Inspection on 31/07/06 for The Melanie Ann Trust Residential Home

This inspection was carried out on 31st July 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 6 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... 30/01/06

The Melanie Ann Trust... 10/05/05

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

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

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

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

CARE HOME ADULTS 18-65 The Melanie Ann Trust Residential Home (S) 251 Saltings Road Snodland Kent ME6 5HR Lead Inspector Justine Williams Unannounced Inspection 31st July 2006 09:30 The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 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 Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 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 Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Melanie Ann Trust Residential Home (S) Address 251 Saltings Road Snodland Kent ME6 5HR 01634 245795 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 3 Category(ies) of Learning disability (3) registration, with number of places The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th January 2006 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 fees range from £1218.43 to £1490.48 The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on 31st July 2006 between 9.30 am and 3.30pm by regulatory inspectors Justine Williams, and Lynnette Gajjar. During that time a member of staff, the registered manager and deputy manager agreed to speak with the inspector both in public and privately. 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. Feedback was given to the manager during and at the end of the inspection. This report contains assessments made from observation, conversation and records. As part of the inspection process comment cards were received from relatives and professionals. The comment cards indicated general satisfaction with the service. Some work toward meeting the requirements and recommendations made at the last and previous inspections has been completed, although much is ongoing. What the service does well: What has improved since the last inspection? The revision of the statement of purpose and service users guides have improved the quality of information available, making this information available in varying formats will allow greater accessibility for residents. The residents’ contracts have been revised and are now more simple and relevant, these have not been made available in varying formats yet. Improvements have been made to the garden, which once complete will enhance resident’s quality of life and safety. The bathroom is nearing completion having been refurbished; this will improve resident’s quality of life and safety. The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 6 Entries made in the daily records are now signed and dated and the content has improved in respect of use of language and entries now provide a good picture of how residents spent their day. The manager is now the appointee for one resident, the remaining residents have their finances managed by the local authority, this will better protect the residents and the organisation. Recent training and development opportunities continue to benefit and guide the staff’s work with service users. What they could do better: 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. Improvements to risk assessments will better safeguard residents against accident and injury etc. The home should look at providing evening activities to improve resident’s quality of life. Detailed information regarding when to administer PRN or as required medication must be documented and form part of the residents care plan. Consideration should be given to providing various documents including the complaints policy into different formats, which can be understood by the residents. Improvements in the recruitment practices would better protect residents from the risk of abuse. Continual monitoring of the use of the undersized bedrooms should be undertaken and documented to ensure residents’ needs continue to be met. Further improvements to the environment including the landscaping of the garden (which is planned) and the provision of a conservatory (also planned) will improve resident’s quality of life. The provision of liquid soap and paper towel dispensers will better protect residents and staff from infection. Detailed job descriptions, further NVQ training, basic core training for new staff and completing induction training within specified timescales of being recruited, will prepare staff for their roles and responsibilities. The manager should complete work to gain the Registered Managers Award qualification within the agreed timescale. The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 7 Continued attention and action to resolve potential hazards for residents and staff is needed. 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 (S) DS0000023848.V306631.R01.S.doc Version 5.2 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 Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 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): 1,2,5 Quality on this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The home has revised its statement of purpose and service users guides and these no longer contain unnecessary personal information about particular residents. EVIDENCE: The statement of purpose and service users guides have been revised but is not yet available in varying formats. Residents have recently been re-assessed by their social workers and are being re-assessed by the home, with new a new model of assessment and care planning being used. The expectation is that this will enable care workers and other professionals to obtain a full picture of the resident’s strengths, needs, likes, dislikes and aspirations. Revised contracts are now in place for residents, and these have been simplified but contain all the information required. As the residents’ levels of ability precludes them from being able to understand and sign their contracts the manager has endeavoured to have them signed by other appropriate individuals. It is recommended however, that the room to be occupied by the resident is included in the contract as stated in the standard, and in line with good practice recommendations. The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality