Care Home: 7 The Mead

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What the care home does well Residents receive detailed pre-admission assessments so that they can be assured that the home can meet their needs. Residents` needs are regularly assessed and care plans drawn up to direct staff on how to meet their needs. Staff clearly knew how to meet the needs of the residents and followed care plans. Staff support residents to manage their own medication whenever they can. The medication records examined were in good order. The home has a policy in place for all medication, and all staff have medication training. The healthcare professional who wrote to us said: "They are proactive in this respect, but discuss with mental health staff first". When we asked what the service does well, one staff member said: "We present a warm, welcoming homely service, with staff who generally empathise with residents. Recovery is what we as a service aim for, placing emphasis on individual need", and another said: "We offer choice within a recovery based approach to care, which is solely based on the individual". When we asked the same question of the healthcare professional, they said: "They liaise well with mental health services. They minimise challenging behaviour. They don`t `panic` when problems arise". What has improved since the last inspection? Medication procedures have improved. At our last visit we asked the providers to make sure that they recorded the date when medication boxes were opened and medication was first used. They had done this immediately. We recommended that the home`s quality assurance programme should be further developed to include the views of families and outside professionals who have involvement with the home. We also recommended that they should record the initials of all staff and residents attending fire drills. They have done both of these things. What the care home could do better: There were many risk assessments in place for individual residents and for the safe running of the home. However, we saw that one risk assessment hadn`t been updated and there was one risk identified prior to the person moving to the Mead which hadn`t been addressed. We have asked to providers to make sure that this is dealt with. The providers told us in their AQAA that they plan to support residents to identify any training/courses to build their confidence and risk taking for any move on from The Mead. Staff files did not all contain the information needed, and the providers have been asked to make sure that this is done. When we asked staff how the service could improve, one person said: "By accessing community links more, and making people more aware of what services are out there for individuals". Another said: "Not sure, but I`m sure we could always improve". CARE HOME ADULTS 18-65 Mead (7 The) 7 The Mead Warminster Wiltshire BA12 8RB Lead Inspector Alyson Fairweather Key Unannounced Inspection 30 September 2008 10:00 th Mead (7 The) DS0000028265.V340413.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 Mead (7 The) DS0000028265.V340413.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. Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mead (7 The) Address 7 The Mead Warminster Wiltshire BA12 8RB 01985 215800 01985 218543 themead@rethink.org www.rethink.org Rethink 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) Vacant Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th May 2006 Brief Description of the Service: The Mead is a care home for six adults in mental health recovery, provided by the Rethink organisation. The building itself is owned by Kennet Housing Association and is made up of two semi-detached houses which have been connected into one larger house. There are six individual bedrooms upstairs and a smoking room, a lounge and a large dining room downstairs. The home is situated at the end of a quiet residential cul-de-sac within short walking distance of Warminster town centre and public transport facilities. There is a large, secluded garden to the rear of the house and a small lawned area to the front, with some parking available. The fees charged by the home are £717.37 per week. Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We recently asked the home’s manager to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how well they were performing and it gave us information about their future plans. We also sent out surveys to the service users, to staff and to health care professionals, so that we could get their views about the home. Two service users replied as well as two staff members and a health professional who works alongside the home. We reviewed the information that we had received about the home since the last inspection in 2006. We made an unannounced visit in September 2008 and met some of the residents and met staff as well as the acting manager and team leader. We looked around the home and saw a number of records, including care plans, risk assessments, health and safety procedures, staff files and medication records. People using the service prefer to be called residents and this is the terminology we use in the report to describe people who live at the Mead. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. What the service does well: Residents receive detailed pre-admission assessments so that they can be assured that the home can meet their needs. Residents’ needs are regularly assessed and care plans drawn up to direct staff on how to meet their needs. Staff clearly knew how to meet the needs of the residents and followed care plans. Staff support residents to manage their own medication whenever they can. The medication records examined were in good order. The home has a policy in place for all medication, and all staff have medication training. The healthcare professional who wrote to us said: “They are proactive in this respect, but discuss with mental health staff first”. When we asked what the service does well, one staff member said: “We present a warm, welcoming homely service, with staff who generally empathise with residents. Recovery is what we as a service aim for, placing emphasis on individual need”, and another said: “We offer choice within a recovery based approach to care, which is solely based on the individual”. Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 Page 6 When we asked the same question of the healthcare professional, they said: “They liaise well with mental health services. They minimise challenging behaviour. They don’t ‘panic’ when problems arise”. What has improved since the last inspection? What they could do better: 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. Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Prospective residents and families are given enough information to help them decide if they want to move to the home. They have their individual needs assessed before they arrive, so that staff know how best to support them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which give an overview of the service which will be provided. This is given to every resident and or their family, and also gives details of the organisation’s complaints procedure. These information leaflets are being continually updated to reflect the service offered, and people are given a “Welcome Pack” when they first move in, which contains lots of information they might find useful. Two people told us they had been asked if they wanted to move into the home, but one person said they had not. One person said: “I was gently moved in the direction of this care home. My key worker did a lot of research”, and another said: “I visited a few times before moving in”. Referrals come usually from the prospective residents’ Care Manager who will provide the service with a recently completed CPA (Care Programme Approach) assessment and any other relevant information, in order to initially identify Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 Page 9 whether the service is appropriate for and able to meet the needs of the individual. Following this, if it initially appears that they are able to offer a service, a visit will be arranged for the person, along with their Care Manager and/or any other appropriate carer, family member, friend or advocate. Visits are made to for meals and overnight stays so that people can meet existing residents and to spend time socialising and interacting with current them as well as members of the staff team. This process is very flexible and can be tailored to meet the needs of the individual. Mead (7 The) DS0000028265.V340413.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Care plans reflect the needs and personal goals of residents, which means that staff are able to support them in the way they wish. They are supported and encouraged to make their own decisions. Residents are supported to take risks where appropriate, and encouraged to be as independent as possible. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has a care plan, known as a recovery plan, which looks at what they want to achieve and how they can best be supported to reach these goals. The daily diary sheets, which used to be completed by staff, are now completed by individual residents. They record the activities they have taken part in that day as well as noting how they have felt during the day. The file layout was clear, with sections for the most recent Care Programme Approach (CPA) reports, risk assessments, recovery plans, correspondence, and the assessment information collected before the resident moves in. All plans had been recently reviewed and were all signed by the residents. One staff member Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 Page 11 said to us: “Recovery is what we as a service aim for, placing emphasis on individual need”. We noted that one resident had recently had a CPA meeting which said that they were setting up an Advance Statement. This means that the person makes decisions about medication and possible treatments at a time when they are well enough to say what they want, and would be used by mental health staff as guidance when or if they become unwell and cannot express their preferences. This Advance Statement was not yet completed, and it is recommended that this is done as soon as possible. Residents told us in their surveys that they could always make decisions about what to do each day. One person said: “It’s very much open to my own ideas, with staff in the background”. We saw that some restrictions on choice and freedom had been recorded on people’s personal files, although house rules appeared to have been kept to a minimum. Some of these restrictions were about the consumption of alcohol and smoking on the premises. Risk assessments were on file, and ways of minimising risks were identified. Some risks identified included working in the kitchen, use of finances and mental health relapse. Staff and residents had agreed how the situation would be managed. Other risks identified included abuse of alcohol (becoming unwell) and the potential danger of fire from people smoking. All these risks are recorded in individual’s files. Residents are, however, supported to take acceptable risks as part of encouraging an independent lifestyle. We saw that one person had a risk assessment in place about taking their medication themselves. This was dated 2007, and was due to be reviewed. However, circumstances had changed, and the way the person was reminded to take medication had altered. The risk assessment had not been updated to reflect this, and the provider has been asked to make sure that this is done every time there is a change in circumstances. On one assessment document, given to the home by the mental health team, there was information which said that a person might be a future risk. There was no evidence given to substantiate this comment, and the acting manager was unaware of the reason for this reference. There was no evidence of any discussion about this statement and no risk assessment in place. The providers have been asked to make sure that where a potential risk is identified by a referral agency, a risk assessment is put in place. Mead (7 The) DS0000028265.V340413.