Inspection on 10/05/05 for The Melanie Ann Trust Residential Home

This inspection was carried out on 10th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Melanie Ann Trust... 29/05/08

The Melanie Ann Trust... 29/05/07

The Melanie Ann Trust... 31/07/06

The Melanie Ann Trust... 30/01/06

The Melanie Ann Trust... 21/12/04

The Melanie Ann Trust... 05/08/04

The Melanie Ann Trust... 09/10/03

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

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 Residential Home 251 Saltings Road Snodland Kent ME6 5HR Lead Inspector Lynnette Gajjar Unannounced 10 May 2005 13:50 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 Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Melanie Ann Trust Address 251 Saltings Road Snodland Kent ME6 5HR 01634 245795 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 Edwards CRH Care Home 3 Category(ies) of LD Learning Disability (3) registration, with number of places The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21 December 2004 Brief Description of the Service: The Melanie Ann Trust is registered with the Charities Commission and currently has two properties based in Snodland 251 Saltings Road is a small semi-detached property close to the Snodland town centre, with a small external courtyard and garage. 251 Saltings Road is registered to provide residential care and accommodation for 3 adults with learning disabilities with additional sensory impairments and behaviours that may challenge. The sister home is very close by and provides care for 2 young adults with learning disabilities and sensory impairments. The care staff currently work across both homes. The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 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 report is written following two unannounced visits on 5th May 2005 14:40pm until 18:50pm with two inspectors following an adult protection alert and the planned unannounced inspection on 10th May 2005 from 13:50pm until 18:40pm. The home currently has 3 service users who have lived here for a number of years and is running with no vacancies. The visit was spent observing ad talking directly with service users, care staff, the registered manager Mrs Jennifer Edwards, and responsible individual Mr Edwards Senior and Mr Edwards Junior who manages the home finances. 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 conversation with service users and direct observation followed by discussion with staff and evidencing records held at the home. A tour of the premises was undertaken. What the service does well: What has improved since the last inspection? What they could do better: Service users lifestyles would benefit by the board of trustees and manager reviewing the current ethos of care and environment. To establish if Melanie Ann Trust can offer independent group living for those with a sensory impairment through the current practices. This must include listening to The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 6 specialist assessments and support from other professionals through the adult protection investigation. Service users would benefit greatly from, living in an environment that promotes safety and supports their sensory loss and has adequate fire precautions in place. Service users and staff would benefit from having consistent leadership and management that is current and up to date with the latest guidance and legislation in relation the adult social care. The quality of lifestyle, care and choices for service users would be greatly improved by addressing staff conflicts, better management of high sickness absence and instigate rigorous recruitment practices. Provide full induction and foundation training from appointment supported by regular formalised supervision and appraisal. The quality of care and management of the business would be enhanced through rigorous quality assurance monitoring by the board of trustees or external agencies specialised in this field. 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 Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,5 Current information provided by the home does not enable service users and representatives to make informed decisions as to whether the home can best meet their individual needs. EVIDENCE: The statement of purpose and service users guide is incorporated into one large booklet for both homes in the trust including policies and procedures. This gives a lot of information but uses out of date professional language, is repetitive in places and holds personal information of current service users. It is not easy to read or in formats that will assist service users and their representatives to make an informed choice as to whether the home can best meet their individual needs. Due to the nature of 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. Care managers spoken with through the adult protection process were not aware of the homes statement of purpose or content. Contracts are held in service users care plans; these are detailed and large documents and would not be understood or easily followed by the current service users and would require representatives signing on their behalf. All service users are currently having full contractual and funding re assessments by their placing authorities. The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9,10, Service users would benefit from further opportunities of participation and choice. This would require a culture change of both management and staffs’ outdated approach to care. Risk assessments and guidelines are not detailed enough to ensure consistent approaches by staff. EVIDENCE: Care managers and health specialists are undertaking a full review of the care provided and records held through the adult protection investigations. Hence care plans were not fully assessed during this inspection. A sample of records was assessed. One care plan seen was large in content but did record personal likes and dislikes and recorded goals to achieve with guidance and strategies to follow. However these were written using out of date language and behavioural strategies. Records held were not dated or signed on completion or evidencing other agency involvement including representatives. The file was large and would be difficult to read and follow as a new or agency staff member. Mrs Edwards expressed that a lot of work has been put into the care plans since the last inspection. It was very difficult to assess whether service users knew or are even interested in the written care plan or evidence that they agree to goals set. No other formats were evident that encourage service users involvement such as visual, object reference or audio systems. The Velcro daily activity board in the kitchen was in written format not using visual The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 10 or offering object reference. Care reviews have taken place with placing authorities in the past 6 months. Direct observation showed service users responding to staff