on this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Simplification and better organisation of care plans and risk assessments, and archiving of paperwork will enable staff to meet the resident’s needs. EVIDENCE: Staff continue to develop the assessments and care plans of the residents, and further improvements have been made since the last inspection. The new care plans are presented in a visual, graphic and simple printed English format, and contains systems for object reference for service users daily routines. The paperwork is being kept in 4 different folders for each resident, which could be confusing for staff. There is also duplication of information causing staff unnecessary additional work to complete. Some of the language used in the care planning documents was inappropriate, although this had also improved and was far less frequent since the last inspection. It is recommended that staff and management demonstrate how individual choices have been made and record instances when others make decisions and why. Risk assessments were spread throughout 3 of the 4 folders and should be consolidated. Individual risk assessments regarding the environment should be personalised. The files contained satisfactory information regarding The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 11 resident’s health needs, liaison with health professional’s correspondence and appointments. Discussion with the manager and staff confirmed that residents now benefit from close liaison with speech and language therapists, behaviour therapists, and other specialists. Reviews of risk assessments were not dated in most cases. It was identified at the last inspection that 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 current up to date information. Staff were observed providing residents with opportunities to make decisions as far as they are able. The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality on this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Service users benefit from a range of activities offered, access to the local community and a varied diet. EVIDENCE: Residents continue to take part in a range of activities, including trampolining, horse riding etc. Residents receive support to access the local community, and the development of more evening activities would benefit residents. Due to service users’ levels of ability, pursuing work or work experience is not within their personal goals. The staff and manager confirmed that relatives are welcomed to the home and are encouraged to participate in activities. Residents are encouraged to help with household tasks although due to their level of ability they are not expected to take responsibility for any tasks alone. 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 and with special attention to special diets required for ongoing good health. The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 13 The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality on this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The personal care and health needs of service users are being met. The home’s medication administration would be improved by documenting when PRN or as required medication should be given. EVIDENCE: Staff were seen to respond to and support residents personal needs during the visit. This will be evidenced further by the completion of the new documentation for care planning. The new care plans indicate preferred times for getting up and going to bed, preferred meals and activities etc. Residents have been benefited from referral for the Kent Association for the Blind, who have supplied them with some equipment and staff training to raise awareness of sight impairment. Residents now benefit from regular support and input from a range of health care professionals including speech and language therapists, behaviour therapists etc. One resident may benefit from a referral to the epilepsy nurse specialist. Residents receive the support they need from staff to attend medical appointments. Due to their level of ability, residents are completely reliant on the manager and staff to manage their health care and this is being done in a satisfactory way. The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 15 Medicines are stored in 2 separate locked cupboards within a locked cupboard. Alight has been installed in the cupboard, and temperature checks are conducted daily and recorded. When the temperature exceeds that stated on the medication packaging, action should be taken to remedy this. Medicines are stored by resident, although internal and external medicines are stored together, and should be separate. Recording of medication given was satisfactory. Full and detailed written instructions for administering PRN or as required medication are still required. One care plan stated that Diazepam should be given to the resident if “tantruming”. Specific behaviours should be recorded and staff should not use inappropriate language. The medication practices witnessed were satisfactory. The home continues to require permission from the senior or on call staff to give PRN medication, the manager states that this is the preference of the home. The home now has an up to date BNF for reference. The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality on this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Arrangements for protecting service users have improved. Knowledge and techniques employed by the home should protect service users from potential risk of harm or abuse. EVIDENCE: Information received in the pre-inspection questionnaire indicates that the home has received no complaints since the last inspection. The home has a written complaints procedure. This has not been made available in other formats yet. Many staff have undertaken adult protection training and this must be accessed for new staff as soon as possible. Some alteration in the home’s recruitment procedures would better protect residents from risk of abuse. The manager requests 2 references and CRB and POVA checks but does not currently verify the references or ask for the most recent employer as one referee. An adult protection investigation is currently taking place through Kent and Medway Adult Protection protocols. The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality on this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Service users would benefit from a living