Care Home: Mawney Road

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What the care home does well What has improved since the last inspection? What the care home could do better: CARE HOME ADULTS 18-65 Mawney Road 89 Mawney Road Romford Essex RM7 7HX Lead Inspector Roger Farrell Unannounced Inspection 27th May 2008 11:00 Mawney Road DS0000027864.V364531.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 Mawney Road DS0000027864.V364531.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. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mawney Road Address 89 Mawney Road Romford Essex RM7 7HX 01708 741388 01708 741 388 greenwichoffice@voyagecare.com londonroad@tiscali.co.uk Milbury Care Services Ltd 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) Frederick Michael Medland Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accommodated is: 6 8th August 2006 2. Date of last inspection Brief Description of the Service: 89 Mawney Road is a care home that provides accommodation and support with day-to-day living for up to six people who have profound learning disabilities, most of whom do not communicate using words. Opened in 1994, all five current residents moved in during the first year. It is run by ‘Milbury Care Services Limited’, now called ‘Voyage’ - which is part of the ‘Paragon Healthcare Group’, a company who run about three hundred homes nationwide. ‘London and Quadrant HA’ own the building, though Milbury are responsible for internal maintenance. This house is on large corner plot in a residential neighbourhood, set well back from one of the main roads that run into Romford town centre. Positive points are good living space - including large communal rooms, and each person having their own big bedroom; a well maintained and equipped garden; and a car park that makes it easy for residents who need wheelchairs outside to use the home’s minibus. The current charge is £1,248.73p for each block contract place. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 11am and 5:30pm on Tuesday 27 May 2008. Mike Medland, the registered manager, and the deputy were on duty. This was very helpful as the manager had not been present for a number of unannounced visits since he took over nearly two years ago. Also, the deputy, who had started just before the last key inspection, has taken a lead on increasing the opportunities for service users to be involved in worthwhile social activities. They were able to show what has been achieved over recent months. The senior care worker was also on duty and made sure the daily routines carried-on and allowed the inspection checks to be carried out efficiently. Inspection reports over a couple of years talked about how this service had slipped. The major change was that the manager who had worked at the home since it opened twelve years earlier, left at the end of 2005. She, like a number of original long-serving care workers knew all the residents from their previous setting. When Mike Medland took over he faced a number of challenges. There were lots of changes in the team as a number of established staff left, and the company’s only other home in the area - Urswick Road in Dagenham – closed, and staff from that home had transferred to Mawney Road. There were also changes in the shift patterns, such as loosing the generous overlap between the morning and afternoon shifts. Although the opportunities for residents to get out and about had dropped off, being involved in activities away from the house practically came to a stop. The major concern raised by inspectors was how the team were coping with residents who were developing physical problems, including those to do with getting older. Our reports also said that Mike Medland was taking too long to complete his application to be assessed as the registered manager. The last key inspection report had a long list of improvements that were necessary to meet the expected standards – setting out seventeen requirements. The reports of the two random unannounced inspections that followed said there was progress, but these items were carried forward. Last year the inspector had given the manager and deputy an overview of the changes in the way care homes are assessed. This includes introducing a new self-assessment form called an ‘AQAA’ (Annual Quality Assurance Assessment); managers providing improvement plans saying how they are tackling the necessary changes; making sure the Commission is kept informed of changes and difficulties; and making public the home’s quality star rating. The challenge facing the manager and company was to demonstrate that areas scored as ‘adequate’ were raised to the more acceptable score of ‘good’. They were also aware that particular attention must be paid to those requirements that had been carried forward beyond the original target date. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 6 The inspector appreciates the warm welcome he receives at this home, and the cooperative attitude of staff. At this visit the manager showed he had taken on board previous advice. The efficient way in which he and the deputy responded to this inspection, including how records are arranged, showed their increased understanding of the standards and legal requirements covering care homes. It also showed how well they work together, and confirmed that strong leadership and practice standards have been restored. One relative told us – “It is certainly back on an even keel. Staff have been marvellous, and there is lots of contact……All my answers would be favourable. I have seen how they have helped (my relative) recover from a stroke… such as attending a music class for people who have had strokes and how she has been accepted in that group.” In addition to talking to the manager and deputy about the requirements that had been carried over and looking at paperwork, our checks at this visit included: • • • • • • • • Reading the detailed ‘Annual Quality Assurance Assessment‘ (‘AQAA’) completed by the manager in April 2008; Checking through all the notifications made by the manager to us over the past year; Listening to the two service users who speak or sign to the inspector; Updating our contacts list, and phoning three relatives who are in touch with their family member and staff at the home; Looking at the five ‘Have Your Say’ questionnaires and one letter returned to the inspector since his last mail-out survey at the end of last year. This report uses quotes from this relatives’ survey; Speaking with the main social workers and reviewing officer who have contact with the home; Looking at the company’s ‘Annual Service Review’ completed last August; Asking the manager and deputy to send on more details about items discussed at the visit. What the service does well: The quality rating for this service is now 2 Star. This means that the people using this service experience good quality outcomes. This home has consistently maintained a very high level of assistance with personal care, and household standards overall. All residents need help with intimate care, such as bathing, dressing and using the toilet. Even during the difficult period following the change of manager, we have always found the highest standards of personal care and attention to cleanliness throughout the house. Other people who visit the home, including relatives, community nurses and social workers share this positive view. A social worker told us recently – “It is a very homely environment, very welcoming, and staff are always Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 7 helpful. I have