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Social and leisure activities are varied and tailored to individual need, with residents choosing what they wish to do. Contact with family and friends is encouraged and supported, and people’s rights and responsibilities are recognised in their daily lives. Mealtimes are an enjoyable time, and residents are encouraged to eat a healthy diet. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are a number of activities which residents are involved with. One has started some work with MIND, a mental health organisation, and others attend Greenacres and Moonrakers. One has started at Lackham College. There is an activities budget for cinema and outings, and people often go out for a meal or to the pub. In-house people watch DVDs, or use play-station games. One person enjoys games of chess with a staff member. The house has broadband internet for those who wish to use the internet. Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 Page 13 All three residents who wrote to us said they could do what they want, and one said: “We must find time though for shopping and medical appointments”. One staff member said residents had a “comprehensive recovery programme tailored to individual need”, but another thought the service could be improved “by accessing community links more, and making people more aware of what services are out there for individuals”. Staff encourage and support links between residents and their families, although the frequency of contact varies depending on individual circumstances. Some residents visit family and others phone regularly. Individual friendships are encouraged, both inside and outside of the home, and visitors are made welcome. All residents have keys for the house and can come and go whenever they like, although they are encouraged to say when they go out. All share responsibility for domestic chores. A rota of tasks is compiled at the residents’ meeting. All residents currently self cater. They compile the shopping list for the week, do the shopping and cook, with support from staff. There are certain rules regarding smoking, illicit drugs, and alcohol. The home’s alcohol policy is given to all residents, and a copy is kept in the house for all to see. Individual’s support plans detail any restrictions agreed with residents about how much alcohol they feel they should consume. It is made clear to residents that illicit drugs will not be tolerated, and that the police will be called and their tenancy will be at risk. One staff member told us that: “There is a total emphasis on individual’s rights, and our managers place emphasis on comprehensive coverage of cultural needs – religious, sexual orientation, or disability. Cultural competence training is given to staff”. All residents are currently self catering, and have their own cupboard in the kitchen for their food. All have weekly food planners, and are allocated a sum of money on a Monday morning for shopping. One resident was seen to be making some food in the kitchen, and lunch was a very pleasant meal shared with staff. Mead (7 The) DS0000028265.V340413.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Healthcare needs of residents are written in care plans so that they can receive support in the way they need and prefer. Self-medication is encouraged and supported as much as possible, and residents are protected by the home’s policies and procedures for dealing with medicines. No residents need personal care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents are registered with a GP and there is input from other health professionals as required. All residents attend mental health reviews on a regular basis, and the care plan may be amended at this time. A list of professional visits is kept, and these included psychiatrists and community psychiatric nurses (CPN), as well as visits to the dentist and the optician. People were seen to attend for regular blood tests because they take certain medication, and to attend regular Cognitive Behaviour Therapy (CBT). Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 Page 15 One staff member told us that they make every effort to see that people’s health care needs are properly monitored and attended to. The healthcare professional who wrote to us said that the service “seeks advice and acts upon it to manage and improve individuals’ health care needs”. There are good medication policies and procedures in place. Residents are encouraged to look after their own medication and supported to be as independent as possible. One resident who has a busy lifestyle, forgot at times to take their medication, so has had a reminder system set up on their phone. Another person was having difficulty, and staff agreed to support them more for a time, and then review the situation. The Monitored Dose System (MDS) is in use, which means that most medicines come supplied from the pharmacy ready made up in dossette boxes or blister packs. We checked the medication cupboard and the stock contained in it and