Inspection on 05/08/09 for Malvern View

This is the latest available inspection report for this service, carried out on 5th August 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Malvern View 28/07/06

Malvern View 26/01/06

Malvern View 03/08/05

Malvern View 14/03/05

Malvern View 03/02/05

Malvern View 17/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Malvern View 573 Birmingham Road Lydiate Ash Worcestershire B61 0HX Lead Inspector Christina Lavelle Key Unannounced Inspection 5th August 2009 10:30am– Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Malvern View Address 573 Birmingham Road Lydiate Ash Worcestershire B61 0HX 0121 453 7727 0121 453 7757 mviewlr@tiscali.co.uk 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) Malvern View (Lydiate) Ltd Julie Lyn Mogg Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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: 2. Learning disability (LD) 10 The maximum number of service users who can be accommodated is: 10 Date of last key inspection Brief Description of the Service: 26th October 2007 Malvern View can provide accommodation with personal care for ten adults. People using the service must require care primarily due to learning disabilities. They may also have a mental health disorder or physical disabilities associated with their learning disability. People living at the home may use behaviours that can challenge a care service and so they are likely to have complex needs. One stated aim of the service is to provide a homely environment in which continuous encouragement, education and stimulation are the core elements of the daily lives of people living there. Another aim is to help them achieve their personal goals, develop independence and integrate in the local community. Malvern View is situated in a residential area on the outskirts of Bromsgrove town and on the public transport route between Bromsgrove and Birmingham. There are local shops and pubs within walking distance and the home has two vehicles to provide transport into town, for outings and activities. The house is large and detached. The original building had five bedrooms and has been gradually extended to provide another five. All bedrooms are single; two are on the ground floor; three are bed-sits and six have en-suite facilities. There is a large, secure garden at the back of the house and an enclosed patio and courtyard at the front. The home has one large sitting/dining room, a separate dining room, one bathroom, two showers and four toilets for everyone to use. The fee level for the service is dependant on the assessed needs of individuals, as agreed between the provider and their funding authority. Extra costs include for such as hairdressing, personal toiletries and effects, dry cleaning newspapers, private chiropody and opticians and additional transport e.g. taxis. Malvern View DS0000041385.V377050.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 that people using the service experience good quality outcomes. This is a key inspection of the service provided by Malvern View. This means all the standards that can be most important to people using care services are assessed. As part of this inspection we, the commission, visited the home for eight and a half hours without telling staff or people living there beforehand. We use a range of evidence to make judgements about the quality of the service. We discussed how the home is being run and plans to improve it with the manager Julie Mogg. It is difficult to ask most people who live there about their experience of Malvern View and lifestyle because their learning disabilities effect their communication and behaviour. We therefore spent time with people observing their activities and interactions with each other and staff. We also spoke with two staff who were on duty during our visit to the home. We discussed their role, training, support and the care and lifestyle of people who live at the home with them. Surveys asking their views of the home were completed by three people who are living at the home, with help from their keyworkers. Five of their relatives and three social or health care professionals have also returned surveys. All their feedback is referred to in our report. The manager had completed an annual quality assurance assessment (AQAA) before our visit. The AQAA asks managers to say what their service does well; could do better; what has improved in the last 12 months and their plans for future improvements. All other information we have received about the home since the last key inspection is also considered. This includes the outcome of a random inspection of the home that was carried out on the 29th of September 2008; events that affected the health, safety and/or welfare of people at the home (we call these notifications) and any complaints and allegations. What the service does well: People living at the home can take part in activities, go out in the community and choose what they do each day. Their relatives are happy with the service and comment that “X is always out and about on activities and has had some successful holiday” and “they always make me feel welcome when I visit”. Staff make sure that the personal and health care needs of people living at the home are met and that their medicines are managed safely on their behalf. Malvern View is an ordinary house and so fits in well with the local community. It offers the people who live there a safe, pleasant and comfortable home. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 6 The home has enough staff to support people living there properly. Most staff are qualified and all are trained to help them keep the home and people safe. The quality of the service is regularly checked to make sure everything is right and plans are made to keep on making it better for the people who live there. What has improved since the last inspection? What they could do better: The home should set up care plans for new people sooner after they move in. These plans would help staff to know their wishes, goals and the support they need to give them to meet all their needs and to achieve their goals. Care plans of people living at the home should be reviewed and updated more regularly and focus on their wishes and personal goals. This means staff would know all their current needs and goals and how they should support them. There should be management plans for individuals’ challenging behaviours, with input from relevant professionals. This is so staff are clear about the ways they should respond to manage behaviours consistently and effectively. Staff should ensure that the activities people living at the home take part in meet their personal interests. Also that they encourage their involvement in household tasks more so they can develop their daily living skills. To help protect people living at the home it should be ensured that staff are clear about how to report any concerns to external agencies if necessary. Arrange for all new staff to complete an induction programme that is especially for staff who care for people with learning disabilities. This should give staff more understanding and knowledge so they can meet peoples’ needs better. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 7 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the home. Prospective service users could be more confident that Malvern View would be able to support them appropriately if the home develops a care plan based on the full assessment of their needs. This would tell staff about them, their needs, wishes, goals and support they need before they decide to live there. EVIDENCE: We discussed the home’s assessment and admission processes for people who may wish to live there with the manager. We also checked relevant records, including the care records of a person who had recently moved into the home. The manager states in the AQAA that “it is important to fully look at all areas prior to admission and maintain regular visits and for staff and myself to build up a consistant admission process so that we are fully aware of the needs of potential service users”. Regarding people admitted to the home most recently the AQAA also says “we spent time with service users, their families and health care professionals so we could find out more fully their needs and behaviours”. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 10 The manager told us that she had visited the family of one person when they were referred for a placement at the home and met them at their day service. One of the home’s team leaders and several support workers had also visited this person at their former day service on five occasions before they were admitted to the home. They made notes of information obtained about the person from day service staff and showed them photographs of Malvern View. One survey completed by a social worker indicates the service usually gathers accurate information as part of their assessment; seeks advice and acts on it. They comment “Regarding my client their admission was well planned, which enabled smooth transition and helped them settle in without incident” and “The service had regular contact with myself and other professionals to gather information about my service user; taking on board family fears and worries”. The new person’s care records includes some detailed assessments carried out by other health care professionals and information about their daily living skills completed with a relative. However this assessment information has not been used by the home to develop an individual plan, as the standards specify. We saw a copy of the home’s care plan format in the person’s file that would cover relevant areas such as “my life story”; a pen picture; their strengths, needs, likes, dislikes, short and long term goals but none of this had been completed even though the person has been living at the home now for over six months. Furthermore although the prospective service user’s community nurse and social worker visited the home before admission the person them self had not made any introductory visits as part of their transition process. The manager told us they had been advised not to arrange any visits to the home by other professionals because of this person’s difficulties and the effect this may have had on them. This advice was not recorded however and anyway introductory visits should always be arranged unless really not feasible in consideration of people already living at the home. This is so staff can consult them (and if this is not possible observe their interactions) to ensure any potential residents are likely to be compatible with and/or will not have an adverse affect on them. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the home. People living at the home could be more confident that their needs are being met, and any risks managed appropriately, if their plans reflect all their current and changing needs. Whilst they can make some choices in their daily lives their plans would also help staff better to support them to achieve their goals and develop life skills if they focused more on identifying their personal goals. EVIDENCE: The manager recognises that people living at the home should be involved in planning their own care and make choices. The AQAA states “we endeavour to increase service users’ choices through regularly reviewing their needs and ensuring we maintain a person centred approach to giving choices”. However there has been limited progress since the last key inspection to develop more “person centred” plans, as was recommended. Whilst some people have had person centred planning meetings with their representatives not all