seen how clients are included, such as not being excluded from the kitchen. Yes, I would say I am happy with the service.” This is matched by the attention paid to individual’s dignity. This can be seen in important areas such as choice and care of clothing, and the furnishing and décor of each person’s bedroom. One such example noted by the inspector at an earlier visit was how bathrooms had each services user’s own preferred quality perfume or aftershave. These commendable household standards are also evident in other home-making signs, like individual photo portraits and the use of fresh vegetables and other quality ingredients to make all meals. Another relative told us – “I would say they have first class standards, and are really doing okay. I see my daughter most weekends as (staff) bring her to visit and she is always well presented……and I do get the monthly reports.” What has improved since the last inspection? The headline finding of this report is that the managers and team have been successful in tackling the areas that caused this valued service to drop to an adequate rating, meaning a long list of requirements was carried over in last year’s reports. Evidence to support this achievement is included under the section headings that follow – notably how care-plan files have been improved, and the major increase in social activities. The manager, deputy and team are commended for this achievement. Further, the positive contribution to this success made by the company’s operations manager is recognised, notably in how she has followed through on problems to do with the flow of information with the Commission, and stepped in at unannounced inspections when the manager has not been available. Aspects of the service - such as the consistently excellent household standards referred to above - suggest this service can aspire to the top ‘Three Star’ rating. Some findings at this visit – such as the plans to support residents when they go into hospital - also show there is substance to the manager and deputy’s aspiration to see Mawney Road become a top-ranked care service. Additional initiatives worthy of mention include: • ‘Monthly Communication Sheets’. Every month key-workers complete a communication sheet for each service user. The information is to update and involve families in residents’ every-day life. The information lets parents and others know about significant life events and what activities have taken place. The deputy said – “We have had excellent feedback from carers. (One relative) sent a letter which is stored in the office in the compliments folder. The letter was to congratulate us on the communication sheet and also mentioned how pleased they are with the activities (their son) is involved in.” One parent said – “I am quite impressed with the monthly reports…….it keeps us informed about DS0000027864.V364531.R01.S.doc Version 5.2 Page 8 Mawney Road everything that is happening. We are always invited to the social gettogethers.” • Makaton Signing. The deputy is a qualified Regional Makaton Tutor. She has been training staff in Makaton and holds a workshop at Mawney Road every Tuesday afternoon. One service user in particular is responding well to a wider vocabulary of gestures, and three others are responding to more symbols. There are Makaton symbols on display to help individuals to make choices, such as in bathrooms to be used when helping with personal care. Symbols have also been included as part of the new pictorial menus. The social worker quoted above also said – “(The deputy’s) skills in this area are impressive, and she has been happy to help as a wider resource.” Colour coded Laundry Baskets. This is a good example of how service users are being helped to understand and do everyday tasks for themselves. Key-workers have supported each service user to purchase towels in a colour that matches their individual laundry baskets. Support workers encourage each person to put their washing into their own laundry baskets. Such small but significant steps are helping develop skills and show choices. ‘Likes Board’. The deputy said – “All service users have a pictorial board in the hallway which shows easily what individuals like. This is aimed at staff to be able to identify quickly some key points of an individual. The board is also intended to prompt individuals to make choices “ ‘Communication Choice Books’. Our report last year said a student on placement had helped a couple of residents do ‘life stories’. One of these residents did a presentation using her picture album to an audience that had included her family. At this visit the inspector heard how one resident was being helped create a ‘communication book’. Staff said – “This book will be extremely useful at the Tuesday social club which the service user attends. She has made a lot of new friends and gets very frustrated because she is unable to express herself verbally. The combook will be a great tool to support her communication, and therefore support her to have a more active social life.” • • • When asked about being given enough information one relative wrote “We have always been in close contact with the manager and the home, therefore communication occurs as a matter of course.” Another person wrote - “We keep in touch through visits, and phone calls are encouraged.” Regarding offering choices one relative stated - “The emphasis is always on individual’s needs and choices about how they live their lives. My sister has, through a combination of advancing years and sometimes poor health, needs a slower and more relaxing lifestyle. She is able to enjoy this whilst staff Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 9 continue to ensure she receives appropriate stimulation and as good a quality of life as is possible.” Asked about what the care home does well, one family member provided the following list: “1. Achieves a balance between personal choice and independence – and the need to provide a safe and secure environment. 2. Staff identify and meet individual needs as far as possible. 3. Treat individuals with respect. 4. Staff constantly strive to create a range of opportunities for residents, within the limits of the abilities of the people they are caring for.” Another list provided by a different relative said: ”1. Each resident is treated as an individual no matter how bad their learning difficulty. 2. They provide well-cooked nutritious meals with lots of variety. 3. They run the home to suit all the residents no matter how diverse their needs.” A letter received from a elderly relative included the following - “It is not possible for me to answer some of the questions because I have not been able to get to the home for a number of years. The carers do bring my daughter to visit me at weekends. They also notify me of her progress when she is admitted to hospital, and about parties and activities at the home.” Other written comments included – “The home is very good at helping my son with Christmas presents and cards and birthdays. I receive flowers from my son and get a post card when he is on holiday.”; “I think it is a lovely home. I have no worries about the way (my relative) is looked after. It does not matter what time you turn up they always make you welcome there.” What they could do better: The final section of this report on the management of the home states – “The positive findings of this report are an acknowledgement that, after a challenging period, Mike Medland has restored team stability and a strong sense of direction to this service. He is quick to acknowledge the significant contribution made by the deputy, notably in the key areas of using community Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 10 facilities; developing in-house skill training for service users; paying greater attention to communication pathways; and keeping relatives involved and informed. They complement each other’s skills, and recognise that they now provide clear leadership – not only by tackling outstanding deficiencies, but also championing some imaginative initiatives which the service users are responding to favourably.” We are now satisfied that all outstanding requirements have been addressed. At this visit the inspector explained to the manager how he could better show evidence of success in the future ‘AQAA’ forms. Other than two recommendations, it has not proved necessary for us to tell this service about any areas that must be improved in order to show they are meeting the minimum standards expected of a care home. 