Inspection on 08/12/09 for Margaret Roper House

This is the latest available inspection report for this service, carried out on 8th December 2009.

CQC found this care home to be providing an Excellent service.

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

Margaret Roper House 17/03/06

Margaret Roper House 08/06/05

Margaret Roper House 28/09/04

Margaret Roper House 06/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Margaret Roper House 447 Liverpool Road Southport Merseyside PR8 3BW     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michael Perry     Date: 0 8 1 2 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 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 Homes for Adults (18-65 years) 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. 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 Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Margaret Roper House 447 Liverpool Road Southport Merseyside PR8 3BW 01704574348 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: mrh@nugentcare.org Nugent Care care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Service users to include up to 23 MD The home must at all times employ a suitably qualified and competent manager who is registered with the CSCI Date of last inspection Brief description of the care home Margaret Roper House is a 23 bedded purpose built home situated in the larger St Thomas Moore complex, which also incorporates a residential home. The home provides long term accommodation for people with enduring mental health needs. Care is provided on four family units on 2 floors. The home is set in its own grounds and garden areas. It is on the main Liverpool/Southport Rd with regular bus services into Southport town centre [2 3miles]. The home is owned by the Nugent Care Society and the Registered Manager is Mr Iswurdut [Fred] Busgeeth who is a Registered Nurse [General and Mental Health] and has long experience at this level. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 23 Brief description of the care home The current fees for the service are #451 - #639.50 Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced and was conducted over a period of one day. We completed a tour of the home looking at the general environment. Care records and other records kept in the home such as health and safety records were also viewed. Residents in the home were spoken to along with members of staff and the Manager. A relative was interviewed. Prior to the inspection survey forms were sent out to residents in the home and some of these were returned and comments have been used in the report. The manager completed an Annual Quality Assurance Assessment (AQAA) prior to the visit, which is a detailed document that gives us a lot of information and update about the home and assists in focusing the inspection. We also had some assistance on the inspection from an expert by experience. This is Care Homes for Adults (18-65 years) Page 6 of 29 a person who has had some previous experience of care services and assists the inspector by focusing on quality of life issues for people in the home and providing feedback for the inspector. During the visit the expert spent two / three hours talking to residents and care staff. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: We found the way care is planned in the home to be very good. The nursing staff draw up care plans with involvement from residents. Residents have the care plan discussed with them on a routine basis. The care plans are generally written with an accent on social skills and interaction rather than concentrating on medical diagnosis. For example a resident with very long standing psychiatric diagnosis had a care plan which concentrated on specific needs such as isolation, controlling smoking and the need to maintain personal hygiene. Progress here would both enable more independence on a daily basis as well as improve quality of life. The care plans are reviewed and evaluated on a three monthly basis. The review notes are very thorough and give a good idea of any progress made set against the care plan. We looked at how the home manages risk as this helps people live lives they choose and to partake in activities of their choice. The management of risk was evidence in care notes and care plans and appropriate risk assessments had been carried out involving the Community Mental Health Team and consultant psychiatrist if needed. Residents interviewed were pleased with the way staff monitored their care and felt supported to live their lifestyles without any undue restrictions. There is a relaxed but busy feel to life in the home on a daily basis. Staff were very supportive and continually reinforced positive social interactions with residents. Residents in turn see the staff as warm and friendly. We spoke to number of people who commented positively about the home: Its smashing here. Im going swimming today. Three or four residents go. Good outing. Go by mini bus. I feel free as a bird. Staff are very good. My room is big and I like it. Staff are really putting themselves out over Christmas. They did the same last year. Plenty of people where coming and going all day. One told us about a luncheon club that they attend so that they can help out. Another was going to the village for a hairdressing appointment. This shows that people are comfortable with their immediate surroundings and are being supported to use local facilities. We looked at the care documentation which included regular medical and social reviews for people with respect to ongoing psychiatric conditions. People spoken with attend the local hospital for these appointments or sometimes community health care staff attend the home. Residents expressed confidence in the staff at Margaret Roper to both monitor and refer for any medical support needed. We found the home to be very well maintained, bright and airy. Residents commented on their individual bedrooms and how homely these were. There is a good choice of day space as each unit has its own lounge all of which are comfortable furnished as well as more shared communal space in the conservatory. This means that there is plenty of room for residents to sit and meet and have some privacy if needed. The home has also been well adapted for people who may have mobility needs so there is easy access to all areas. This means that the home are willing to consider a wide range of diverse needs. Care Homes for Adults (18-65 years) Page 8 of 29 The level of service at Mgt Roper has been consistently high over previous inspections. Feedback from all parties spoken with was positive about the way the home is run and there is a confidence in the managers abilities. All of the residents were aware of who the manager was and the role of other key staff. There is a clear management structure. The manager was able to discuss plans for the home over the next year. This shows consistent and ongoing good management of the home. What has improved since the last inspection? What they could do better: 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. