offer a format that supports this practice. The senior carer spoke of providing a format to accurately record the information required by regulation. A prescribed medicine was seen in the bathroom and had not been correctly locked away after use. Medication was not inspected in depth during this inspection however requirements awarded during previous inspections in relation to medication administration will remain until full evidence of achievement has been assessed and consistently achieved. Visual awareness training from Kent Association for the Blind is arranged for March 2006 and training in Makaton. Once completed, this training will greatly benefit staff to gain key communication skills and techniques to enable effective and interactive contact with service users. The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 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 the following standard(s): 22 23 Arrangements and guidance for protecting service users have improved and standards are met in part. Service users would benefit from access to a complaints procedure that they can understand and use. EVIDENCE: The home has a written complaints procedure. No other formats were evidenced to support service users to raise a concern or complain about the care and support they receive. The manager is aware that other formats are required due to the service type offered. Language and techniques recorded and promoted by staff in managing adults with challenging behaviours has improved with the support and direction of specialist intervention. Management strategies and techniques, including possible use of restraint for dealing with any potential challenging behaviour is now appropriately recorded in individual plans of care and staff are aware of actions to be taken to safeguard service users from self harm and to protect other individuals in the home. Interventions should be monitored to ensure management strategies have been properly assessed and reviewed and desired outcomes consistently achieved. An adult protection investigation has recently taken place through Kent and Medway Adult Protection protocols. This is now complete and has been closed. The home continues to make progress to address and resolve the issues reported and discussed with them during the process. The manager said that she has been informed that expectations regarding offering choices and opportunities for service users have been met to care manager’s satisfaction. The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 18 Care staff and management have undertaken adult protection training and four staff have accessed one day training in behaviour management through Studio 3. The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 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 the following standard(s): 24 25 26 27 28 29 30 Service users would benefit from a living environment designed and equipped to promote their personal independence and fully meet their care needs. EVIDENCE: 99 Saltings Road is a small-adapted four-bedroom property located within walking distance of Snodland high street and shops. One bedroom is used as a staff sleep - in room. Two further bedrooms are for single use and of a comfortable size to meet the needs of the two service users who are resident in the home. One bedroom had been redecorated with a new carpet laid. The third bedroom has been converted into a sensory lights and sound room for relaxation. On the day of the visit this room was being used to store items not associated with the rooms stated function. There is an open plan kitchen and integrated dining area leading to a small terraced garden, with railed steps to the back entrance. The step edges have now been highlighted following advice from Kent Association for the Blind. The doormat at the back entrance was aged with curled edges and was a slip/trip The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 20 hazard. Its removal and replacement was discussed with staff. The homes laundry facilities are located in the kitchen. The lounge is small but meets the needs of the 2 service users. The homes bathroom requires upgrading and refurbishment. Taps, including those in the bath, are not fitted with thermostatically controlled mixer valves. Staff stated that temperatures are checked prior to service users bathing, records seen supported this. There is no private area available for visitors or to enable service users a quiet area. Fire doors have been completed to a satisfactory standard and full certification received from the Fire Officer. The Fire Officer recommended ‘Hold open’ devices fitted to fire doors that remain outstanding. In use, these aids would provide a much better environment for individuals with sensory impairment, allowing freedom of movement in the home. Service users have lived here for a number of years and appear to have adapted to the current environment, they were however observed to require staff guidance and direction to negotiate hazards. Evidence gathered during the inspection showed ongoing consultation with Kent Association for the Blind in assessing the environment and advice given in colour techniques and lighting for the home. The hall carpet had recently been replaced. The doorbell fitted had visual and sound triggers. The home was clean and free from any unpleasant odour. The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 33 35 36 The standard and consistency of care services service users are offered has improved. There is a definite willingness and motivation to improve the services provided and to work as a team, which actively benefits service users. EVIDENCE: The staff team work in both of the homes managed by the Trust Staff rosters were seen. Some vacant establishment hours exist to which the manager is currently recruiting. Agency staff are used to cover rota absences or leave. Because of the complex nature of service users needs, regular agency staff are used who know and understand the service users. Staffing levels were adequately meeting service users needs on the day of inspection. The