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. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 11 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 Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 12 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 and 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Before agreeing admission the service carefully considers the assessed needs for prospective residents, and the capacity of the home to meet their needs. Prospective residents are given the opportunity to spend time in the home. Staff give them information and special attention to help them to feel comfortable in their surroundings, and involve relatives who are encouraged to ask questions about life in the home. EVIDENCE: At the last key inspection it was expected that an eighty-two year old resident who was in hospital would need to move to a nursing home. A prospective new resident had been referred for the anticipated vacancy, and had started to visit. In the absence of the manager, staff could not locate or provide further details – though it was believed that an overnight stay was due to take place that week. The inspector raised the matter with the operations manager. She came to the home and showed the inspector the detailed Milbury ‘Generic Assessment’, the ‘Health and Care Assessment’ and updated referral policies that she said would be followed as part of all referrals. The inspector said that it is expected good practice to commence a log once a prospective resident starts to visit the home, saying he would look closely at the assessment Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 13 process at a future visit - with the expectation that the company’s procedures would be followed. A requirement was set on this matter, adding that guidance on what needs to be covered during the assessment is listed under Standard 2.1 in the ‘National Minimum Standards’ (‘NMS’). This matter was checked at the unannounced random inspection on 6 March 2007, followed by a more detailed case-tracking examination at the inspector’s next visit. The findings were very positive, showing a thorough approach and incorporating all the company’s assessment and move-in records. Also included were good details carried over from the person’s last care home; records of early stage reviews involving the person’s family, health and social workers; and other important information such as health issues and personal history. The inspector wrote to the manager concluding – “I was pleased to see that all the company’s assessment; move-in monitoring sections; and care plans had been completed in the new service user’s file. He appeared relaxed when we were introduced, and all comments confirm that he has had a successful transition.” Following this, the new person’s main family member returned a questionnaire to the inspector showing he was very happy with the transition and service, adding – “My brother is very happy in this home. The staff take him out on outings and trips which he enjoys.” Sadly, this resident had a persisting respiratory problem and passed away in hospital before Christmas, a year after he had moved in. The inspector also talked with this person’s social worker. She said – “I would say they did a brilliant job. He had a much better quality of life and had become more sociable. I know his brother was very pleased with how the move went.” At this recent visit the inspector asked about discussions that had taken place about filling the vacancy. The manager and deputy said that they had been keen to work with one person referred, but had been obliged to conclude that this person would not have fitted in with the other residents. The inspector voiced a word of caution when there was reference to an emergency admission as the home’s main legal document – the statement of purpose - does not describe this as a quick response facility. In addition to the most recent statement of purpose (last revised 1 April 2008), the inspector also looked at the new service users’ guide (last revised 15 February 2007). The company have made good steps on introducing formats that are more likely to be understood by service users, including using pictures and simpler statements in larger, bold print. Each resident now has their own customised service users’ guide folder in their bedrooms. The inspector looked at an example. This includes guidance for relatives or other representatives on how to raise queries and concerns, including a comments postcard that can be used anonymously. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 14 The evidence checked at this visit means that all the standards under this heading can be scored as met, including the important key standard covering assessment. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 15 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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Care plans are now person centred and are agreed with the individual using their means of communication. Services users, their relatives and others such as health care workers can now be confident that there are much better systems for planning and tracking care needs, so that people’s needs are met. EVIDENCE: Care plans are now person centred. They are much better arranged, and look at all areas of the individual’s life. They include reference to equality and diversity where relevant, and address any needs identified in a person centred way. Staff have skills and ability to support and encourage residents to be involved in the development of their plan. A key worker system is being developed that allows staff to work on a one-to-one basis and contribute to the care plan for the individual. Our reports over recent years have talked about problems with the important core responsibility of having worthwhile care-planning, monitoring, and review Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 16 records. The previous manager set up new care plan files that covered the expected areas, and these were kept in the upstairs office. However, most other staff neither understood nor used these files, continuing with the oldfashioned system that was kept downstairs. Inspectors found staff confused about these two separate sets of files, and showed they had difficulty looking up basic personal and medical details. The current manager’s initial attempts to introduce a revised system resulted in a number of false starts. We found that support workers still struggled to find basic details; paperwork was out of sequence; and most worryingly – some sections such as pressure sore assessments and