requests to do activities/tasks, they were on occasion slow to respond, but did not display any negative physical behaviour, body language or verbal response to indicate not wishing to do the activity during this visit. However it could not be clearly assessed either as to whether this compliance was through ‘choice’ or ‘having to’. There is no evidence of what choice and agreement service users had with the sister home to use their sensory room. Guidelines and strategies seen require more detailed and current information to ensure staff follow these in the same way, for example ‘remove from the car’ does not guide staff in what verbal or physical techniques are, or are not, to be used to maintain the service users (or their own) safety, protect from abuse and maintain dignity. Files are stored in locked filing cabinet in the lounge, and personal information is held in the statement of purpose and communication book that anyone can access. Mrs Edwards remains appointee for all service users, with no further action since the last inspection, to transfer this to a relative/advocate or placing authority client finance services. Environmental risk assessments have been produced, these records were held at the Mrs Edwards home. Mrs Edwards was seen to enter the home using a set of keys, without ringing the doorbell or waiting to be invited in by the service users. Mrs Edwards described the ethos of the home as “to live as a family”. From direct observations, there is a clear “parental model” promoted by management. During this visit there was not any reference to developing independence through group living ethos and the dynamics this entails with three young adults. The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15,16, Service users lifestyles would benefit from further opportunities through management and staff having current and up to date training/ skills and awareness of good practices, resources and support techniques. EVIDENCE: Records seen showed service users attending horse riding, trampoline, pottery, gardening, swimming, dancing, health suite stretch and relax sessions, cook and eat in the local community and through local adult education services. A Service user smiled and nodded when asked if they had enjoyed horse riding that morning. Staff confirmed taking service users to such activities, sometimes on 1:1 basis. Mrs Edwards stated 2:1 staffing was for hospital appointments and holidays only. A service user was supported by staff to make cakes during this visit. Service users were observed to be encouraged by staff during rest periods of the day to engage with children’s electronic sound, light toys and wooden puzzles. The TV was on during some of the visit at a service users request. 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 but also due to the The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 12 limited leadership and monitoring by management to ensure this is offered at a level suitable to the individual The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20, Service users would benefit from staff having key communication skills and techniques to enable effective and interactive contact. Service users continue to be at risk as the home has not yet completed all actions set from the last inspection relating to medication. EVIDENCE: Full health assessments are being undertaken through the adult protection investigation. Service users have contact with health care professionals. Including support from local Primary care trust (PCT) Psychologist. Records and discussion with Mrs Edwards did not indicate contact or assessment from a speech and language specialist. Mr and Mrs Edwards were observed to sign to a service user but other staff were seen to use pointing, vocal language and physical direction to communicate and direct service users in daily activities. A service user had attended the dentist that morning. 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. Staff have received training in using injection pens. Further training and assessments of competencies have been booked. A staff member had signed MAR sheets that has not yet completed a competency assessment. Medication was stored in separate containers for internal and external medication. This working area is very cramped, dark and in a corridor restricting access. The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 14 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 Due to the lack of up to date knowledge and techniques in supporting adults who may challenge the service, service users are at risk of being supported inappropriately. EVIDENCE: The home has a written complaint procedure, which is in the written format. No other formats were evidenced to support service users to raise a concern or complain about the care and support they receive. Mrs Edwards is currently investigating 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 recorded and promoted by management in managing challenging behaviours is out of date and entirely reactive. Staff have not undertaken any training in current behaviour management strategies and techniques including possible restraint. Mrs Edwards stated four staff has been booked to undertake Studio 3 training in two weeks time. A senior carer who had completed the diploma in Challenging Behaviour left the service in October 2004. There is currently an adult protection investigation taking place through Kent and Medway Adult protection protocols. The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 15 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 from a living environment, designed, decorated and equipped to promote their personal independence, and individual care needs. EVIDENCE: 251 Saltings Road is a very small-adapted four-bedroom property located within walking distance to Snodland high street and shops. Staff and management expressed concern at the high crime in the area and concern for their belongings and property. There is a sleep-in room that has used floor space in one service users room. Two bedrooms are below minimum standards for sizing and personal furnishings. Two have been redecorated with the third being planned. The lounge is small and when in full use by all threeservice users and three staff is cramped and noisy. With visitors and management also it was impossible to maintain personal space. Two service users were supported to go out of the home for short periods of time. There is no private communal area for visitors or to enable service users a quiet area. The kitchen/dining area is in use constantly also. The toilet and bathroom require upgrading and redecoration, which Mrs Edwards stated this was being planned. Toilet seats are constantly being broken and on this visit had been removed. Fire doors and frames are currently being fitted but these were not The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 16 completed or offer a safe fire preventative environment. Staff on duty had not undertaken fire drills and were unaware of fire procedures or fire risk assessments completed due to the current work. This was however addressed and in place on the second visit. Despite this work the home was clean but redecoration through out is now required. There is no doorbell fitted (visual or sound), tactile object references are not in use. The lighting, flooring, decoration and layout of the home do not promote a safe environment that will promote independence for those with a sensory impairment. The garden is very uneven with broken paving slabs, steps, and no guiding equipment such as railings or colours to highlight steps with a high risk of tripping and falls. It does not offer a stimulating or relaxing area to those with sensory impairment. 