Inspection on 10/05/10 for Mary House

This is the latest available inspection report for this service, carried out on 10th May 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mary House 22/07/08

Mary House 20/08/07

Mary House 05/07/06

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for adults (18-65 years) Name: Address: Mary House 490 The Ridge Hastings East Sussex TN34 2RY     The quality rating for this care home is:   one star adequate 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: Melanie Freeman     Date: 1 0 0 5 2 0 1 0 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Mary House 490 The Ridge Hastings East Sussex TN34 2RY 01424757960 01424757969 PaulSimmons@marthatrust.org.uk www.marthatrust.org.uk Martha Trust Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 12 The registered person may provide the following category/ies of service only: Care home with nursing (N) only - service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) Date of last inspection Brief description of the care home Mary House is situated on the outskirts of Hastings close to the Conquest hospital. The historic town of Battle is a short drive away. The home is approximately a fifteenminute drive to Hastings where there are shops and local amenities. It is purpose built with all accommodation in single rooms at ground floor level. The home is registered to accommodate twelve adults with learning and physical disabilities and to provide personal and nursing care. The registered providers are Martha Trust, which is a Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 12 12 Brief description of the care home registered charity, founded in 1983 specifically to care for people with profound disabilities. CQC reports and current fee information can be obtained directly from the home upon request. The home now has a hydrotherapy pool. Care Homes for Adults (18-65 years) Page 5 of 30 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: one star adequate 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: For the purpose of this report the people living at Mary House will be referred to as residents. This was a key inspection that included an unannounced visit to the home on Monday 10 May 2010. The inspection to the home was brought forward in response to the increase in the homes capacity, and following an unexpected death of a resident, that was investigated under the safeguarding vulnerable adults procedures. The allocated inspector spent approximately six hours in the home and was able to discuss matters with the appointed manager and the registered manager from the sister home. Who was working in the home in a supporting role. There is currently no registered manager at the home, and director of nursing for the organisation has applied for this post. The manager in day to day charge of the home is called the appointed manager by the organisation, and this is the title used in this report. Care Homes for Adults (18-65 years) Page 6 of 30 Follow up contact was made with a residents relative and four professionals who have had recent contact with the home. At the time of this visit there were 11 residents living in the home. The inspection involved a tour of the premises, observation of working practices, examination of the homes records and discussion with the appointed manager, the domestic, a selection of care staff, a registered nurse and the chef. The main focus of the inspection was to focus on the quality of live that residents experience. The required Annual Quality Assurance Assessment (AQAA) was completed and returned prior to the inspection visit, and information from this has been used to inform this report. At the time of compiling the report, in support of the visit, the Care Quality Commission received survey forms about the service from five staff members. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: 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. Care Homes for Adults (18-65 years) Page 8 of 30 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 30 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 30 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. Prospective residents have all the required information available to enable them to make an informed choice about the home, and if they want to live there. The admission procedure ensures that residents are admitted only on the basis of a full needs assessment, undertaken by people competent to do so. Prospective residents have the opportunity to visit the home, and know that it is able to meet their individual care and support needs. Evidence: A copy of the service users guide and statement of purpose was readily available in the home. This was extensive, however on close examination it referred to when the home was registered for eight people, and when it had a previous manager. It would appear that it had not been fully updated since 2006. Contact with the home following the inspection confirmed that this document is currently under review and would be totally updated in the near future. The last admission to the home was identified and the admission process followed for Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: this individual was tracked, including a review of the relevant documentation in the home. The appointed manager confirmed that the care manager considering a placement in Mary House visited the home before an assessment was completed, to satisfy herself the the home would be able to meet the prospective residents needs. The initial assessment was completed by the companys assessment nurse and was completed in the prospective residents current home. This visit was arranged with the involvement of his parents and the care manager. Part of the pre-admission assessment included two staff members spending time with the prospective residents