weight monitoring were wildly inaccurate. This reflected badly on the manager and team’s professional competence. The inspectors’ set requirements, but found these needed to be carried forward in last year’s reports. The manager was aware that this had a major bearing on the home’s overall lower rating, and that the Commission would commence formal action if worthwhile solutions were not introduced. Important improvements seen last year such as having up-to-date care plans and risk assessments have been maintained, and other shortfalls have been put right, such as sloppy recording in basic areas like monitoring weight gain or loss. We are happy to report that this significant shortfall has now been put right. At the last two visits inspectors have monitored the promised changes. At this visit we looked in detail, section by section at an example of a full set personal records. These were compared to the notes taken of the two samples ‘case-tracked’ last August. The manager and team are congratulated as there is now a comprehensive, well-arranged and up-to-date care-record system in operation. There are two main working files: 1. The Service User Daily File (‘Section 1’ or ‘Flexi File’). This is the main individual recording file used by support workers. The logical sequence includes current care plan sheets – covering about twelve support areas; specific monitoring sheets for such matters as seizures and medical conditions; accurate weight charts; foot-care; an activity record; a body map if an injury is noted; and specific sheets such as a daily exercise log and wheelchair checks. Of particular note is the introduction of a two-page daily recording and observation form covering behaviour and support - such as help with baths, choice of clothes, and what meals the service user has had. These are completed by the shift staff. 2. The Care Plan File. Unlike on previous visits, these files were arranged in sequence, were being kept up-to-date, and now provide a much improved system for health and care monitoring. We are including the file format to show how they have met requirements set under this important standard, and as an aide to monitoring continued compliance at future visits: Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 17 • • • • • • • • • • Section 2: Care Record; Personal Profile; Relatives Birthdays; Missing Person Profile; Pen Picture; Likes/Dislikes; Do’s/Don’ts. Section 3: The main care-plan sheets covering specific support needs. Section 4: Review Meetings. Section 5: Healthcare Notes. Section 6: Risk Assessments. Section 7: Correspondence. Section 8: Personal Inventory. Section 9: Current Medication; weight; GP appts; optician appts; chiropody visits; dental appts; outpatient visits; audiologist visits. Section 10: Funeral Plan Information. Section 11: Service Agreement. Apart from one service user who recently had a CPA meeting, all other main reviews were now overdue. The inspector spoke with the person who had carried out the last round of annual reviews. She highlighted the positive aspects of the service, again praising the high care standards, but shared the view about needing improvements in care records and tracking systems. Havering Council ‘block-purchase’ all places, and told the inspector that they are now planning the next round of reviews. The inspector was shown letters from the manager and deputy pushing the placing authority to fix dates. Standard 7 covers decision-making. Generally, residents are not able to make informed decisions on matters such as how they spend their personal money. Previous reports have stressed the need to discuss and gain the agreement of the next-of-kin or other representative before making major purchases such as bedroom furniture and signing-up for funeral plans. The individual ‘service user guides’ now contain an ‘expenditure agreement’. This sets down that staff must consult with, and gain the written agreement of the next-of-kin or other representative for all purchases over £50. The manager showed that he has a good understanding of recent changes under the “Mental Capacity Act”, and there are completed assessment forms regarding financial assistance and spending money. In the past the inspector has asked for clarification of the company’s policy on what proportion of replacement costs are available as part of normal landlord responsibilities when items such as replacement bedroom furniture is bought. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 18 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, 14, 15, 16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents are increasingly able to enjoy a stimulating lifestyle with a variety of options to choose from. The home has sought the views of the residents and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. This area has been significantly improved, with new innovative options being explored. EVIDENCE: This area has been significantly improved, with new innovative options being explored. The managers and team are congratulated for this turn-around. This much improved aspect of the service was summed-up by one relative who told the inspector – “In fact I was at the home today to see (my sister) and all the other residents were out.” Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 19 The last main report said – “This home can no longer demonstrate that it is helping residents have opportunities to be involved in varied and worthwhile social and leisure activities that once was the case. The requirements under these standards have been carried forward.” In practice, residents hardly went out, and the ‘in-house’ activity programme promised much, but provided little – meaning residents were largely housebound and bored. Over recent months the energy and enthusiasm to help residents have opportunities has been revived. Last year our reports said that evidence under the activities standards were a cause for concern. The relevant sections in the care plan files were blank, and general enquiries showed that there had been a significant reduction in chances to go out and use community facilities. In some instances this has been due to ill-health, but descriptions showed an overall reduced and more limited range of activities. One suggestion was that the decrease in helping residents go out was because of a shift change that removed what was a generous ‘overlap’ time between the morning and afternoon shifts. Another reason cited was the reduction in the number of staff who could drive the home’s vehicle. Nevertheless, what was being provided was sparse and unimaginative – mainly concentrating on visiting a local park and shops. One person’s log was a succession of repeated entries saying ‘Walk around the block’. One visitor summed up by saying – “I think there is good care..the residents are always well presented and the house clean and tidy. But what I see is a lot of sitting around….I agree that there needs to be more activities.” Significant improvements have been made. Much more belief can now be placed in the ‘activity charts’ posted in the kitchen and office – and each person’s own weekly programme sheet showing in-house and outside activity. The daily recording sheets have a section for details, and this includes recording reasons if a resident’s planned activity did not take place. The deputy has taken a lead in this matter. In addition to showing the inspector photos, she provided a detailed report showing significant progress in this area. As well as the set weekly programmes, fun activities have included Remembrance Concert at Queens