manager says formal staff meetings are now taking place monthly and formal staff supervision is also being offered. Staff files and records were not fully inspected on this occasion. The manager spoke of staff training events planned for the first part of 2006. Training events mentioned included visual awareness, first aid and Makaton. Staff continue to prove competence at NVQ Level 2 and 3. Staff who hold the qualification currently number 6. The manger is considering training one of the senior carers as an NVQ assessor to speed up the process of staff proving competence and gaining qualifications. It was clear from discussion with staff that recent development opportunities, interventions and guidance offered by The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 22 visiting professionals had significantly benefited and guided their work with service users Staff spoken with felt positive about the environmental improvements in the two homes, but more could be achieved. Staff morale and motivation is developing with more communication between staff and management. They felt there were also improvements in team working, but still some way to go to improve on trust, confidentiality and voicing opinions that might challenge managements view. Staff felt they could approach the manager for advice, but were unsure of how autonomous they could be in daily practice. The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 38 39 42 The manager has a good understanding of areas in which the service has to improve and develop. Clear leadership, attention to detail and a focus on the promotion of current good care practice will further consolidate and advance the homes progress. EVIDENCE: The Registered Manager holds a current registration in nursing for learning disability level 2 and has attended other relevant short term training courses since January 2005. The manger has asked for additional time to complete the Registered Managers Award qualification. The manager was open and honest during the inspection, recognising that certain standards had yet to be fully and consistently met. The Board of Trustees is making regular provider visits to the home. A written report of their findings is shared with the registered manager and the CSCI. Staff felt they benefited from these visits and views they expressed to Trustees were being taken into consideration. The manager stated that a quality The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 24 assurance questionnaire regarding the services offered by the home has been complied and will be sent to interested parties in the near future. Responses will be collated and acted upon. It was evident from this inspection that the care delivered is now evolving and developing to the benefit of service users. Staff training and development opportunities have improved. The manager and the staff spoken with felt more confident and supported in their work. There is every indication that the whole team are consistently improving their knowledge and applying new skills to daily practice. The manager and staff are aware that there is still some way to go, but positive progress is now being made. Policies and procedures have been developed but many require updating to reflect current legislation and good practice. Records regarding health and safety checks were up to date. Some poor practice was noted regarding basic food hygiene and deficiencies in the correct storage of food as mentioned elsewhere in the report. Certificates demonstrate the home has adequate insurance cover. Incidents or accidents that adversely affect the well being of service users are being notified to the CSCI. The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 X 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 2 28 3 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 2 2 X X 2 X The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 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 YA1 Regulation 6 Requirement 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 revisions within 28 days. Information must be accurate, reflect the services provided and include all that is required under schedule 1. Remove all unnecessary information and policies (Previous timescale of 30th November 2005 not met) The registered manager develops and agrees with each service user a written and costed contract/ statement of terms and conditions between the home and the service user. Service users are supported by relatives/advocates or representatives when drawing up the contract and the document is in a format/ language appropriate to each service user. Reasonable efforts have been made to explain the contract. The DS0000023847.V277481.R01.S.doc Timescale for action 31/05/06 2 YA5 5 (b) (c) 30/04/06 The Melanie Ann Trust Version 5.1 Page 27 3 YA9YA28YA24 13 (4) 4 YA24 23(2)a,b, f,n,o 5 YA33 18 91) (a) manager and service user or their representatives sign the contract. The registered person shall 30/04/06 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 kept under review and appropriate action continues, particularly with regard to the fitting of thermostatic mixer valves,full bathroom refurbishment and the availability of ‘hold open’ devices for ease of access through fire doors for service users. The registered person shall 30/04/06 having regard to the number and needs of service users ensure that: The physical design and layout of the premises to be used as a care home meet the needs of the service users The premises to be used as a care home are of sound construction and kept in good state of repair externally and internally. The size and layout of rooms occupied or used by service users are suitable to meet their needs. Suitable adaptations are made and such support, equipment and facilities are provided for service users who are physically disabled (sensory impaired) ( previous timescale of 30th September 2005 not met.) The registered person shall 30/03/06 having regard to the size of the care home, the statement of purpose and number and DS0000023847.V277481.R01.S.doc Version 5.1 Page 28 The Melanie Ann Trust 6 YA42 16(2) (j) needs of service users: 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 that all the homes care and management staff have undertaken core and foundation training and assessed competent by accredited trainers. (Previous Timescale of 30th November 2005 not met. The registered person shall make suitable arrangements for maintaining satisfactory standards of food hygiene in the care home. In that: food must be stored and kept appropriately in the home and out of date food disposed of to protect the safety and welfare of residents. 