in his place of residence. A transition plan was also completed and the prospective resident attended the home for trial visits, including one full day in the home accompanied by his mother. Clearly each new resident is very different and the admission process is adapted in order to be flexible, to ensure maximum information is gathered to help with ensuring a smooth transition of care. Discussion with a relative following the inspection visit confirmed that the admission process was both thorough and well executed, ensuring a smooth and well organised move to Mary House. Discussion with the appointed manager in the home confirmed that the last two admissions to the home have very complex care needs, and were more challenging than other residents in the home. This has caused some disruption in the home and has taken time for these new residents to adjust to their new environment, and for the staff and other residents to have an understanding of their needs. A management plan has been put in place to assist in this matter and to ensure the safety and comfort of all residents in the home. This includes very close supervision for both new residents during the day which has been accomplished with increased staffing levels. Discussion with a relative and care manager confirmed that the staff work hard to understand individual care needs and adapt accordingly, developing their understanding of peoples emotional and physical individual need. Care Homes for Adults (18-65 years) Page 12 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident has a plan of care that enables staff to meet the assessed support and care needs of residents, in a structured and consistent manner. Residents are treated with respect and some systems are in place to enable decision making about day-today living. Evidence: Two plans of care were reviewed in depth and the views of relatives were sought in respect of these residents as part of the inspection process. On the whole the plans were found to be full, evidencing a needs assessment with risk assessments being used to inform the care and the activity of individuals living in the home. With an emphasis on limiting a restrictive lifestyle whenever possible. It was however noted, that some information was difficult to find and a risk assessment for the use of bed rails had not been completed. Further clarity on information recorded is needed with a systematic approach to risk assessment. The appointed manager confirmed that this was being worked on. There was evidence that the personal care plans had been updated and the AQAA recorded that these are developed with the next of kin or Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: other suitably qualified person. A record of who was involved as the residents representative should be recorded within the care documentation. Daily record sheets are used to record information about each resident. This includes information about a residents physical and health needs. The rear of the sheet is used to record information about activities that they have participated in over the course of the day. These provide information about the residents health and well being in a chronological way. The care documentation explores peoples individual choices and these are reflected. It was noted that residents able to use picture charts for communication are encouraged to do this, and the home are currently working with a community specialist to improve systems for communication throughout the home. Specific care needs are well recorded and staff are provided with guidelines on how to provide the care. For example in relation to epilepsy there is information about the type of epilepsy experience by each individual and how to respond should they experience a seizure. This includes records around the length and type of the seizure. A recent review of the documentation completed by community specialists as part of a safeguarding investigation identified the need for clearer records. Including more up to date and accurate epilepsy guidelines, and more robust reporting procedures with regard to incidents and accidents in the home. The management of the home are working with the local authority and community specialists to improve these matters, and the nurse assessor who works for the organisation is taking a lead on this. On the day of the inspection a senior manager was registering two applications for the deprivation of liberty in respect of two residents in accordance with advice given from social services. Although there was a number of assessments completed with regard to the Mental Capacity Act the homes guidelines on deprivation of liberty was not clear and work was being progressed to address this shortfall. Senior staff in the home have completed training on both the Mental Capacity Act and deprivation of liberty. During discussion with the appointed manager the homes policy on residents who collapse in the home was raised. She advised that the staff would respond according to the situation, but the expectation would be that a basic resuscitation procedure would be followed including the establishment of clear airway, use of oxygen, and cardiac massage if suitable for that individual. There are no clear guidelines in the home currently and the manager agreed that further clarity was required and that she would address this with senior managers in the organisation. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: Since the inspection visit the home has provided the Care Quality Commission with draft policies on deprivation of liberty and resuscitation. Care Homes for Adults (18-65 years) Page 15 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the opportunity to take part in leisure and community activities. Individual rights are respected and dietary needs are met. Evidence: The environment and facilities at Mary House allows for a very varied activity and entertainment programme. Facilities include a cinema screen, a hydrotherapy pool, an art room and sensory room. During the inspection visit staff were seen to be engaging with residents and worked hard to promote interest and activity within residents lives. One residents had a therapy session in the hydrotherapy pool, and a small group of residents were involved in the cooking and eating of some scones. Other staff were reading to residents. Staff were able to demonstrate a good understanding of residents, and how they communicate and express their pleasure and displeasure. The home are working with community specialist to develop the levels of communication Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: further and routine activity programmes. One relative expressed high satisfaction with the activities provided in the home, saying that the range of activities in the home have improved my sons quality of life immensely. Mary House also maintains links with the community and accesses these with the provision of two mini buses, and a car that can take a wheelchair. The care staff assist the residents to attend the cinema, bowling, local places of interest, local shops and restaurants, family events and celebrations. Some residents regularly attend places of religion and are helped to practice their faith. The AQAA recorded that family members are encouraged to use facilities within the home and will often use the hydrotherapy centre. On arrival at the home the inspector noted that two residents were preparing to go on holiday with staff. And the was advised that a further two residents were going on holiday the following week accompanied by staff. These holidays are available to all residents. The chef was spoken with and he was able to demonstrate that he knew the residents that he catered for well. A rolling menu is in place. He knows residents likes and dislikes and is able to tailor the menu to these. If however a resident does not eat the meal provided alternatives are made, as in a domestic environment different meals are provided. Residents weights are closely monitored along with what each resident is eating. In this way problems are highlighted to a nurse and responded to. Some of the residents have specific nutritional needs, including parenteral feeding and identified food allergies. These are recorded and responded to with individual guidelines in place. During the inspection visit staff were seen to be supporting residents to eat and drink, whilst those able to do so independently were encouraged and provided with appropriate adapted utensils. Staff were seen to be treating each resident in a respectful way, and the AQAA recorded that all staff are aware of the need to respect residents dignity while providing, what is often very personal care. All personal care is undertaken by two staff after they have spent time with the resident and have been deemed as competent by the shift leader. The home is at present introducing dignity champions within the Martha Trust. Care Homes for Adults (18-65 years) Page 17 of 30 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. The systems in place ensure that the health care needs of the residents are met. Evidence: The rapport between residents and staff was seen to be positive. Residents enjoyed the contact with staff and responded to them in a positive way. Staff included them in conversations and activity in the home, including domestic and housekeeping activity. The storage facilities in the home for medicines were found to be good. The practice observed confirmed that medicines are administered by the registered nurse working in the home, and that this is done directly from the medicines trolley. The records seen were found to be accurate and well maintained. Individual guidelines are in place for epilepsy medicines and parenteral feeding. Each resident had an emergency box which contained relevant medicines and guidelines on use. The labels on these could be rubbed off and some had become difficult to read. It was suggested that these boxes are labeled more clearly, and the appointed manager later confirmed that laminated labels had been used to ensure clarity. Each resident has a health action plan in place that is reviewed regularly. Record Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: keeping is in place to show that residents weights are monitored regularly. Detailed records are kept of all medical appointments and the AQAA confirmed that residents are assisted to attend medical appointments. These are often local to the Home but can be as far away as London. When appropriate the next of kin attends with a qualified nurse from the home. Due to the severe physical disabilities and complex needs of the residents, the home provides a member of the support team to assist if any resident is admitted to hospital. A physiotherapist works in the home and provides support advice and training to staff. Residents have a list of daily exercises to be undertaken. The home has links with community health care specialist and have recently re-established supporting contacts with the specialist nurse and speech and language therapist, and are using their skills and knowledge to improve the documentation and services in the home. All residents have chairs that are suitably assessed for the individual and fitted by a specialist these are fitted with straps that secure residents in a safe way. Additional equipment is available to move and change residents positions including a standing frame and turn table. Care Homes for Adults (18-65 years) Page 19 of 30 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 are procedures in place to ensure that anyone wishing to make a complaint can do so, and that any safeguarding issue is responded