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. The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 The standard and consistency of care offered within the home is adversely affected by low staff morale, high sickness levels and staff conflict. EVIDENCE: The care staff team work in both homes managed by the trust. Rosters are colour coded but very difficult to follow. During the first visit staff rostered could not be accounted for or tracked down by other staff initially, there was confusion amongst staff. On the second visit there was three staff and the Mrs Edwards at the home. The home has had a number of staffing issues to manage through staff leaving over the past 12 month, two vacant posts totalling 53.5 hours and high sickness absence. A further two fulltime staff have been suspended in the past two weeks, pending disciplinary hearings. Mrs Edwards has been covering hours through existing staff doing extra shifts and casual staff. Mr Edwards Senior and Junior have also covered shifts. Consideration to use agency had not been taken until the inspection occurred. There are a high number of internal conflicts amongst staff towards each other and management, with allegations about personal conduct, bullying and intimidation being made. The staff have not undertaken core induction and foundation training many of whom have been in post over six months. Training records evidence some core health and safety training taking place since January 2005 for a portion of staff and further training being booked in coming weeks. There are still gaps in core induction training before moving The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 18 into foundation recommendations. The home has recruited staff who have not work within learning disability or care before, the management were unaware of the core LDAF induction and training that they could have completed. Induction records have not been completed or signed off and these were ‘being caught up with in the past week’. Formal supervision of staff has not been taking place until recent weeks. Through the visits and direct observations staff do not have autonomy to make decisions or change activities on shifts without clearance from Mrs Edwards. Formal group staff meetings have not taken place. The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 19 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) 37,39,42 The home has not had clear leadership; training and monitoring systems in place to enable the management of the service to develop and promote new and current good care practice, potentially putting service users at risk. 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 in Autism, adult protection, epilepsy, first aid appointee, diabetes and using pen injections 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 this was due to start in October 2004 and was put on hold as the allocated company cease trading. Mrs Edwards is currently awaiting allocation of new assessors through Business Link. Mrs Edwards and Mr Edwards SNR and JNR are not aware of current legislation and guidance on changing social care for adults. No quality assurance systems are in place. The Melanie Ann Trust has four trustees one The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 20 of whom is Mr Edwards SNR. Trustees meet twice a year with Mrs Edwards. Trustees do not undertake unannounced visits to the home to monitor care; records, finance and staff practice including the manager. The family as founders of the trust have strong personal ties to the homes, all in daily contact and working within the homes. Mr Edwards JNR manages the home financial records that are audited by an external accounts. The trust does not currently have a developmental plan for the service, evaluation of appropriateness of current service and properties to meet the needs of current or new service users. Policies and procedures have been developed but many require updating to current legislation and practice. Fire safety is a major concern with work remaining incomplete and insufficient fire precautions in place. Paperwork and clothing was stored under the stairway, the only means of escape from the first floor, fire doors are unfinished and offering no means of protection. No fire drills had been completed. Mr & Mrs Edwards hold current first aide appointee training. No staff hold a full first aid a work certificate. Accident records were seen and incidences recorded had not been notified to the commission. The homes accident book is not compliant with data protection as required from December 2003. The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 21 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 x 2 Standard No 22 23 ENVIRONMENT Score 2 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 2 1 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 2 2 2 1 1 2 Standard No 11 12 13 14 15 16 17 x 2 2 2 3 2 x Standard No 31 32 33 34 35 36 Score 2 1 1 2 1 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Melanie Ann Trust Residential Home Score 2 2 2 x Standard No 37 38 39 40 41 42 43 Score 1 x 1 x x 1 x H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 22 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 31st July 2005 2. YA2 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. Unless it is impracticable to carry 31st August out such a consultation the 2005 registered person shall after 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 latest legislation and promote good practice and protect service Version 1.30 Page 23 The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc 3. YA9 13(4) ,YA24,YA28 4. YA20 13(2) 5. YA 24 TO YA30 23(2)(a)( b)(f(n)(o) 6. 23 (4)(c)(d) 24 users from potential risk of harm.Not met from previous inspection 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 safetyIn that environmental risk assessments will be undertaken and appropriate action taken, particularly with regard to the grounds, and individual risk assessments be expanded upon in scope.Partially met since the last inspection on 12th December 2004. It is required that staff dispensing and administrating medication are the one to sign original MAR sheets, not other staff observing. 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 usersØ The premises to be used as a care home are of sound construction and kept in good state of repair externally and internally.