all were found to be in order. The providers told us in their Annual Quality Assurance Audit (AQAA) that staff are aware that changes in medication can have an impact on a person’s health and that all changes are well communicated within the team. They prompt a review of medication when needed. They also told us that they have supported one service user to manage their own repeat prescriptions and collections, and to take full responsibility for the storage of their medication. They said they will continue to encourage others to do so. One staff member told us: “All staff are appropriately trained in medication administration. We have an effective medication monitoring procedure in place, and all service users are encouraged to self medicate”. The healthcare professional who wrote to us, when asked if the care service support individuals to administer their own medication or manage it correctly where this is not possible, said: “Always. They are proactive in this respect, but discuss with mental health staff first”. Mead (7 The) DS0000028265.V340413.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Each resident has a copy of the home’s complaints procedure, and have their views listened to and acted on. The policies and procedures the home has in place try to ensure that residents are safeguarded from abuse and harm. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure which gives details of the time in which complaints will be investigated, and who will be responsible for making sure it happens. It also gives details of how to contact the Commission for Social Care Inspection (CSCI). All residents are given a copy of the home’s complaints procedure when they come to live there. The manager and staff take all complaints seriously, and record the nature of the complaint, any action taken and the outcome. We saw that where complaints are of a sensitive nature, the acting manager has handled these with tact and confidentiality. All three residents who wrote to us said they knew how to make a complaint if they had to and who to speak to if they were not happy. The home has copies of the “No Secrets” document, as well as the organisational policy and procedure on responding to allegations of abuse. Rethink provide Vulnerable Adults training and all staff have done this. A “Whistle Blowing” procedure is also available for all staff, and risk assessments are in place for all residents. All staff have Criminal Records Bureau (CRB) checks and are checked against the Protection of Vulnerable Adults (POVA) register. Mead (7 The) DS0000028265.V340413.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The care which residents and staff take to maintain the home means that residents live in a homely, comfortable safe environment, which is clean and hygienic. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Mead is a care home for six adults in mental health recovery, provided by the Rethink organisation. The building itself is owned by Kennet Housing Association and is made up of two semi-detached houses which have been connected into one larger house. There are six individual bedrooms upstairs and a lounge and a large dining room downstairs. There is a large, secluded garden to the rear of the house and a small lawned area to the front, with some parking available. The Mead is a comfortably furnished home, with residents’ bedrooms decorated in a homely way and each containing individual personal items. Residents have a rota for their household chores, and there is an expectation that each person will keep their own room clean and tidy, Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 Page 18 although people are still supported by staff when necessary. It was clean and hygienic, with policies and procedures in place for the maintenance of the building. One room has had a change of use, from smoking room to a room where service users can have their keyworker or review meetings. Residents can also use the room’s computer, which has internet facilities. No confidential information is kept in the room, but copies of Rethinks policies and procedures are available for residents to read. The room has been fitted with modern laminate flooring, and has French doors which lead into the garden. When we asked residents if the home was fresh and clean, they said: “Always”, and one said: “We have a good cleaning rota”. All staff have had infection control training as well as food safety. Mead (7 The) DS0000028265.V340413.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Residents are supported by competent staff, some of whom have obtained formal qualifications. Their needs are met by staff who have appropriate training, and they are supported and protected by the home’s recruitment policy and practices. They benefit from well supported and supervised staff. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Currently there is one member of staff with NVQ Level 3 and another two people studying for this qualification. The providers told us in their AQAA that two of the three staff who are not yet NVQ qualified have training and qualifications in communications and counselling. The other member of staff has a higher level of education. Staff were seen to display good understanding of residents’ mental health needs when working with them. On the day we visited, there was a good ratio of staff to residents, and one person was going out shopping with a staff member. One staff member said to us: “We don’t know the answer to all questions, but will do our best to find the answer to any problem present”. However, one staff member told us: “Occasionally staffing levels preclude certain support”. When we asked the Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 Page 20 healthcare