their plans Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 12 and risk assessments have been reviewed and updated to reflect their current needs, wishes, goals and support needed from staff to meet or achieve them. Care staff are allocated to certain people living at the home as their keyworker. They spend time helping them with such as their clothes, personal toiletries, keeping their bedrooms tidy, activities, arranging trips and health care checks. Keyworkers are expected to advocate for them and to take some responsibility for care planning, which is good as they should know their preferences. They are also expected to monitor and review peoples’ daily reports, plans and risk assessments monthly and record any significant events, behaviour, health etc. We looked at a sample of care records including plans and risk assessments. As already discussed in Choice of Home one person has not had a care plan developed although they were admitted six months ago. A review was held in March when this person had been at the home for 28 days and notes say that a “bespoke package of care will be devised”. By now they should have a plan showing their current needs, abilities, wishes, activities and goals and how they can be supported by staff with those identified and develop their life skills. This person’s records also do not include their photograph or history and whilst a detailed assessment was previously undertaken about their communication needs stating that they use a book of symbols this did not seem to be available and staff we asked about it were vague. In addition there are no management plans in place to help staff to deal consistently with aspects of their behaviour that can be challenging or self harming, even though their daily reports show that at times this person can be extremely vocal, swear a lot and lashes out. Another person’s plan includes important life events, a brief pen picture and some needs, strengths, likes, wishes and goals. One of their goals is to gain further life skills, but their plan does not detail how this may be achieved and just says they clean their room and make cakes. One other goal is to decrease their anxiety, agitation and aggression towards people and staff are advised to use techniques such as disengagement and diffusion and/or there is a list of restrictive physical interventions. Each person should however have individual management strategies set up that clearly describe in what circumstances staff should use such interventions and how. In view that most people using the service have complex needs professional input could also be of great benefit to help staff to draw up and review behaviour management plans, for example a behaviour therapist or psychologist. Incident reports are made and should always fully detail the duration and type of aggression and show all the staff involved so that they can be monitored, analysed and reviewed properly. Plans do include other risk assessments (which should be dated and signed) but this comprises a generic checklist relating mostly to reducing safety risks. Some aspects such as moving and handling have not been completed and one for bathing just says “switch shower on”. Risk assessments also need to show how people are supported to take risks to promote their independence. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 13 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): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using this service experience good quality outcomes overall in this area. We have made this judgement using a range of evidence, including a visit to the home. People living at the home take part in a range of activities and are enabled to go out in the community. Whilst the home aims to encourage people to make choices in their daily lives and routines, they should all be facilitated to follow their personal interests and to develop their daily living skills more. Staff support people to maintain links with their families and provide healthy meals. EVIDENCE: The manager and staff understand that people living at the home should be enabled to take part in a range of activities so they can have interesting and meaningful lives. The AQAA says that “since the last inspection the home has increased activities to suit individuals’ needs” and “we now have regular social evenings and film nights and do lots of in- house activites such as make up Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 14 sessions, craft activities, in and outside games”. The AQAA also describes how people pursue daily activities as requested and go out on day trips and annual holidays. The manager told us that swimming has restarted and the home plans to set up recycling and to use the courtyard as a recreational area. They plan to monitor each person’s activities on a weekly basis to ensure they take place and one staff member has recently been designated as activities/family officer and will work 20 hours a week facilitating outings and family visits. For most people opportunities for work placements and attending day services are limited due to their complex needs and level of support they require. Staff aim therefore to increase their community integration using the home vehicles for trips out such as shopping, bowling, to the cinema, pubs and cafes. Some people are supported to use public transport or go out for local walks. During our visit about six people went out for walks, for lunch and/or shopping. Peoples’ plans appropriately include their interests and activities they like. One person has a list written for by their relative showing they like singing, music and making things with glitter; however their plan does not show how they are being enabled to do these activities. Their terms and conditions say the home will “develop a structured seven day programme of