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Inspection on 12/07/07 for The Mendips

Also see our care home review for The Mendips for more information

This inspection was carried out on 12th July 2007.

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 16 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Resident`s needs are likely to be fully assessed to ensure that the home is suitable to meet individual requirements prior to admission. Residents` friends and family are made welcome by the staff at the home ensuring that links with family and friends are strengthened.

What has improved since the last inspection?

Following the last inspection there have been some improvements to the information provided to prospective residents and their representatives so that prospective residents have the information they need to make an informed choice about where to live.The MendipsDS0000026568.V339096.R01.S.docVersion 5.2

CARE HOME ADULTS 18-65 The Mendips 2-3 Shamrock Road Upper Eastville Bristol BS5 6RL Lead Inspector Sandra Gibson Unannounced Inspection 12th July 2007 1:00pm 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 Mendips DS0000026568.V339096.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 Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Mendips Address 2-3 Shamrock Road Upper Eastville Bristol BS5 6RL 0117 9518548 F/P 0117 9518548 s_ghamy@hotmail.com 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) Mr Mamode Raschid Ghamy Mrs Bibi Ghamy & Mr M R Ghamy Mrs Bibi Ghamy & Mr M R Ghamy Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (9) The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 9 persons with mental disorder aged 30 years and over 12th July 2006 Date of last inspection Brief Description of the Service: The Mendips is operated by Mr and Mrs Ghamy, it is a registered care home for nine adults with mental health care needs, aged 30 years and over. The home is situated close to the Fishponds Road and is within walking distance of shops, library, places of worship and other amenities and bus routes. The property has the appearance of a domestic dwelling and blends well with its local environment. The fees range from £334.00 - £533.54 per week. Items not included in the fee include dry cleaning chiropody, clothing and hairdressing. Currently prospective residents are given this information verbally. The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This one day, unannounced key inspection took 5 and Half Hours. The inspector worked with evidence from a whole range of different sources, including: • Information provided by the manager in the self assessment questionnaire • Information taken from resident survey forms • Information from professionals who visit the home • Speaking with residents • Looking at a number of residents records • Speaking with care staff • Walking round the home • Examination of some of the homes records • Observing some of staff practices and interaction with the residents. The overall analysis is that the home is an adequate place in which to live and to work. What the service does well: What has improved since the last inspection? Following the last inspection there have been some improvements to the information provided to prospective residents and their representatives so that prospective residents have the information they need to make an informed choice about where to live. The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 6 What they could do better: The contracts / statement of terms and conditions provided to residents are out of date. Urgent attention is required to ensure updated copies are provided to all residents to ensure that resident rights and best interests are protected at all times. The care planning system in place is still not satisfactory. There has been very little improvement since the last two inspections so residents are not likely to be consulted about their assessed and changing needs or personal goals which should be reflected in their individual care plans. Residents are supported to make limited decisions about their day-to-day life at the home but may not be fully protected, since new risk assessments are no longer completed and those that are in place are not reviewed and up dated as required at the last inspection. Following the last inspection there have been no consultation with residents about their goals in terms of education and occupation so that the arrangements for residents to access community facilities may not be adequate. Care plans are not up to date and accurate. This must be improved so that residents always receive personal care in the way they prefer and require. The staff at the home monitor and recognise residents health care needs and seek appropriate advice. However, further attention must be given to residents’ physical and emotional needs as a result of the ageing process. Residents have confidence with the service provider’s abilities to resolve complaints so that they feel their views are listened to and acted upon. There have been improvements to homes policies and procedure so that residents are better protected from risk of harm. However further improvement is still required to be made by providing safeguarding adults training for all staff working in the care home. The recruitment process is not satisfactory. Attention is needed to ensure that residents are fully protected. Staffing levels must be closely monitored to ensure that resident’s dependency levels are met at all times. The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 7 Following the last inspection staff are being provided with mental health training. However further training is required to ensure that individual residents specialists needs are met at all times. The management and administration of the home is based on openness and respect. However the quality assurance systems are not fully affective and need to be developed further. The service provider although qualified and experienced needs to up date practice and management skills to ensure that the home is run in the best interests of residents. Further improvement is required to ensure that meals are well managed: provide daily variation, good nutrition and that residents are involved in menu planning. The physical environment in this home has started to improve since the last inspection. However further improvement is required to ensure that residents benefit from a home that is clean safe and comfortable at all times. 