Ø The size and layout of rooms occupied or used by service users are suitable to meet their needs.Ø Suitable adaptations are made and such support, equipment and facilities are provided for service users who are physically disabled (sensory impaired)Ø External grounds, which are suitable for, safe for use by, service users, are provided and appropriately maintained. The registered person shall after consultation with the fire 31st July 2005 31st July 2005 The board of trustees are to supply a written response by 30th June 2005 to the commissio n as to the action that will be planned and set timescales for completion Immediate Page 24 The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 7. YA32 & YA35 18(1)(a) 8. 37 12 (1)(2) 9. 39 26 authority make adequate arrangements for;Ø Detecting, containing and extinguishing fires Ø For evacuation in the event of fire of all persons in the care home and safe placement of service users Ø Make suitable training for all persons working in the care home to receive suitable training in fire prevention and to ensure by means of fire drills and practises at suitable intervals, that persons working in the care home and so far as practicable service users are aware of the procedures to following case of a fire, including the procedure for saving lives.Partially met since the last inspection on 12th 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. 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. Where the registered provider is 31st August 2005 immediate 30th June Page 25 The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 10. 39 24(1) 11. 42 37 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 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 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. The registered person shall give notice to the commission without delay of any occurrence of: Ø The death of a service user, including circumstances of his deathØ The outbreak in the care home of any infectious disease which in the opinion of any registered medical practitioner attending persons in the care home is sufficiently serious to be notified.Ø Any serious injury to service usersØ Serious illness of a service user at a care home at which 2005 31st July 2005 Immediate The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 26 nursing is not provided.Ø Any event in the care home which adversely affects the well-being or safety of any service userØ Any theft, burglary or accident in the care home.Ø Any allegation of misconduct by the registered person or any person who works at the care home.Ø Ant notification made in accordance with this regulation which is given orally shall be confirmed in writing. 12. 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. 2. Refer to Standard YA1 YA5 Good Practice Recommendations It is recommended that the service users guide is devised into a format that is easily understood by service users. It is recommended that service users be supported by 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 appropriate 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 clearly dated and signed by all involved.Staff sign strategies and guidance in care plans of their understanding and commitment to follow as detailed. H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 27 3. YA6 4. YA6 5. YA6 The Melanie Ann Trust Residential Home 6. YA7 7. YA7 8. 9. YA7 &23 YA10 10. 11. YA11 YA16 12. YA16 13. YA18 14. YA20 15. YA20 16. YA22 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 strongyl 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. 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. It is recommended that the daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual care plan and contract. It is recommended that staff enter service users home; bedroom and bathrooms only with the individual’s permission and normally in their presence and techniques are in place (e.g. doorbells, flashing lights, according to disability) to ensure privacy for all service users. It is strongly 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.Partially met since last inspection on 12 December 2004 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 if kept of all issues raised or complaints made, details of any investigation, H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 28 The Melanie Ann Trust Residential Home 17. YA23 18. YA24 19. YA25 20. YA26 21. YA27 22. YA29 23. YA31 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 strongly recommended that the home meet the requirement of the local fire service and environmental health dept, health and safety and buildings act and regulations and from 1st April 2004 the Disability Discrimination Act 1995 Part 3. It is recommended that although service users have resided in the home before 31st March 2002 and as an existing home, rooms do not need to be 10sqm and over. However two rooms are below 8.5sqm and should be closely reviewed and assessed to individual sensory and care needs and are fit for purpose through the care review process. It is recommended that 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. Partly met since the last inspection on 12 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. 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, 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 strongly recommended that detailed job descriptions be devised, and that staff be issued and are familiar with H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 29 The Melanie Ann Trust Residential Home 24. 25. 26. YA32 YA33 YA33 27. 28. 29. 30. YA35 YA35 YA36 YA36 31. 32. 33. YA36 YA37 YA37 34. YA38 35. YA40 the GSCC code of conduct. Ongoing from the last inspection 12 December 2004. It is recommended that staff continue to be facilitated to attain NVQ qualifications as stated in the standard. Ongoing from the last inspection 12 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 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 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.Ongoing from the last inspection 12 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.Ongoing from the last inspection 12 December 2004 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 responsibilityPartly met ongoing from the last inspection 12 December 2004 H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 30 The Melanie Ann Trust Residential Home 36. 37. YA41 42 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 homes accident-recording book is replaced and procedures amended to ensure that they comply with Data Protection as of December 2003 iwith a clear audting and monitoring system to identify trends or reoccurance. The Melanie Ann Trust Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 31 Commission for Social Care Inspection 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 Residential Home H56-H06 S23848 251 Saltings Rd V223192 100505 Stage 4.doc Version 1.30 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!