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: 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 this service. People are given information and are assessed prior to being admitted so that their care needs can be known and a care plan can be put in place. Evidence: People admitted to the home are assessed, prior to being offered a place, by one of the senior staff members [more usually the manager]. The home has very good links with the local Community Mental Health Team [CMHT] and most referrals are through this route. Care files seen [2] contained assessments from the CMHT including assessment of risk factors such as self-harm and neglect. The assessment completed by the manager was thorough. This is important so that the home can be clear about meeting peoples needs. Some of the assessments seen were not signed or dated. It is important to complete records so that they are clearly referenced. We spoke to a person who has been recently admitted and they said that they had been given some information prior to admission and that they had visited and had Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: been given a period to settle in. The social worker had liaised well with the home and had been to do a review to make sure that things were going well. Another person said that the process of being introduced and admitted to the home had been managed well and that they had been made to feel comfortable from the beginning. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. care planning and risk management ensure that people are consulted and included in their care and that they can live their lives with least restriction. Evidence: The nursing staff draw up care plans with involvement from residents. The residents concerned had signed all of those care plans seen and residents also had their own copy. Residents have the care plan discussed with them on a routine basis. The care plans are generally written with an accent on social skills and interaction as basic concepts rather than concentrating on medical diagnosis. For example a resident with very chronic and long standing psychiatric diagnosis had a care plan which concentrated on specific needs such as isolation, controlling smoking and the need to maintain personal hygiene. Progress here would both enable more independence on a daily basis as well as improve quality of life. Resident rights are also included in the plans so that this is highlighted. For example one resident on a legal notification under the Mental health Act had this highlighted Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: and explained in the care plan so that they were clear and staff were also clear about any boundaries. The person concerned said that staff had been supportive and he felt that some progress had been made. The care plans are reviewed and evaluated on a three monthly basis. The review notes are very thorough and give a good idea of any progress made set against the care plan. We did not find any evidence in the reviews of the person being consulted or included although those spoken with said that staff do talk about the care plan with them. The evaluations would be a good time to ensure that residents wishes are considered. This shows that they are included at all times in their care. Over all the quality of the care planning is very good and residents feel involved in and encouraged to own their care. We looked at how the home manages risk as this helps people live lives they choose and to partake in activities of their choice. The AQAA states: Risk taking can extend further afield. For example, when residents go on organised holidays, all residents involved are risk assessed in line with Nugent Cares Policies and Procedures. The management of risk was evidence in care notes and care plans and appropriate risk assessments had been carried out involving the Community Mental Health Team and consultant psychiatrist if needed. For example one person was on a program of gradual socialization in community activities and this was well planned so that the person could see progress. The care plan was appropriate in that it balanced the residents need [and right] to go out of the home with the concerns around general health. Residents interviewed were pleased with the way staff monitored their care and felt supported to live their lifestyles without any undue restrictions. Two of the people spoken with said: We are able to come and go as we wish and staff are excellent and it is a very friendly place to live. We are like a big family. People talked about choices available and that they feel supported whilst also maintaining their independence. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a good range of social experiences for people so that they can feel they have some say in the running of the home and can feel supported in their choice of daily activity. Evidence: There is a relaxed but busy feel to life in the home on a daily basis. People were seen to be socializing and mixing and interacting with other residents and staff. Staff were very supportive and continually reinforced positive social interactions with residents. Residents in turn see the staff as warm and friendly. We spoke to number of people who commented positively about the home: Its smashing here. Im going swimming today. Three or four residents go. Good outing. Go by mini bus. I feel free as a bird. staff are very good. My room is big and i like it. Staff are really putting themselves out over Christmas. They did the same last Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: year. The home has decorations in place for Christmas and there were plenty of notice boards advertising coming events and activities such as a Christmas meal at a local restaurant. Plenty of people where coming and going all day. One told us about a luncheon club that they attend so that they can help out. Another was going to the village for a hairdressing appointment. This shows that people are comfortable wit there immediate surroundings and are being supported to use local facilities. People also told us about the planned activities that are organised daily. There is a staff member employed for 20 hours weekly to organize activities for people. They also talked about