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 summary of this inspection report can be made available in other formats on request. The Mendips DS0000026568.V339096.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 Mendips DS0000026568.V339096.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Following the last inspection there have been some improvements to the information provided to prospective residents and their representatives so that prospective residents have the information they need to make an informed choice about where to live. Resident’s needs are likely to be fully assessed to ensure that the home is suitable to meet individual requirements prior to admission to the home. The contracts / statement of terms and conditions provided to residents are out of date. Urgent attention is required to ensure updated copies are provided to all residents to ensure that resident rights and best interests are protected at all times. EVIDENCE: The statement of purpose was examined. This document sets out the aims and objectives of the home and includes a service users guide which provides The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 10 basic information about the service and the specialist mental health care the home offers. There have been some improvements since the last inspection including updated information on the admission process. This guide is made available to individuals in a standard format only. Evidence confirmed that the majority of residents have been at The Mendips care home for a number of years and consequently there is no initial needs assessment in place for some of those residents. However, residents who were admitted in the last five years have had a needs assessment carried out before they were admitted to the home. The manager also demonstrated his awareness that he would need to consult assessment information to see if he could meet any prospective individuals needs before they make a decision to accept any new applications for admission to the home new resident. Evidence confirmed that the small staff team have the necessary specialist skills and ability to care for the residents. However this will be discussed further in the report in the section on staffing Comments received included: “I looked around and the home seemed to suit my needs which it has done”. Evidence confirmed that residents are provided with a statement of terms and conditions / contract on admission to the home. These contracts give basic information on what people who live in the home can expect to receive for the fee they pay. However the sample seen were out of date as they had been drawn up in 1994 and 1996. The manager explained that a new contract had been drawn up for residents and was included in the revised service users’ guide. However evidence confirmed that only one resident has seen and signed this contract . The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care planning system in place is still not satisfactory. There has been very little improvement since the last two inspections so residents are not likely to be consulted about their assessed and changing needs or personal goals which should be reflected in their individual care plans. Residents are supported to make limited decisions about their day-to-day life at the home but may not be fully protected, since new risk assessments are no longer completed and those that are in place are not reviewed and up dated as required at the last inspection. EVIDENCE: The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 12 Evidence confirmed that the service recognises the rights of individuals to take control of their lives and to make decisions and choices. This does not always happen in practice as staff have a limited understanding of how to do this effectively as they have not had training following The Mental Capacity Act 2006. There is some evidence that residents are involved in some decision making about the home such as day to day living and social activities. These decisions are discussed in the residents meetings that take place on a regular basis. Residents confirmed this at the time of the inspection. From a sample of records seen evidence confirmed that each individual has a care plan but the practice of involving residents in the development and review of the plan is variable. The plans compiled in the home contain basic information necessary to deliver the residents care, but are not detailed or person centred. There was no evidence to confirm that the care plans are used as a working document or that the home has an identified member of staff involved in each individuals care. Consequently, there is a lack of individual support and attention for residents. Evidence also indicated that reviews do not take place on a regular basis. From a sample of four residents care plans seen only two had been reviewed in the last year. There is little evidence of risk assessments. Those that are in place are out of date and there is no evidence that they have been reviewed However, evidence confirmed that residents are allowed to make informed choices and take risks. Comments received included:” I go out 3 or 4 times /week which is my decision”. Another resident said: When I am well I decide what I’m going to do each day When I am unsteady on my feet and my walking is not good staff advise me not to go out or not too far but I make my own decisions I speak to the manager or care staff if I have a problem. Managers and staff always help when they can. I am happy at The Mendips and I would not want to move.” One resident is subject to section 117 Mental Health Act 1983 and must comply with the conditions of the after care arrangements. It is evident from the documentation that three residents can become aggressive. Despite a requirement