environment designed and equipped to promote their personal independence and care needs EVIDENCE: 251 Saltings Road is a very small adapted four-bedroom property located within walking distance of Snodland High Street and shops. There is a staff sleep in room that has used floor space in one service user’s room which was hot and uncomfortable for staff to sleep in, a mobile air conditioning unit has been purchased and this has eliminated this problem. Two bedrooms are below minimum standards for size and the comfortable accommodation of personal furnishings and belongings. The lounge is small and when in full use by all three-service users and three staff is cramped and can be noisy. When these conditions prevail, it is almost impossible to maintain personal space. There is no private communal area for visitors or to enable service users a quiet area. The kitchen integrates a dining area and is in frequent use. The footings for a conservatory have been dug and the Trust is in the process of raising money for the building of the conservatory. The toilet and bathroom required refurbishment at the last inspection. The bathroom is now almost complete. Toilet seats are constantly being broken. The manager was investigating the purchase of a toilet seat that will withstand The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 18 the rocking movement of some service users following the last inspection; a raised toilet seat is currently in use. At the last inspection the Fire Officer recommended ‘Hold open’ devices fitted to fire doors. In use these would have provided for a much better environment for individuals with sensory impairment, allowing freedom of movement in the home. The manager has investigated the devices but has been advised by the fire officer that these cannot be used. 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 negotiate their way around the house. The manager has commissioned quotes and plans from a landscaping company to improve the garden. Attention is needed in the meantime to fix the broken fencing and the back gate as this is a security issue. The overflowing rubbish bins and ashtray used by staff should also be away from areas used by the residents. The ashtray should also contain sand to minimise the risk of fire. The safety of residents would be improved by the separately storing soft furnishings and gas bottles. The COSHH cupboard should be kept locked, as it was left open, and safe storage of tools in the shed would all enhance residents safety. The storage of items on top of cupboards should also be reviewed as these are a potential hazard. The home was clean and free from offensive odours on the day of inspection. The downstairs toilet did not have liquid soap or paper towels, this could present an infection control hazard. The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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): 31,32,34,35 Quality on this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Improvements in both support and training opportunities continue to develop the standard and consistency of care offered within the home. EVIDENCE: Staff do not have clear job descriptions, there is one job description for all care staff regardless of them being care staff, seniors or even deputy manager. Staff have an understanding of their own roles. Staff have been provided with the GSCC code of conduct. Staff are receiving support to gain the competencies required to meet residents complex needs, through external training opportunities. Some staff are NVQ trained although the organisation needs to continue to support staff to enrol for NVQ training. Staff who have no previous experience of caring for learning disabled people should receive LDAF accredited training, the manager was not aware of this. Three staff recruitment and training files were seen. The home uses the Mulberry House recruitment policy, which requires updating to reflect the recent changes in legislation. Some alteration in the homes recruitment procedures would better protect residents from risk of abuse. The manager requests 2 references, but does not verify the references or ask for the most recent employer to complete one of the references. The provision of training has improved however two new staff members had not completed the induction, one of which had received training in food The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 20 hygiene and medication administration, epilepsy training had been booked, but there was no evidence to suggest other “core” training had been booked or planned. Staff still do not have training and development plans. The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality on this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Clear leadership, attention to detail and a focus on the promotion of current good care practice will further consolidate and advance the home’s 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 manager continues to work toward the registered managers award. The manager has not yet received a reviewed job description. The Board of Trustees continues to make regular provider visits to the home. A written report of their findings is shared with the registered manager and the CSCI. The manager stated that a quality assurance questionnaire regarding the services offered by the home has been complied and was sent to interested parties, responses were to be collated and acted upon. This work has not been completed. The Inspectors discussed the new regulations and methodology around quality assurance systems with the manager. The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 22 Some health and safety issues were identified, as mentioned in standard 24. The home adopts safe working practices with regard to moving and handling, food hygiene, and infection control. Information received in the pre inspection questionnaire indicated the home is up to date with various checks and servicing of equipment. The environmental risk assessments did not reflect or address the current areas of risk. The manager is aware of her responsibilities to report accidents injuries etc. The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME 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 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 2 32 2 33 x 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 1 X X 2 X The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 24 