03/02/06 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 YA6 Good Practice Recommendations It is strongly recommended that care plans are regularly reviewed and revised to ensure up to date individualised procedures for service users likely to be aggressive or cause harm or self-harm are maintained and that procedures focus on positive behaviour, ability and willingness and are compiled with current good practice guidance,Dept of Health guidance and Legislation. It is recommended that all entries made to the care plan are clearly dated and signed by all involved. Daily records relect the demands of the care plan and evidence that the homes practice is in line with individual plans of care. Staff DS0000023847.V277481.R01.S.doc Version 5.1 Page 29 2 YA6 The Melanie Ann Trust 3 YA7 4 YA7 5 YA7YA23 6 YA10 7 YA11 8 YA18 9 YA20 10 YA20 sign strategies and guidance in care plans of their understanding and commitment to follow as detailed. It is recommended that all entries made to the care plan are clearly dated and signed by all involved. Daily records relect the demands of the care plan and evidence that the homes practice is in line with individual plans of care. Staff sign strategies and guidance in care plans of their understanding and commitment to follow as detailed. It is recommended that all entries made to the care plan are clearly dated and signed by all involved. Daily records relect the demands of the care plan and evidence that the homes practice is in line with individual plans of care. Staff sign strategies and guidance in care plans of their understanding and commitment to follow as detailed. Termono;ogy used in daily records protects service users dignity and status as adults. 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. Work should continue to secure this safeguard for all service users. It is recommended that personal information regarding service users is 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 and the practice is maintained in the home.. 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 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. Indicators for administering PRN medication should be recorded on the MAR sheet and entries regularly reviewed. Entries reviewed may prompt a medication review with the service users GP. It is recommended that the list of staff who have received DS0000023847.V277481.R01.S.doc Version 5.1 Page 30 The Melanie Ann Trust 11 12 YA20 YA20 training and have proven competency to administer insulin is kept up to date in the home. It is recommended that prescribed medicines and homely remedieds are appropritaely stored between use. 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 to be maintained of all issues raised or complaints made, details of any investigation, action taken and outcome, and this record is checked at least 3 monthly 13 YA22 14 YA27 It is recommended that the bathroom and toilet be upgraded as part of the homes redecoration programme to ensure facilities are maintained to good standards and promote infection control management. It is strongly recommended that Thermostatic Mixer Valves are fitted to bathroom and sink taps to maintain a safe water temperature for service users. 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. Homes offering a service to the sensory impaired provide specialist aides and adaptations as needed to include for example: Loops/microphones/mimcoms/textphones/videophone Additional and/or antiglare lighting, colour contrasting Tactile symbols, objects of reference, varied textile surfaces. Florescent or padded hazard/obstruction (where they cannot be removed) Computers for personal use TV with video/DVD recorder with subtitle or sign language facility. Safety systems and equipment are appropriate for people with sensory problems 15 YA27 16 YA29 The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 31 17 18 YA32 YA33 It is recommended that staff continue to be facilitated to attain NVQ qualifications as stated in the standard It is recommended that minutes of regular staff meetings are available to evidence that these events are consistently taking place and actions decided at meetings are recorded and acted upon. 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 staff have an individual training and development assessment and profile It is recommended that staff have an individual training and development assessment and profile 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. It is strongly recommended that the registered manager continues to undertake updated and current training to develop her knowledge and skills in sensory impairment and challenging behaviour It is strongly recommended that the registered manager continue to undertake updated training and reading in 19 YA33 20 YA35 21 22 23 YA35 YA35 YA36 24 YA36 25 26 YA37 YA37 The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 32 developments in adult social care and relevant guidance and legislation. It is strongly recommended that the manager fulfil her stated intention of gaining the RMA qualification. 27 YA39 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 recommended that the doormat sited at the kitchen entrance door be replaced with a non-slip type to eliminate the current slip/trip hazard. 28 YA39 29 30 YA40 YA42 The Melanie Ann Trust DS0000023847.V277481.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone 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. 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