being made at the last two inspections there was no evidence to confirm that reactive strategies have been developed to ensure that members of staff can manage aggressive situations consistently. The requirement to develop risk assessments for activities that may involve an element of risk has also not been actioned by the service provider following the last two inspections. Following discussions with the service provider it became apparent that he may benefit from risk assessment appreciation training. The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 13 Members of staff record daily events in the home’s diary, which is later transferred by the service provider into individual residents records. Evidence confirmed that there were gaps in daily records for example one record seen had no entry since the 28/06/07 and prior to that it had been completed on a weekly basis. Evidence of choices and decisions made by residents are also not included in the daily reports . The service provider explained that the views of the residents are sought on a daily basis. There was no evidence to confirm this information. English is not the first language for one resident and simple words are used to communicate, with family members assisting. The inspector observed a good rapport between this resident and on of the female members of staff The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,,1415,16,17 Quality in this outcome area is adequate . This judgement has been made using available evidence including a visit to this service. Following the last inspection there have been no consultation with residents about their goals in terms of education and occupation so that the arrangements for residents to access community facilities may not be adequate. Residents’ friends and family are likely to be made welcome by the staff at the home ensuring that links with family and friends are strengthened. The meals in The Mendips have improved since the last inspection. However further improvement is required to ensure that meals are well managed: provide daily variation, good nutrition and that residents are involved in menu planning. EVIDENCE: The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 15 Following discussion with a staff member evidence confirmed that staff are aware of the need to support residents to develop their skills including social , emotional and communication and independent living skills . However evidence confirmed that as there are currently very few staff members so it is not always possible to make this support available . Comments were received such as “ I talk to the residents a lot” I play bingo with them “ Residents enjoy one to one time. I try to give them that time when they have an assisted bath. I always make time to talk”. Residents in the home are given a limited opportunity to take part in a few activities both with in the home and in the community. On the day of the inspection the majority of residents were at home . There was no evidence that activities had been arranged for residents that day. The inspector was informed that two of the residents had spent the majority of the day in bed. There was no evidence to confirm that these residents were not well. Four residents currently attend structured community based activities. One resident canvasses during the day, with members of the congregation as part of his religious beliefs. During the inspection this resident told the inspector that he was planning a trip to Cardiff for a few days with his congregation. Four residents can leave the home independently and staff accompany four residents to assist with crossing the road. However, it was noted with the reduction in the staff team this may not always be possible at this time. Several of the residents consulted reported that they were able to leave the property without staff support. Despite a requirement being made at the last two inspections there was no evidence to confirm that educational and employment opportunities are explored with residents. Visitors to the home continue to be made welcome. Residents confirmed that whenever their friends and family visit, the staff greet their visitors in a positive manner. Visits can take place in the shared space or in their bedrooms for additional privacy. During the inspection one of the residents chose to see his social worker in the communal lounge whilst other residents were having tea and a snack in the communal dining area. The service provider stated that residents are provided with keys to their bedrooms and to the home. Residents confirmed this information. However, one of the residents told the inspector that he had reported his lock broken several weeks ago and nothing had been done to repair this lock since that time. During the course of the inspection the inspector observed that staff were aware of residents privacy and dignity. Evidence confirmed that the food provided in the home has improved since the last inspection. Following the last inspection residents were being offered a The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 16 high percentage of fast food as a result of the staff not being experienced in preparing and cooking meals. This fast food included a high level of burgers and fish fingers and chips being served and very little fruit and vegetables . This menu on display in the kitchen is not currently used. Meals provided are now recorded in a book maintained by staff. On the day of the inspection residents were offered cheese and potato pie or faggots and gravy with vegetables at lunch time. This information needs to be made available for residents to see and evidence that residents have been involved in menu planning must be available. The inspector observed the contents of the fridge and found only basic food such as dairy products and cold meat. The member staff on duty confirmed that there was another fridge freezer that the service provider maintains. There is a high percentage of frozen food eaten in the home but information confirmed that residents have fresh meat and vegetables on a Sunday. Evidence confirmed that residents are provided with