professional if the care staff had the right skills and experience to support individual’s social and health care needs, they replied: “For the most part. There has been recent use of more agency staff”. We watched and listened as staff members spoke to the residents who were at home. They treated them politely and listened to them when they spoke. They asked service users for their opinion about everyday matters. Two of the three residents who wrote to us said that staff “Always” treated them well, and one said: “Usually”. They commented: “Sometimes on the over-confident/brash side”. All new staff were seen to have had induction training. Other training included first aid, safe handling of medication, safeguarding adults, food safety, professional boundaries, racial equality, de-escalation, and basic mental health awareness. One person had a Level 2 Certificate in Infection Control. One resident was noted to have epilepsy, and although the acting manager had been on an epilepsy awareness course, none of the other staff had evidence that they had done so. It is recommended that all staff should have specialist training when required, eg epilepsy. This means that all staff would be able to support the resident appropriately if they had a seizure. Staff recruitment is assisted by Rethink’s human resources department. All potential staff members meet with residents informally and it is hoped that one will become more involved in the formal interview. All staff have Criminal Records Bureau (CRB) checks and are checked against the Protection of Vulnerable Adults (POVA) register. Two written references are also required. There is a six-month probationary period, and the manager meets with staff half way through this period to review progress. We looked at two staff files, and found that one had only one reference and another had no photographic ID and no health declaration. The providers have been told that all staff must have appropriate information on file, specifically two written references and photographic ID. There were records of staff supervision on file, and these meetings were seen to be held regularly. All staff members we spoke to said they felt well supported by their manager, and that they would be able to go to her if they had any problems. Mead (7 The) DS0000028265.V340413.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Residents benefit from a well run home. They know that their views underpin the monitoring and review of care practice. The home’s policies and procedures, and the health and safety checks carried out, mean that residents live in a safe environment. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager has been in post for six months, whilst the registered manager works in another Rethink home. She has done NVQ level 4 and has agreed to study for her Registered Manager’s Award (Registered Managers Award). She was previously team leader at the Mead, and has a good knowledge of the home’s residents and of current mental health issues. The post of permanent manager will be formally advertised soon and the succesful candidate will apply to be registered manager. Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 Page 22 There are various quality assurance methods used in the home, including regular monthly visits to the home by the provider’ representative. House meetings are held weekly and the organisation conducts its own quality assurance internal audit. The providers told us in their AQAA that they had recently been audited on their 7 Principles of Good Practice, and that the results were “very satisfactory”. The providers also told us that they actively seek service user feedback from satisfaction surveys, Service Advisory Group meetings and recovery planning. They said that residents are advised that when they receive mail from CSCI it is in their best interest to give feedback openly and honestly with the support of their care manager if needed. When we asked residents if carers listened and acted on what they said, two people said: “Always” and one said: “Usually”. There were good health & safety records in place, and the acting service manager has had infection control training. Rethink also undertakes a regular Health and Safety Audit of the home. There are regular daily, weekly and monthly checks done in the premises. The home’s fire extinguishers are serviced on a contractual basis, and there was an up-to-date fire risk assessment in place. Mead (7 The) DS0000028265.V340413.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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X 3 X 3 X X 3 X Mead (7 The) DS0000028265.V340413.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA9 YA9 Regulation 13 (4) (c) 13 (4) (c) Requirement Timescale for action 04/10/08 3 YA34 19 Schedule 2 (1) (3) All risk assessments must be updated whenever circumstances change. Where a potential risk is 04/10/08 identified by a referral agency, the providers must make sure that a risk assessment is in place. 04/10/08 All staff must have appropriate information on file, specifically two written references, and photographic ID. 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 YA19 YA35 Good Practice Recommendations Any outstanding Advance Statements should be completed as soon as possible, so that residents’ wishes are known in the event of illness. All staff should have specialist training when required, eg when a resident has epilepsy. This means that they would be able to support the resident appropriately if they had a seizure. DS0000028265.V340413.R01.S.doc Version 5.2 Page 25 Mead (7 The) Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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. 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