Theatre; Makaton Christmas Carols Evening; YMCA Xmas/50th Anniversary; Social Evening attended by most involved relative; Mother Goose and Cinderella Pantomimes; Ice Skating Festival; Old McDonalds Farm; Easter Egg Hunt; Southend Sealife Centre; Grease Musical at Piccadilly Theatre; an ‘animals visit’ to the home; help to attend the ‘Tuesday Club’; Sensory Garden and meet Arsenal football celebrities – in addition to shopping trips, pub lunches, and going to the cinema. Last year three residents were supported to have holiday breaks. Plans this year include five holiday bookings so far – including two groups to Strode Park Bungalows, and a week at a Butlin’s Camp. The deputy’s report also set out the contacts they have had to gain access to leisure and educational courses, including the Nasson Waters Day Centre, Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 20 Romford Educational Project, and The Learning Centre. This has involved discussions with the company and the sponsoring agency about funding arrangements. This major leap forward in supporting residents have stimulating and educational activities away from the home is commended. This essential improvement was mentioned by all relatives who talked with the inspector. Equally, help to see parents who are now unable to visit the home is highly appreciated. Regarding offering choices one relative wrote - “The emphasis is always on individual’s needs and choices about how they live their lives. My sister - through a combination of advancing years and sometimes poor health needs a slower and more relaxing lifestyle. She is able to enjoy this whilst staff continue to ensure she receives appropriate stimulation and as good a quality of life as is possible.” All relatives who spoke with us praised the new ‘monthly communication’ reports that they receive. On a consistently positive note, and in line with the good housekeeping standards – arrangements for meals were again found to be satisfactory. There were good stocks of varied foodstuffs, and fresh vegetables were part of the main meals. There are now much better picture and symbol menus, and what each person has at meals is recorded. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 21 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, 20 and 21. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People receive personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. EVIDENCE: We have consistently found high standards in the way residents are helped with their with personal care. Personal healthcare needs including specialist health, are now clearly recorded in each person centred plan or health action plan. They give a comprehensive overview of their health needs and act as an indicator of change in health requirements. Personal support is responsive to the varied and individual needs and preferences. The delivery of personal care is individual and is flexible, consistent, and reliable. Staff respect privacy and dignity and are sensitive to changing needs. The service listens and responds to individuals’ choices and decisions about who delivers their personal care. People are increasingly supported to have more choice and can take responsibility for their personal care needs. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 22 The inspector met all five residents at this visit in their lounge - three having arrived back from the cinema - and all were well presented. Positive signs include assistance with clothes care and how bedrooms are maintained. One resident showed the inspector the clothes she had bought earlier that day. A challenge facing the team was adjusting to higher physical dependency needs. Our reports in 2006 had been very critical on this matter. Previously, the top ‘commendable’ score had been given for the quality of the health care monitoring, including how medical matters were recorded. This has included helping one person who has a fear of hospitals. There were good guidelines on helping this person, including agreeing consent for blood tests covered in the ‘physical intervention protocol’. This also included a photo sequence showing how to support this resident during blood tests and arranging major dental surgery. His relative had written - “My brother is treated well and with respect…he had a much needed operation. The staff were persistent in seeing {he} had all the treatment and aftercare he needed.” However, our next inspection report said - “It needs to be a cause for serious concern that the rating for the medical standard has dropped from the top ‘commendable’ to the bottom ‘not met’ rating over three inspection visits.” One report had focussed on arrangements for the highest dependency resident, notably understanding pressure sore prevention. There was also a failure to keep medical recordings up-to-date and cross-referenced, and incompetent use of basic risk assessments. This showed that support staff did not understand the important significance of these formats, nor how to calculate the risk. Requirements in this important area had to be re-notified in last year’s reports. These requirements have now been met. The sections in the support files covering health monitoring and treatments - listed on page 17 above - are now being kept up-to-date. The manager is double-checking that monitoring sheets are recording accurate readings and observations. The inspector did however point out how one record – monitoring a growth on a person’s foot – that could be better charted, but this was the only exception to an otherwise significantly better recording system. The improvements demanded in the way health care needs are monitored and dealt can be summed up in the following quotes – • “My sister has had health problems requiring hospital admissions or GP assessments over the past few months. I have always been contacted and kept up-to-date with matters affecting her.”; Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 23 • “How they link in with doctors is very good. (My relative) does not like doctors or medical contacts. They do very good in this area.” The team have continued to maintain high standards of personal care. This includes assistance with intimate care, such as toileting. Staff who joined from another Milbury home had confirmed to us that there are high expectations, and attention to dignity is stressed. As said earlier, daily notes are now more specific about the help that has been provided on each shift – and there is a lot more evidence around encouraging basic self-help skills. One excellent example of how thoroughness has been restored is the new Hospital Admissions Folder. The manager and staff had concerns about the care and treatment of service users whilst in hospital, in part arising from residents’ limited ways of communicating. One worrying example raised by the inspector last autumn was a resident who had been discharged with painful medical complication that had not been addressed or followed up by medical staff. At this visit we saw the new way of providing information to hospital staff, and maintaining daily contact with the ward. This includes the initial written and verbal information given to nursing staff, covering - current medication; the main care plan; likes and dislikes; and linking up with the home’s staff and other supporters. The manager said – “We had real concerns about residents when admitted to hospital, especially as we could no longer have staff there through the day. The hospital plans have been a real success. Our contact and the care plans means that we get much more respect from