breakfast, lunch, tea and supper but this is not currently recorded. No residents currently cook but the majority make hot drinks, use the toaster and microwave. On the day of the inspection the inspector was offered a hot drink by a resident. This is good practice. Following discussion with residents, several positive comments were made about the food. One resident also said “ I am never hungry. I get enough to eat” Evidence confirmed that they have the freedom to prepare refreshments and light snacks at anytime. However one resident said “sometimes the food is cold . I think it is because the plates are cold.” There is a rota for setting the table and washing-up displayed in the kitchen listing the designated person to complete the tasks. The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are not up to date and accurate. This must be improved so that residents always receive personal care in the way they prefer and require. The staff at the home monitor and recognise residents health care needs and seek appropriate advice. However, further attention must be given to residents physical and emotional needs as a result of the ageing process. EVIDENCE: Evidence confirmed that currently four residents require assistance from staff with personal care. Despite this being made a requirement at the last inspection evidence confirmed that the care plans for people with personal care needs continue to vary in detail. The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 18 Evidence confirmed that there are three people at the home that are from diverse cultures. The service providers said that the residents have no specific cultural needs. For one resident, family member’s provide the support to meet religious needs and for another resident there is good support from the local congregation. Evidence confirmed that residents who live in this home have access to health care both with in the home and the local community. Records confirmed that health needs are monitored and appropriate action taken. Until recently aids and equipment have not been provided in this home and residents have therefore had to be mobile to live in the home. However it was observed that one resident has started using a walking frame. The service provider said the resident in question only uses this aid on rare occasions”. He confirmed that this residents needs were changing as a result of getting older and that a rail had been installed on the staircase leading to this resident’s room. There was no record of this changing need in the care plan or any reference to the ageing process. However during the inspection a member of staff demonstrated her awareness of one of the residents changing needs as a result of the ageing process and how she was helping the resident in question to keep a diary of their changing needs which would help to inform any Health professional involved with this residents care. Records confirmed that the residents have psychiatrists involved in their care. Residents access NHS facilities within the local community. The service provider stated that dental and optician appointments are arranged for the residents. A care coordinator confirmed “Feels that they look after individual needs well and keep people informed. .There is a lack of resources which is an ongoing problem.” Residents consulted during the inspection reported that the service provider accompanies them on GP’s, hospital and specialists visits. The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have confidence with the service provider’s abilities to resolve complaints so that they feel their views are listened to and acted upon. There have been improvements to homes policies and procedure so that residents are better protected from risk of harm. However further improvement is still required to be made by providing safeguarding adults training for all staff working in the care home. EVIDENCE: Evidence confirmed that The Mendips has a complaints procedure that meets the National Minimum standards and Regulations. The procedure is up to date and is found in the service users guide in a standard format. There have been no complaints received from residents at the home since the last inspection. The owner and one of the family members who works in the home have attended external safeguarding adults training. One of the members of staff on duty has not attended up to date training in safeguarding adults but demonstrate her awareness of what to do if she suspected abuse had taken place. The other member of staff employed in the home had nor received this The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 20 training either. Following the last inspection the service provider confirmed that the home’s Abuse Guidance policy has been up dated to comply with Bristol City Council a safe guarding adults policy and procedure “No Secrets” guidance. . Residents giving feedback about the care provided in the home confirmed that the owner would be approached with any concerns or complaints. One resident said “Having been in a few homes before my social worker advised me that this home was the right place for my needs and he was right .We talk to the manager and his wife or care staff to make a complaint or we have a complaints book.” The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical environment in this home has started to improve since the last inspection. However further improvement is required to ensure that residents benefit from a home that is safe and clean at all times. EVIDENCE: Two terraced properties were originally converted to offer accommodation to nine adults with mental health care needs. The property of the service providers adjoins and can be accessed through the care home. It has the appearance of a domestic dwelling, which blends well with its immediate environment. The home is within walking distance of shops, library, amenities and bus routes. While there is a gentle gradient into the property, residents must be mobile, as the property does not allow for aids and equipment. As discussed earlier in the section on personal and health care support one The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 