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 YA9 Regulation 13 (4) Requirement The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. In that: environmental risk assessments will be undertaken and appropriate action taken, particularly with regard to the grounds, and individual risk assessments be expanded upon in scope. Timescale for action 30/09/06 2 YA20 13 (2) Previous timescale 30/03/06 Partly met The registered person shall make 30/09/06 arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home- in that The staff when considering administering PRN medication uses specific written instructions describing the triggers for administering medicines, agreed by relevant health care professionals wherever possible. Alternative arrangements are DS0000023848.V306631.R01.S.doc Version 5.2 Page 25 The Melanie Ann Trust Residential Home (S) 3 YA24 4 YA24 made for the safe storage of medicines at the correct temperatures, in accordance with manufacturers guidelines. Internal and external medicines are stored separately. 13 (4) The registered person shall 30/09/06 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 will be undertaken and appropriate action taken, particularly with regard to the grounds, and individual risk assessments be expanded upon in scope. Previous timescale 30/03/06 Not met 30/09/06 23(2)(a,b) The registered person shall (f)(n)(o) 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) External grounds, which are suitable for, safe for use by, service users, are provided and appropriately maintained (previous timescale of 30th September 2005 and 31/03/06 not met.) DS0000023848.V306631.R01.S.doc Version 5.2 Page 26 The Melanie Ann Trust Residential Home (S) 5 YA34 19 The registered person shall not employ a person to work at the care home unless subject to paragraph 6 he has obtained in respect of the at person the information and documents specified in paragraphs 1 to 6 of schedule 2 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. (Previous timescale of 30th November 2005 and 30/04/06 not met) 30/09/06 6 YA39 24 (1) 30/09/06 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. 2 Refer to Standard YA5 YA6 Good Practice Recommendations It is recommended that the room to be occupied is identified on the contract. 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. Partly met Repeated from the last inspection 30/01/06 It is recommended that staff and management demonstrate how individual choices have been made and record instances when others make decisions and why. Not met DS0000023848.V306631.R01.S.doc Version 5.2 Page 27 3. YA7 The Melanie Ann Trust Residential Home (S) 4. YA7 5. YA23 6 YA22 7 YA24 Repeated from the last inspection 30/01/06 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. Partly met Repeated from the last inspection 30/01/06 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. Partly met Repeated from the last inspection 30/01/06 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. Not met Repeated from the last inspection 30/01/06 It is strongly recommended that the stated aim of covering radiators to all areas to which service users have access is fulfilled. The provision of additional grab railing and banisters to the stairway should be fitted as recommended. Partly met Repeated from the last inspection 30/01/06 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 10 sq m and over. Two rooms are below 8.5 sq m and should be closely reviewed and assessed to individual sensory and care needs and are assessed as fit for the purpose through the care review process. Not met Repeated from the last inspection 30/01/06 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. Partly met Repeated from the last inspection 30/01/06 DS0000023848.V306631.R01.S.doc Version 5.2 Page 28 8 YA25 9 YA27 The Melanie Ann Trust Residential Home (S) 10 YA30 11 YA31 12 YA32 13 YA33 14 YA35 15 YA35 16 YA35 17 YA36 18 YA36 It is recommended that the liquid soap and paper towel dispensers be re fitted in the toilet, that they be kept stocked up and used by residents and staff to help eliminate infection control hazards. It is strongly recommended that detailed job descriptions be devised, and that staff be issued and are familiar with the GSCC code of conduct. Not met Repeated from the last inspection 30/01/06 It is recommended that staff continue to be facilitated to attain NVQ qualifications as stated in the standard Ongoing Repeated from the last inspection 30/01/06 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) Partly met Repeated from the last inspection 30/01/06 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) Partly met Repeated from the last inspection 30/01/06 It is recommended that each staff have an individual training and development assessment and profile Not met Repeated from the last inspection 30/01/06 It is strongly recommended that staff working in learning disability use LDAF accredited training to provide underpinning knowledge for progress towards NVQ. It is strongly recommended that staff working in learning disability use LDAF accredited training to provide underpinning knowledge for progress towards NVQ Not met Repeated from the last inspection 30/01/06 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 Repeated from the last inspection 30/01/06 It is recommended that staff have annual appraisal with DS0000023848.V306631.R01.S.doc Version 5.2 Page 29 The Melanie Ann Trust Residential Home (S) 19 YA37 20 YA37 21 YA39 22 YA39 23 YA40 their line manager to review performance against the job description and agree career development plans Partly met Repeated from the last inspection 30/01/06 It is recommended that the Manager have an appropriately detailed job description. Not met Repeated from the last inspection 30/01/06 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 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. Ongoing Repeated from the last inspection 30/01/06 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 Not met Repeated from the last inspection 30/01/06 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 Not met Repeated from the last inspection 30/01/06 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 Not met Repeated from the last inspection 30/01/06 The Melanie Ann Trust Residential Home (S) DS0000023848.V306631.R01.S.doc Version 5.2 Page 30 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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