the nursing staff, who have thanked us for our level of involvement. There was even an instance where a doctor apologised for making assumptions about (the service user).” The deputy added – “We now have had a totally different experience. During (one resident’s) recent admission things were much better…she was much more settled as a result. I think that we, (the person’s family) and (the service user) have much greater reassurance.” During hospital admissions home staff will visit and spend time at the bedside each morning and afternoon. Staff also keep a log of their contacts and observations during these visits, allowing informed follow-up by the manager should a concern arise. Equally, one relative talked about the good recovery her relative had made following a suspected stroke last year. The inspector talked to this resident about how her strength had returned and how she could again walk around, and her new multi-position bed. Under medication checks, at this visit the inspector concentrated on following through the action that had been taken following a serious error last year. At Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 24 that time the inspector wrote: ‘We discussed the matter of the medication error that had occurred the previous month when a service user was given almost double doses of anticonvulsants over four days prior to being admitted to hospital. This was the result of the ‘old’ and ‘new’ courses being on the MAR sheet, and staff not recognising the error. Although the subsequent hospital admission may not have been the result of this maladministration, we recognise that this was a serious lapse in procedures and safety monitoring. I am satisfied that you followed the necessary steps once hospital staff had raised the alert. This involved you telling social services, the service user’s family, and notifying the Commission. I repeated my earlier advice to you that where a serious incident occurs you should try to speak to your lead inspector in addition to sending a fax. A strategy meeting was held and a series of actions agreed.’ This included: • • • • Involving the company’s ‘medical review committee’ who investigate drug errors. A representative visited the home. All staff, including the three people who had given out medication over the four days, attended further medication training with the supplying pharmacist. Meetings were arranged with the GP and pharmacist to reinforce safe procedures and tracking alterations. A concluding report summarising how tighter procedures had been introduced was sent to all stakeholders. That report added – “You are aware that the Commission has specialist pharmacy inspectors who carry out detailed medication audits. Please make sure that the lead person on duty is aware of the policies, procedures and current responsibilities to deal with such an unannounced inspection.” Procedures for administering medication were checked at the unannounced random inspection on 29 January 2008. Since then there have been two minor signing errors that had been picked-up quickly. These had been followed up with the staff in question with details on a specific supervision sheet. Staff responsible for minor errors are taken off administration duties, and have to attend retraining. If errors reoccur, the company’s ‘medication review committee’ become involved. Medication audits are a standard section in the operations manager’s monthly checks. Although there is still a high level of satisfaction with the main GP, the manager talked about frustrations they still experience with coordinating repeat prescriptions. The supplying pharmacist has been helpful in providing training sessions and advice, however she has not been visiting over recent months to do ‘spot-checks’ on the overall arrangements. A recommendation has been made on this matter. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 25 Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 26 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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. There is sufficient awareness, and guidance to make sure the right steps are taken if there is a complaint or concern, to make sure residents are protected. EVIDENCE: The company’s guidance and procedure on making complaints are available. At unannounced visits over the past year duty staff were able to locate the ‘The Milbury Complaints Book’. There is also a pictorial version of a complaints procedure in each person’s service user guide, and ‘comment postcards’. There haves been three complaints recorded over the past year, of which two were minor neighbourly niggles that have been addressed. The main complaint was a parent unhappy about the level of support provided when his family member was in hospital. At that time the home’s statement of purpose promised that staff from the team would provide a bedside presence throughout the day and evening, and this had been provided in the past. However, the statement of purpose has now been amended, and the effective replacement arrangements described earlier are working well. This relative confirmed that he is happy with how the matter had been addressed. This reflects the general level of satisfaction with how complaints and concerns are followed through. Another relative contacted about an earlier complaint wrote – “We are satisfied that the matter was dealt with appropriately from the start”. More recently, other written comments from relatives about this heading included - “I have not had to raise concerns about my relative’s care as staff appear to be forward thinking and creative in meeting her sometimes Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 27 complex needs.” Another wrote in response to making complaints - “I have never had to worry about that.” There is an up-to-date policy and procedure on responding to allegations and suspicions of abuse. This makes reference to the main national guidance called ‘No Secrets,’ and the need to follow the local Havering guidelines, a copy of which is available. In the past appropriate action was taken following a worker raising a concern. All staff have been given a copy of the ‘General Social Care Councils’ Code of Practice, and told about the phased programme of registering. Last year the local safeguarding adults procedure was followed in response to the medication error referred in the previous section. We are satisfied that the right procedures were followed. At this visit the inspector was given details about a probationary staff member who failed her appraisal due a disrespectful incident towards a service user whilst away from the home Further, a social worker and the inspector had raised concerns about a large purchase made by the resident who had since moved to a nursing home. A chalet with a hot tub was installed in the side garden, paid for out of the inheritance of that elderly resident. It is said that another of her relatives had confirmed the order, by implication giving consent for such a large purchase. However, this gave rise to queries about how residents are being guided on using their money. The introduction of checks mentioned earlier – such as the ‘expenditure agreements’ – are designed to provide stronger safeguards on service users own money, and establishing explicit consent. Recently, both the manager and social worker told the inspector that this matter has now been closed and is no longer being considered as possible ‘safeguarding’ matter. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 28 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 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The managers and staff have ensured that the physical environment of the home provides for the individual requirements of the people who live there. The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, clean, safe and comfortable, well maintained and reflects the individuality of the people using the service. The arrangements promote the privacy, dignity and autonomy of residents. EVIDENCE: The house has plenty of space, including large single bedrooms. High standards of cleanliness and safe arrangements have been found consistently at our visits over a number of years. Staff have continued to help make this a comfortable, welcoming and homely setting for residents. The combined area of the kitchen/diner and large lounge considerably exceed the minimum levels. The communal rooms are well decorated and furnished. Three residents use wheelchairs for going out. There is wide ramp access with Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 29 sturdy support rails at the back of the house. There is also ramped access to the front door. At our unannounced inspections we have looked at all bedrooms. These are all big, ranging in size from 16.4sqm to 21.5sqm. They have all had individual makeovers, including new beds, furnishings and fittings. These have been designed to reflect the tastes and interests of each resident. This includes the person whose behaviour results in higher wear and tear. Staff now make sure that all furniture is properly assembled. New carpets were fitted last year in the lounge and hall, and replacement sofas were inherited from the nearby Milbury home that closed. Replacement equipment has included a new boiler, fridge and dishwasher. Recent decoration has included the kitchen and parts of the hall and stairwell. Bedrooms were redecorated again when a couple of residents changed rooms over the past year. There is good attention to safety, such as radiator covers; thermostatic safety valves on wash-hand basins; and first floor window openings are restricted. All bedrooms have suitable locks, but no resident is able to use a key. There is a system of reporting problems to the company’s buildings coordinator. The manager said that it is still necessary to make sure contractors, and the company’s roving maintenance staff, carry out work to a satisfactory standard. The bathrooms are also large - there being one on the ground floor, and two on the first floor. The ground floor bathroom has a fixed electric chair hoist. There is ceiling tracking in this bathroom, but this is not needed at present. As with other parts of the house, staff have added homemaking touches and there is a consistently good attention to detail. Residents paid for their bedroom upgrades, including new fixtures and fittings, and for the decoration. The inspector has been given assurances that this personal expenditure will always be discussed and agreed with a suitable representative on behalf of each resident. He said that evidence of such consent must be recorded on each person’s file, including in the minutes of reviews. The expectation is that the company must make a reasonable contribution in line with their legal responsibilities as the ‘registered providers’. The well maintained garden has had recent changes. The delightful ivy-clad pagoda was no longer popular as a dining area, so it has been re-modelled as a games and sensory area. The whirlpool cabin is no longer used as a dumping area. It is now laid out as a relaxing lounge, and steps are being taken to have the whirlpool available for more regular use. The inspector has previously been concerned that staff did not understand how to safely operate a specialist bed used to prevent pressure sores and assist moving. At this latest visit a different resident had been helped to buy a specialist bed. The manager said that an assessment would be carried out by an ot, and staff given operating instructions before any of the specialist Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 30 features were introduced – such as the side-rails. This matter will be checked at the next visit, with the expectation that the shift-leader can demonstrate safe use of this bed and any other disability aids subsequently introduced. A recommendation has been set on this matter. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 31 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 and 35. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People have confidence in the staff who care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. All staff receive relevant training that is focussed on delivering improved outcomes for residents. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Relatives who speak to us say they are very happy with the staff team. EVIDENCE: This team has reformed and consolidated following a difficult period of change over a year ago. All parties say there is a strong sense of team unity. This favourable view is supported by comments sent by relatives, such as – Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 32 • “The staff group consists of experienced staff and new members who are developing their skills. From my observations they appear to receive appropriate training and mentoring.” – and, “I am impressed by the level of care and commitment shown by staff towards my sister, on a practical, physical and emotional level. My mother is 92 years of age and is suffering from dementia. She is currently receiving 24hr care. Staff take my sister to visit her on a weekly basis when possible. It is clear by the response by both to each other that these contacts assists in meeting their emotional needs by maintaining an important family link while it is still possible.” “Staff work in partnership with family members.” • • For many years this home had a remarkably stable staff team. In the year that followed the original manager’s departure there was considerable change, and some dissatisfaction about shift pattern changes. This included a number of staff moving to the old manager’s new service, and care staff from the company’s home in Dagenham that closed transferring here. Mike Medland had started as the deputy in June 2005. Following a period as acting manager, he was confirmed as the new manager in April 2006, but did not complete his registration until July 2007. A major challenge was rebuilding the team. Last year’s reports said that good progress had been made, and welcomed the appointment of a new deputy. By the time of the last key inspection the manager, operations manager and support staff said that good cohesiveness had been re-established within the team. One worker summed it up as follows – “There were some big changes, and things did take a while to sort out. I would say that there is a good atmosphere. We all get on very well.” One staff member who had transferred in added – “I believe there is a lot of skill, and good caring (in the team). The place is much more relaxed. We have all settled-in, and there is good teamwork.” There is now an arrangement where the Commission does central checks on the company’s staff files to make sure the necessary vetting has been carried out, including doing CRB checks. This means that original documents are now kept at the company’s main national office. However, where appropriate, the manager has kept copies at the home which are locked away. Checks at the last two unannounced visits confirmed that the right vetting steps were being followed. This was helped by the way the manager had reorganised the staff files, including