22 resident has now been provided with a zimmer frame following a recent hospital admission. The service provider has installed rails on the stairs leading to this residents room on the first floor. The service provider informed the inspector that the resident does not need the zimmer frame to access stairs and rarely uses the frame in the house. The accommodation is arranged over two floors with shared space on the ground floor and bedrooms on both floors. Shared space at the home comprises of a lounge, dining room, kitchen and smoking room. In the lounge and dining room there is sufficient seating for all the residents to sit together as a group. There is a pay phone available in the corridor for residents to make personal calls. A tour of all the communal areas was conducted . The home smelt fresh . All bedrooms are single and lockable, with a combination of the home’s furniture and residents’ personal belongings. As discussed in a previous section one bedroom lock had been reported as in need of repair. Two bedrooms were viewed and the residents consulted reported that their bedrooms were suitable to their lifestyles. Improvements to the vanity units have started to take place in this home following the requirement made at the last inspection. Comments received were: “I think the manager is doing his best to keep the maintenance of this home”. The owner confirmed that call alarms are installed in all bedrooms. It was understood that this alarm system had been installed so that all residents including those over 65 years of age could access support at night from the service provider in the adjoining house. There are no waking night staff in this home. Two call alarms systems were checked. One was found to be fully functioning and located close to the residents bed .The other had been hidden behind the resident furniture and could not be accessed .The resident was not awre that the call alarm system was available. The owner agreed that this situation would be dealt with as a priority following consultation with the resident about relocating the bedroom furniture. There are two bathrooms with toilets on the first floor and a downstairs toilet shared by the residents at the home. Both bathrooms were noted to be worn and in need of urgent attention. One of the bathroom locks on the first floor is not working and so does not provide privacy for residents. The toilet on the ground floor is currently not in use as this area is undergoing major refurbishment. There are plans to install a new ground floor bathroom / shower facilities. There are other building works taking place in this area to improve the utility / laundry facilities. Scaffolding is in place on the outside of the building and residents have been verbally informed not to use this exit to The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 23 the rear garden. However, no risk assessment was completed prior to this building work taking place. The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment process is not satisfactory. Attention is needed to ensure that residents are fully protected. Staffing levels must be closely monitored to ensure that resident’s dependency levels are met at all times. Following the last inspection staff are being provided with mental health training. However further training is required to ensure that individual residents specialists needs are met at all times. EVIDENCE: The service providers are the main carers for the residents. Two members of staff are employed and one family member is also on the duty rota to maintain the staffing levels during the day. The two service providers are available at night and provide a sleep in service. The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 25 One of the owners said that three other members of staff had left the care home after the last inspection . He could not be specific about reasons but said he had difficulties recruiting staff. One family member said “The staff try their best. Improvement would be – more experience staff instead of younger family members working there. Overall they do their best and get the job well done. When they are short of staff then things are not done as well”. On the day of the inspection there were satisfactory staffing levels in place. The staff personnel files of the staff currently employed at the home were examined. The completed application forms, references and Criminal Records Bureau (CRB) disclosures are held to demonstrate the process followed. However it was noted that one of the members of staff work permit may have expired. The service provider was advised to contact The Home Office for advise. It was also noted that this members of staff Criminal Records Bureau / Protection of Vulnerable Adults had not been completed by The Mendips. The owner explained a second Criminal records bureau / protection of vulnerable adults check had been sent off from the care home and until this check was received this member of staff would not be working alone. The service provider was also advised that the references obtained for this member of staff from overseas were not recent and therefore not acceptable as there had there is a substantial gap in time which was not accounted for. One member of staff is a qualified psychiatric nurse from overseas but is currently working in this country as a care assistant until she has completed an adaptation course to work as a qualified nurse. The other member of staff has undertaken NVQ level 2 in another care setting and has indicated that she would like to complete NVQ 3 training . This member of staff has received training in schizophrenia but has received no other training in mental health. The service provider confirmed that both staff have attended statutory training course prior to working at The Mendips. One member of staff confirmed that she had been involved in a staff appraisal since she stated working in the home but the service provider had provided no formal supervision. There was also no record of the other staff member receiving formal supervision or an appraisal since she had started working in the