the resident meetings and how these are held regularly is that people can discuss the running of the home. Residents stated that family and friends where encouraged to visit and that contacts are reinforced by staff. Staff interviewed displayed a good knowledge and understanding of the residents life histories and their current social needs. This is reinforce by life histories and entries in the care notes. The expert by experience who accompanied the inspector on the visit made some observations about the lifestyle of people living at Margaret Roper and concluded: Following the interviews, it was apparent that the service provided to residents was extremely good. Although a couple of points were raised during interviews, none of the residents appeared to be unduly upset or unhappy and I felt that the residents feel comfortable and safe. Independence is visibly encouraged and supported both in the home and within the community. I witnessed the staff team going about their tasks in what appeared to be a naturally comfortable way. They are committed to their roles and appear to actively promote independence, choice and wellbeing. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: 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 this service. Health and personal care is managed well so that peoples are supported to feel well. Evidence: We looked at the care documentation which included regular reviews for people with respect to ongoing psychiatric conditions. There is regular review with the Community Mental health Team and these are recorded. People spoken with attend the local hospital for these appointments or sometimes community health care staff attend the home. Residents expressed confidence in the staff at Margeret Roper to both monitor and refer for any medical support needed. An example of this reflects the more recent admissions to the home of a younger age group of people with more acute care needs. One person has regular reviews of medication and attends for blood tests due to the medication. This is well monitored. The home still supports more elderly people as well. One elderly resident who is now frail is supported with appropriate nursing aids and bathrooms are well equipped with hoists to support people who need this. This resident receives personal care for basic needs and this is highlighted in the care plan. Staff spoken with were aware of the Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: importance of maintaining privacy and dignity while carrying out care. This shows that the home are willing to support people with a diverse range of care needs. There are no residents who self medicate although the staff were able to give examples of where this had been carried out previously although staff reported that this had failed for various reasons. We discussed this in some depth as supporting people to self medicate encourages Independence and autonomy. The manager explained that there is a younger age group now being admitted who require more intense rehabilitation programs and there is a person who has recently been assessed for admission who wishes to self medicate. We looked at two people who are actually self medicating in that one is maintaining and applying their own creams for a skin condition and another has various inhalers for a chest condition. The risk assessment of these does not include any reference to this [both say that the persons do not self medicate] and the care planning documentation, although making some reference, does not say that the person concerned is responsible and how this is carried out and monitored. We discussed the need to revisit the self medication policy and perhaps look at the suitability of the current risk assessment tool as this may not suit current or future need. We looked at medication records [MAR charts] and saw that a number of these had medications which had not been recorded as given. Indeed the managers are aware of this as an ongoing issue and there is reference to it in the medication audits. We would strongly recommend that this is addressed as the medication records need to be up to date and clear as omissions make it difficult to audit the stock. It may also indicate that the correct method of medication administration is not being followed. Policy and procedures for the safe administration of medicines were available. Residents spoken to stated that their medicines were given on time. The nurse spoken to was knowledgeable regarding the medicines given to residents. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: 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 this service. There is a complaints procedure and staff are responsive to concerns so that people can feel safe in the home. Evidence: The AQAA states: The Home displays Complaints Procedures and leaflets. They are encouraged to lodge any form of complaint at any time they so wish. This in turn is utilised as a quality assurance tool. We spoke with people living in the home who were aware of a complaints procedure and felt that any concerns that they had would be listened to and taken seriously. There is a complaints procedure on various notice boards around the home and a copy of the procedure is also in the residents information pack. The manager keeps a record of complaints and the file was seen but did not contain any complaints or concerns as none have been received. We did note that the current complaints procedure needs to be updated with the address of the Care Quality Commission [CQC]. The manager has introduced a sheet in the care files so that any grumbles can be listed and acted on. For example one person was concerned about a vegetarian diet Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: on one occasion and this was recorded and responded to. The home has a copy of the local Adult Protection Procedures and staff were able to demonstrate an understanding of good care principals. There have been various training initiatives to raise the level of awareness around abuse in the past and also more recently. Staff interviewed were aware that procedures were available for dealing with accusations of abuse. Residents spoken to had no concerns or complaints about the service. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained so that people are living in comfortable accommodation. Evidence: In the AQAA the manager tells us: I carry out an audit every year to inspect inside and outside of the building. Out of this inspection, I draw an action plan and all staff have an input in addressing the problem areas. I encompass this method as part of my quality assurance monitoring. The home is very well maintained and is bright and airy. Residents commented on their individual bedrooms and how homely these were. There is a good choice of day space as each unit has its own lounge all of which are comfortable furnished as well as more shared communal space in the very popular conservatory. This means that there is plenty of room for residents to sit and meet and have some privacy if needed. The conservatory opens onto a garden and so there is easy access. There is a full and ongoing maintenance plan and records seen were up to date. The home is clean and hygienic in all areas seen. Residents comments were that this was consistent. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: There is a wide diversity in the age range of residents and those more elderly have had some aids and adaptations installed to assist with independence and personal care. For example some bathrooms have hoists fitted. The home has been developed so there is easy access for anybody who has mobility needs. This means that the home are willing to consider a wide range of diverse needs. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: 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 this service. Staff are recruited and trained appropriately so that care can be delivered effectively. Evidence: On the day of the inspection the home had 23 residents in the home. Staffing consisted of 2 trained nurses and 2 care staff. The duty rota confirmed that the minimum staffing is 3 carers. The manager is supernumerary to these numbers. There were adequate ancillary staff as well as a full time administrator employed. Margaret Roper tends to have a slow turn over of staff so that people receive a consistent standard of care. The trained staff have a skill mix that includes Mental Nurse cover [RMN] and also nursing staff who are originally trained in general nursing and have had some years experience in working with people with mental illness. Care staff have attended appropriate training with respect to residents in the home. There are training files for staff and staff training is discussed in regular supervision sessions. Staff told us that they have had recent training in the Mental Capacity Act and we saw that this has been translated into assessments in care notes. This means that staff are keeping up their skills and knowledge. Staff spoken with all had NVQ training at either level two or three and this is well supported in the home. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Those staff interviewed displayed an enthusiasm to work in the home and a genuine interest in the resident group. Those residents spoken to stated that staff were helpful and supportive and easy to approach. People knew who their key worker was and found this relationship helpful. Again this shows consistency of care. Staff files were inspected and the necessary recruitment checks prior to employment were available so that staff employed are fit to work and people in the home are afforded some protection. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems in place to ensure that the home continues to develop and be run in the best interests of the people living there. Evidence: The level of service at Mgt Roper has been consistently high over previous inspections. The Registered Manager has been in post for five years and continues to provide an effective leadership role. He has many years experience working previously in the NHS at senior management level and displays an understanding of how the service should be developed. To this end there has been liaison with local mental health services and the manager has played a key role. The AQQA gives us some evidence of continued development of the service and also of consistent standards: The Manager has completed his RMA Registered Managers Award now. The day to day operations have been managed excellently. The Quality Assurance portfolio endorses the good practices at Margaret Roper House. There has not been any major incidents Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: which highlights that safe working practices are exercised at Margaret Roper House. All relevant information for the Home is accessible via the website. Feedback from all parties spoken with was positive about the way the home is run and there is a confidence in the managers abilities. All of the residents were aware of who the manager was and the role of other key staff. There is a clear management structure. There are various ways that the views of residents are sought and how their voices are listened to. This ranges from residents meetings, which are frequent, through to the residents committee, which also has some input into recruitment of staff. There are more formal auditing process such as a yearly external quality audit as well as regular monthly audits by Nugent Care, which look at care issues as well as management processes. We saw an example of one of these audits which had been completed in good detail and referenced how the service was responding to issues around the Mental Capacity Act. The manager was able to discuss plans for the home over the next year. There are appointed health and safety officers on the staff and the records seen were satisfactory and up to date. [We looked at fire records principally].The AQAA tells us that all safety certificates are up to date. We looked at records of incidents which have occurred in the home such as accidents and other incidents involving residents. We saw a record of an incident between two people which the home should report through to us [CQC] as a routine notification. This is important so that we can keep up to date with the service and, as regulators , monitor issues within the home. Over the past year we have not received any notifications. We would recommend that the manager review this and any notifiable incidents must be reported through. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 2 6 20 All assessment need to clearly signed and dated. We would recommend that the reviews of the care plans include evidence of residents being consulted and included. We discussed the need to revisit the self medication policy and perhaps look at the suitability of the current risk assessment tool as this may not suit current or future need. We would strongly recommend that the regular omissions with respect to the recording of medicines administered is addressed. 4 5 22 42 The complaints procedure displayed needs to be updated with the address of CQC. We would recommend that the manager review incidents in the home and ensure they are reported through as notifications to CQC. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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