meaningful day care activities designed around their needs, choices and preferences” however this person no longer attends a day service and whilst information in their care records say they are capable of doing domestic tasks and cooking they are not involved in these tasks at Malvern View. The home should ensure that people are enabled to pursue activities that meet their personal interests and also have opportunities to develop their life skills and their plans should reflect this. The manager told us staff do try to involve people living at the home with the domestic routines and household tasks if they can and want to. The AQAA also says people are supported to make choices about décor, spending their money, their activities etc. Meetings are held regularly when everyone is encouraged to take part to discuss issues, plan and make decisions about the home’s dayto-day running, outings, garden, holiday’s etc. The home also enables people to maintain links with their families, invite them to socials and involve them in care reviews. Five relatives completed our surveys and all indicate the home always helps their family members keep in touch and they are kept informed about important matters. Their comments include “they get service users out as often as possible” and “they always make me feel welcome when I visit”. Regarding food provided at the home there is now a seven week menu that we saw to include a variety of wholesome meals. Staff aim to promote healthier eating options and most meals are home made. We saw plenty of fresh fruit, vegetables, yoghurts, high fibre cereals, prunes and porridge etc. in stock. People living at the home are asked in meetings about their meal preferences and staff know their likes, dislikes and particular dietary needs and make sure that they provide suitable meals and/or alternatives as needed or requested. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the home. People living at the home receive the personal support they need. Their health care needs are met and when necessary there are procedures in place for staff to follow. Their medicines are managed safely by the home on their behalf. EVIDENCE: We saw that care plans of people living at the home detail the personal support they each need to maintain good personal hygiene. This includes such as use of creams, nail and foot care and plans also guide staff to encourage self care and healthier meal options. One person’s relative comments in their survey “X is always smart and well cared for and his bedroom is always clean and tidy”. Each person has a health action plan (HAP), which are recommended by the Department of Health for people with learning disabilities. The HAP format covers all aspects of general health and welfare that need to be monitored, for example skincare, hearing, feet, nutrition, continence and mobility. They also Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 16 cover any special needs and how they should be managed and can be used to make sure that people receive regular and specialist health care check-ups at the expected frequency or as their particular needs require. Some people’s HAPs still need to be completed more fully with information about their health history, condition, assessments of health need in all areas and communication. Whilst this would provide a more comprehensive overview of people’s health care records we looked at do include assessments made by other health care professionals and information and guidance for staff about particular health issues. For example there is detailed information about one person’s epilepsy including type of seizures, medication and an epilepsy plan that shows seizure indicators, triggers, interventions with a monitoring sheet. Another person has a skin problem for which they are prescribed ointments and staff are instructed to examine their skin daily for signs of such as rash, irritation and pinkness. The AQAA confirms that Malvern View continues to have regular reviews with health care professionals about all health issues. Staff are expected to monitor and report health care concerns and any incidents, interventions and accidents are recorded and reviewed by senior staff. Keyworkers complete monthly behaviour analysis sheet and make routine appoinments for people such as dentists and opticians. The home also has input and support from a consultant psychiatrist, an epilepsy liaison nurse, a chiropodist who visits 6 weekly and hold a weekly exercise class in the home. One health care professional who has ongoing involvement with people at the home confirms in their survey that the home manages their medicines correctly and comments that “the service balances the rights of the clients to have privacy etc. with the duty of care to ensure they are properly supervised due to their vulnerable status”. Regarding medication prescribed for people living at the home the service has detailed policies and procedures in place for staff to follow to manage them safely. They include protocols for medication administered as and when needed and for medication errors. Monthly audits are carried out to make sure that procedures are operating properly and checks are also made of medicines ordered and received by the home. We found the receipt; administration and disposal of medicines are all being recorded and maintained appropriately. The home also has suitable and secure storage with external preparations (creams and ointments) kept separately. A monitored dosage system is used and any other bottles of medicines, creams etc are appropriately dated when opened. There is a photograph of each person prescribed medicines with information for staff about what they are all for and any possible side effects. No one currently living at the home is able to self medicate and consent forms have been signed for them by their next of kin when they are unable to do so. Staff designated to administer receive formal training on the safe handling of medicines and there is a list of the signatures of staff authorised to administer. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using this service experience good quality outcomes overall in this area. We have made this judgement using a range of evidence, including a visit to the home. People living at the home are supported to express their views and there are systems in place to manage complaints about the service. The home takes action to protect people from abuse and to follow up allegations but it would better ensure people are safeguarded if all staff are clear about procedures. EVIDENCE: There is a written complaints procedure provided for the service, which is also in a format that people with learning disabilities should be able to understand more easily. People living at the home who had completed surveys with their keyworkers’ support confirm they know who to speak to if they are not happy and how to make a complaint and also staff listen and act on what they say. Four relatives of people living at the home also confirm in their surveys they would know how to make a complaint (one can’t remember) but all indicate the home has responded appropriately to concerns they have raised. Meetings are held and people are also supported to complete monthly surveys when they can raise issues and be involved in plans and decisions about the home. The home also has a record for logging complaints and their AQAA states “we continue to have an open policy and people are encouraged to come forward and raise concerns. All concerns and complaints are fully investigated and documented and have recomendations and outcomes”. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 18 Two complaints had been received by the home since the last key inspection. One raised concerns about the care of people using the service and was also made to the commission. We asked the manager to tell us what action had been taken following their investigation. Their report shows they considered the four main concerns. They concluded that some care plans did not show how peoples’ challenging behaviours were being managed; there was not a policy for staff use of mobile phones and one staff member had not recorded an incident when disengagement techniques were used on one person living at the home and had made poor decisions. It was confirmed that appropriate action would be taken to review and update care plans; a policy had been put in place about staff use of cameras, mobile phones and videos etc. and that disciplinary action was taken in respect of the staff member involved. We received another complaint about the home since the last key inspection. This related to injuries received by a person whilst admitted to the home for a short period. This matter was referred under local multi-agency safeguarding procedures for vulnerable adults. It was decided that we would investigate the matters raised and so we carried out a random inspection of the service. We found that the person involved had been inappropriately admitted to the home because their pre-admission assessment had not been thorough enough and Malvern View was not able to suitably meet their needs. Recommendations were made about this that have been addressed although the home still needs to ensure that people have individual management strategies in respect of their behaviours, with input sought from relevant professionals as necessary. The service also provides policies and procedures on abuse, protection and whistle blowing. Staff are expected to sign a checklist at the end of every shift they work to report any indicators or incidents that could be abusive. The manager told us that protection of people living at the home and whistle blowing are discussed in staff supervision sessions and team meetings. Staff we spoke with are clear about their responsibility to report any suspicion or incidence of abuse to the provider and manager. They feel confident that management would deal properly if any concerns or abuse etc are reported to them but were not sure about who to refer incidents to externally if needed. The home appropriately has a copy of local multi-agency adult safeguarding procedures, which staff are supposed to have read and signed up to. The manager is clear about how and when to report issues through safeguarding procedures and is due to attend further training soon. Although staff receive training on abuse the manager should make sure therefore that staff also have this training or instruction, and confirm in individual supervisions that they all know about and would use safeguarding procedures. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the service experience good quality outcomes overall in this area. We have made this judgement using a range of evidence, including a visit to this home. The accommodation provided by Malvern View offers the people who live there a secure, comfortable and reasonably well kept home. Suitable arrangements are in place to make sure that the home is kept clean, tidy and fresh, although one aspect needs improvement to make sure that good hygiene is promoted. EVIDENCE: Malvern View is situated in a residential area on the outskirts of Bromsgrove town and is on a main bus route. There are facilities such as shops and pubs within a reasonable walking distance. The property is compatible with other housing nearby and has been extended over time to increase the number of bedrooms to ten. The main sitting room was also enlarged last year to include dining space and the separate dining room now provides another sitting area. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 20 Our overall impression of the home’s environment is comfortable and pleasant, however some communal areas would benefit from redecoration and new furniture, which the manager says is planned. The main sitting room needs redecorating and the paintwork is scratched. The suite is also tatty; although staff told us a new one has been purchased and would be delivered soon. The back garden was totally cleared a while ago but still needs landscaping. The AQAA states plans to improve the home’s environment in the next 12 months include completing work on the courtyard and back garden; to finish any redecoration and to continue work to personalise peoples’ bedrooms. Also that the home could do better by having a continual programme for refurbishment and improvement and this should be set up and implemented. The AQAA also says that two people’s bedrooms have been refurnished and decorated since the last key inspection. There is also now a greenhouse in the enclosed courtyard area and a new office for team leaders and support workers has been made in the large sitting area. This is useful for enabling staff to observe people more discreetly; for confidential handovers and so care records and seniors are more accessible to care staff. Bedrooms are furnished and fitted to meet the particular needs of individuals that occupy them and those we looked at are well personalised. People who are able to hold their own key and lock their doors if they wish. They chose the colour of décor, furnishings and furniture and/or their relatives were involved. We confirmed in the last key inspection that the home provides comprehensive health and safety policies and procedures, which include for promoting good food hygiene and infection control. Cleaning schedules are also in place with records kept. All areas we visited were clean, tidy and fresh and disposable gloves and aprons were available for staff. Liquid soap and paper hand towels facilities were also provided in most communal bathrooms but we noticed that one WC had no toilet paper, soap or paper towels. We were told by the manager that this is because one person living at the home puts them down the toilet. Although some people living at the home do have en-suites it is not acceptable that these facilities necessary for good hygiene are not available and suitable arrangements should be made to ensure they are. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: 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 home. People living at the home receive safe and appropriate support as there are enough qualified staff on duty at all times. They can have confidence in staff because checks are done to help to make sure they are suitable. Whilst staff receive some training relevant to people’s disabilities their understanding and knowledge would be enhanced, and so could help them meet peoples’ special needs better, if new staff also complete an accredited training programme. EVIDENCE: The staffing situation at the home has improved since the last key inspection, which is positive for people living there. Rotas show that there is normally six or seven staff on duty during the day time and a minimum of five evenings. No agency staff have been deployed for months and the home now has two bank staff to cover staff leave. The AQAA says that “due to the staff team being more settled and there not being such a turnover this has settled the home considerably. There has also been a decrease in staff sickness, which in turn Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 22 creates continuity within the home”. Staff we spoke with feel there is enough staff to meet peoples’ needs, although it would be good if they had more time to offer them one to one support. One person’s relative comments in their survey that “staff and the management team are always caring, supportive and professional in the level of care they give”. Regarding recruitment the AQAA, manager and staff we talked to confirm all staff had necessary checks taken up before starting work at the home. We checked the records of two new staff and both include relevant documents such as proof of their identity, a health declaration, two written references and a satisfactory criminal records bureau check. Although one of them had only ever done voluntary work before, and so had no previous employer to give them a reference, the manager knows that potential staff are required to give their full employment history (with gaps explored and satisfactory explanation given) before their appointment is confirmed. Also that references must include one from their last employer and be from a creditable source. The provider has produced a comprehensive induction programme, which new staff must go through during their first six months. The home has still not arranged however for new staff to go on to undertake the Learning Disabilities Qualification (LDQ) induction programme, which the Standards specify for staff who work caring for people with learning disabilities. New staff appropriately always work shadow shifts and are mentored by a senior staff member during their probationary period and before their appointment is confirmed. Staff complete training in required health and safety training areas; care related topics such as abuse awareness for vulnerable adults and in respect of special needs such as autism, epilepsy and positive interventions for the management of challenging behaviour. This could be extended to include mental health. The AQAA says that all staff are doing training on equality and divesity currently; the manager and deputy manager to a higher level. The home uses a staff training matrix to plan further training and updates. Most staff have achieved an NVQ or are currently working towards level 2 or 3. The manager recognises the importance of teamwork and staff meetings are held regularly. Individual supervision is also arranged covering relevant areas, such as work performance, training and development goals. Staff say that team work and communication has improved recently. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: 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 home. Appropriate management arrangements ensure that Malvern View is run well. There are ways to monitor and review service quality to check that everything is right and continually improves for the benefit of the people living there. The environment is kept safe because health and safety practices are carried out. EVIDENCE: The manager (Julie Mogg) has been registered in respect of Malvern View since the last key inspection from November 2007. Mrs Mogg was previously the registered manager of another of the provider’s care homes and is a qualified learning disabilities nurse and has achieved a National Vocational Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 24 Qualification (NVQ) level 4 and an advanced certificate in health and safety. The deputy manager is a trained mental health nurse and has NVQ level 4 and all the home’s team leaders have NVQ level 2 and have either completed or are in the process of completing NVQ level 3. Management tasks within the home are appropriately delegated to the deputy manager, assistant manager and team leaders. For example the deputy has responsibility for oversight of the health, medication and care plan reviews of people living at the home. There appears to be an open, positive management approach and the staff team seem committed to developing a more person centred approach to supporting people. The manager confirms that the home, and she also feels, they are well supported by the provider. The provider operates thorough processes to monitor the quality of the service. This includes the required monthly visits from one of their managers when all aspects of the home are checked and an audit checklist is completed. This all results in monthly action plans (with timescales), which become part of the service’s annual development plan. The manager also carries out monthly audits that are signed off by external management. As part of this quality assurance and monitoring the views of people living in the home are obtained through surveys that their relatives and keyworkers help them to complete. The AQAA contains clear, relevant information showing some improvements made and aspects they need and plan to develop and improve. It could include more evidence about how this has resulted in good outcomes for people living at the home and all relevant areas should be covered such as food provided; family involvement; medication and safeguarding vulnerable adults. Regarding health and safety in the home previous inspections confirm that comprehensive policies and procedures are in place. Staff training is arranged in the mandatory topics such as first aid, food hygiene, fire safety and infection control. The AQAA states that tests and checks on the fire safety system are being carried out at specified intervals and following a Fire Authority inspection the system has been upgraded. In addition the AQAA confirms electrical checks and portable electrical appliance tests are undertaken; gas appliances and the central heating system are maintained and/or serviced regularly; COSHH risk assessments are in place and there are suitable waste disposal arrangements. Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 25 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 X 2 2 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.2 Page 26 Malvern View DS0000041385.V377050.R01.S.doc Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered persons meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider 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 to consider carrying out. No. 1 Refer to Standard YA2 Good Practice Recommendations The home should develop with each potential resident a care plan based on their needs assessment. This is so that staff know peoples’ needs, wishes and goals and how to support them to meet their needs and achieve their goals better. Progress to develop more “person centred” care planning should continue and the plans of people living at the home reviewed and updated accordingly. This would ensure staff know all their current needs and focus more on their wishes and personal goals and support needed to achieve them. The home should ensure that plans of people living at the home include risk assessments and individual management strategies in respect of their behaviours, with input from relevant professionals as necessary. This is so staff are clear about strategies they need to deploy to respond effectively and consistently to behaviours and so manage them better. Staff should ensure that people living at the home are enabled to take part in activities in line with their personal interests and that their involvement in household tasks encouraged to help them to develop their daily living skills. DS0000041385.V377050.R01.S.doc Version 5.2 Page 27 2 YA6 3 YA9 4 YA16 Malvern View 5 YA23 The home should ensure through training, instruction and/or and individual supervision that all staff are clear about the procedures for safeguarding adults, particularly about when incidents need external input and who to refer incidents to. Consideration should be given to ensure that necessary facilities are always available to people living at the home in all communal WCs. This is to promote good hygiene. The home should arrange for all new staff to complete accredited induction training. This training specifically relates to people with learning disabilities and so should give staff more knowledge and skills to help meet peoples needs. 7 YA30 8 YA35 Malvern View DS0000041385.V377050.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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