home. The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39, 40 , 42,43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. However the quality assurance systems are not fully affective and need to be developed further. The service provider although qualified and experienced needs to up date practice and management skills to ensure that the home is run in the best interests of residents. EVIDENCE: The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 27 Evidence confirmed that one of the owners is a qualified psychiatric nurse and now takes the lead in managing the home. The other service provider is now less involved and chose not to be part of the inspection. During the last inspection the inspector was informed that one of the owners was planning to enrol on NVQ 4 training. To date this has not happened although the service provider is aware that they need to keep up to date with practice and continuously develop management skills. The home has a statement of purpose that sets out the aims and objectives of the service. The service provider with another family member are starting to improve and develop systems that monitor practice and compliance the plans , policies and procedures of the home. However more work is required in this area. Evidence confirmed that the manager is aware of the need to promote safeguarding adults and has in place a health and safely policy that generally meets health and safety requirements and legislation. The manager has highlighted arrears where they need to make improvements and has an action plan in the self-assessment sent to CSCI for undertaking this work. Evidence confirmed that the service provider is aware of the need to plan the business activity of the home and manage the finances and resources to deliver the business plan. The service provider takes responsibility for the homes accounts and business development. As discussed in the section on individual needs and choices that record keeping needs to be improved. The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 3 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 1 32 3 33 2 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 1 x LIFESTYLES Standard No Score 11 3 12 1 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 x 2 2 3 2 3 3 3 3 The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 29 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 YA5 Regulation 5 (1)(2) Requirement The registered person shall supply a copy of the service users guide to each service user which includes: • the terms and conditions (other than those relating to fees ) in respect of the provision to service users of accommodation (including the provision of food) and personal care • details of the total fees payable in respect of the services and the arrangements for the payment of such fees • a standard form of contract for the provision of services and facilities by the registered provider to service users An up to date care plan must be available for all residents that is person centred All care plans must be reviewed at least six monthly a) Risk assessments must be completed for activities that may involve an DS0000026568.V339096.R01.S.doc Timescale for action 31/08/07 2 3 4. YA6 YA6 YA9 15 14 13(4)(b) 30/09/07 31/10/07 31/08/07 The Mendips Version 5.2 Page 30 element of risk. b) Manual handling assessments must be completed for residents that require assistance outside the home c) Reactive strategies must be developed for residents that may exhibit aggressive and violent behaviour. (Previously required 14/02/06 and 12/07/06 The service provider is advised that Legal advice is currently being sought 5. YA12 12(1)(b) Residents must be consulted on their goals for education and occupation to develop and action plan to meet these goals. (Previously required 14/02/06 and 12/07/06). The service provider is advised that legal advice is currently being sought 6. YA18 15 Attention must be given to care plans to ensure that they contain the detail so that residents receive the personal care support in the way they prefer All staff must be provided with Safeguarding adults training which complies with No Secrets in Bristol Locks to bathroom and bedroom door must be repaired All residents over sixty five years and those under sixty five years who have been assessed as DS0000026568.V339096.R01.S.doc 30/09/07 30/09/07 7 YA23 13(6) 31/10/07 8 9 YA26 YA29 23(2) (c ) 23 (2) (n) 31/07/07 31/07/07 The Mendips Version 5.2 Page 31 10 YA24 13(4) 11 YA34 18(1) 12 YA33 18(1) (a) 13 YA35 18(1) (c ) 14 15 YA39 YA37 24 10(3) 16 YA36 18(2) needing an emergency call alarm must have access to a fully functioning, accessible call alarm in their bedrooms Risk assessments must be carried so that all parts of the home to which residents have access are free from hazards Recruitment process must include: two written up to date references relating to that person Staffing levels must be monitored closely to ensure that residents dependency levels are met at all times night and day Further mental health training must be provided in this home to ensure different mental health needs are understood by all staff. A Quality assurance system must be developed. The service providers must attend regular training to up date their knowledge. This must include training such as risk assessment appreciation training and Mental capacity Act 2006 awareness training. Staff must receive regular supervision. 31/07/07 31/07/07 31/07/07 31/10/07 31/10/07 31/10/07 30/09/07 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 YA17 Good Practice Recommendations Residents are offered a choice of suitable menus which met their dietary and cultural needs and which respect their individual preference. The serving of the meals should be reviewed to ensure The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 32 2 YA21 that they are served hot The changing needs of residents with deteriorating conditions should be reviewed and met swiftly to ensure the resident retains maximum control The Mendips DS0000026568.V339096.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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