having a handy checklist at the front saying when the necessary documentation was received. Files checked had the required vetting evidence, including two references and documents that confirm identity. There is a separate record of CRB certificates or reference codes. The only gap was not having a photo, but this has now been done The staffing complement was understood to be - manager; deputy; 9 support worker posts, including night hours. Total care hours, including nights being Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 33 449, including 20 hours of the manager’s time. The normal pattern of core cover is – three people on each of the early and late shifts (7.15am to 9.15pm); with one person awake, and one on sleeping-in at night. At the last key inspection the operations manger said that no cover hours had been lost as a result of removing the generous overlap period in the afternoon – as there is was an additional person on an eight-hour day shift each day. At this visit the inspector had some difficulty establishing the current staff level. The section in the statement of purpose has been changed to say total hours are now 402 hours. Even allowing for the one post the manager held in reserve as a contingency for absences due to maternity leave and sickness and such, it would still seem that there has been a cut of at least one full-time post. Arguably, the team is working at greater capacity than previously, notably the hours now being used on activities away from the home. Nevertheless, where a permanent reduction is intended, the registered providers must notify the Commission as they in effect are changing details in their statement of purpose, and indeed should have talked about this with the sponsoring authority. The manager said he still believed there was adequate staff time to meet the assessed needs, especially as there had been only five residents so far this year The manager provided an updated training matrix at this visit. Checks on staff training were part of the last unannounced inspection on 29 January 2008, the report saying - “The training matrix at the home was examined and it was positive to note that all but one of the staff employed at the home had completed medication training. The manager stated that alongside this training he undertakes in-house training with all staff, and that all staff members had completed this. Mawney Road has recently been supplied with a training device lap top computer on which staff members can complete such training as health and safety, food hygiene, adult protection and an introduction to the service.” Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 34 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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The manager and staff team provide an increased quality of life for residents with a strong focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. There is also a focus on person centred thinking. There is a strong ethos of being open and transparent in all areas of running of the home. EVIDENCE: The manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. The team have been Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 35 working hard to improve this service. The manager leads and supports a strong staff team who have been recruited and trained to a good standard. The manager is aware of current developments both nationally and by CSCI and plans the service accordingly. Safety records are well-organised and kept upto-date. This home now has competent on-site managers, and the operations manager continues to provide consistent support, and carries out the required monthly checks. The company carry out detailed ‘annual service reviews’. The positive findings of this report are an acknowledgement that, after a challenging period, Mike Medland has restored team stability and a strong sense of direction to this service. He is quick to acknowledge the significant contribution made by the deputy, notably in the key areas of using community facilities; developing in-house skill training for service users; paying greater attention to communication pathways; and keeping relatives involved and informed. They complement each other’s skills, and recognise that they now provide clear leadership – not only by tackling outstanding deficiencies, but also championing some imaginative initiatives that the service users are responding to favourably. Another decisive factor has been having a well informed and consistent operations manager, as in the past her predecessors moved on after relatively short periods. She has supported the service well, staying well informed about each service user’s main issues. She has also been diligent in carrying out the required ‘monthly visits’, and completing detailed monitoring reports. Mike Medland hopes to complete the ‘Registered Manager’s Award’ by October 2008. The deputy is doing the company’s management course – when completed, she will finish her RMA. The company are also demonstrating good commitment to upholding their responsibilities, such as revising their key policy and procedure portfolio to meet current practice and regulatory advance. Of particular note are the detailed ‘Annual Service Reviews.’ This comprehensive format is geared towards establishing as far as is reasonable the views of the service users. It also uses pictures as a step towards making the surveys and results more understandable. The overall standard of arranging files and paperwork is much better than was the case before last year. A detailed check of safety documents was carried out at the visit in January 2008. Records regarding fire safety were examined, and the home had appropriate risk assessments in place, records of monthly health and safety checks, weekly fire alarm tests and of practice evacuations. The evacuations carried out at the home are full evacuations and include staff members and residents. People involved and the time it takes are well documented. The ‘Planned Preventative Maintenance Call Form’ completed by Contract Fire Security on 08/01/2008 was also seen. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 36 The last report available report by an environmental health inspector dates back to 2005 - however, there was positive feedback at visit carried out in 2007, but no report was received. We always find the kitchen and laundry room clean and safely arranged. Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 37 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 3 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 3 26 3 27 3 28 3 29 3 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X X 3 X Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 38 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. Standard Regulation Requirement Timescale for action 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 YA20 Good Practice Recommendations The registered person should speak to the supplying pharmacist asking if they can visit periodically to check the medication arrangements, and leave a report setting out any recommendations on improvements. The registered person must make sure staff know how to safely operate equipment, such as specialist beds. As appropriate, complete a risk assessment, and where necessary can involve a competent person such as an occupational therapists. 2. YA29 Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Mawney Road DS0000027864.V364531.R01.S.doc Version 5.2 Page 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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