to. Evidence: During the inspection visit it was noted that there is an open and friendly feel in the home, with the appointed manager available and approachable. There is a clear complaints procedure and the home encourage views about the service to be shared through forums and close contact with residents, and their representatives. There is a simplified version of the complaints procedure in the service users guide. The AQAA completed in March 2010 recorded that no complaints or safeguarding concern had been raised. Since the completion of this document a safeguarding concern has been raised, and is currently under investigation, with identified improvements from this being implemented within the home already. Some money is held for each resident for safe keeping. A small selection of money held along with the associated records were checked and found to be correct. Systems are in place to ensure monies are safeguarded. Records seen, and discussion with the appointed manager confirmed that staff have received training on safeguarding vulnerable adults, and that an appropriate policy and procedure is in place. Senior staff have also completed training on the Mental Capacity Act and deprivation of liberty. Recruitment practice ensures that staff have Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: an enhanced criminal records check (CRB) along with other checks to ensure only staff suitable to work with vulnerable people are employed. Care Homes for Adults (18-65 years) Page 21 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well maintained and the standard of decor is of a high quality. Evidence: Mary House is a purpose built home that has recently been extended to provide accommodation for 12 residents and to provide further facilities. The home is well equipped with excellent facilities, well maintained with adaptable and spacious communal space. Each resident has an individualised room that is large enough to accommodate any equipment and personal possessions to make the room a home, and suitable to meet individual need. Rooms have direct access into a fully adapted bathroom. On the day of the inspection visit the home was found to be comfortable, warm and clean throughout. Suitable hand washing facilities were found at all hand washing areas. It was however noted, that some cleaning substances were not locked away safely. Once this was identified to the appointed manager she raised it appropriately with the cleaner who dealt with this matter immediately. Suitable systems need to be established to ensure safe practice and that procedures are followed at all times. Equipment was also found to be clean and in good working order. Care Homes for Adults (18-65 years) Page 22 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing arrangements are reflective of the residents needs and include a registered nurse on duty at all times. Although robust recruitment procedures ensure the safety and protection of residents appropriate staff training needs to be established for all staff to ensure the same. Evidence: Since the home has increased in occupancy the staffing levels have been adjusted and these were increased further in response to the needs of two residents that require closer supervision. A registered nurse is on duty in the home 24 hours a day and the manager of the home is in addition to this cover. Discussion with staff during the inspection visit confirmed that the staffing levels were good, and allowed for a high level of interaction with residents. All feedback about the staff from residents representatives and professionals was positive, with staff praised for being kind and supportive, and for developing a good understanding of residents needs. One professional said how impressed she was with the way one registered nurse worked as a residents advocate. During the inspection visit it was observed that communication and contact between staff was difficult due to the size of the home. The appointed manager has since confirmed that systems to improve communication are currently under review. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Feedback from staff surveys and discussion during the inspection visit indicated that although staff training in the past has not been very good, in recent months they have had a large amount of training that has been both useful and interesting. The appointed manager confirmed that due to recent staff shortages at the sister home of Mary House staff training had suffered, as staff had been removed from their training responsibilities. The training officer has also now left the organisation. A new training co-ordinator has been appointed to structure the training schedule, and to source a suitable training provision. The homes training matrix recorded that most care staff currently working in the home have completed their mandatory training although this now needs to be established as an ongoing process. The training matrix also needs to be adapted to record all staff working in the home Recruitment practice overall was found to be thorough with appropriate measures in place to ensure that all checks are carried out prior to staff appointment. A small shortfall noted was addressed by the appointed manager following the inspection visit ensuring a full employment history is recorded for all staff. During the inspection it was noted that a new staff member was shadowing another and this is part of the induction procedure, that is well documented. Care Homes for Adults (18-65 years) Page 24 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements are not well established with a registered manager still not in post. Systems for quality monitoring and the development of the service are not robust. The health and safety practice in the home on the whole promote residents and staff safety and welfare, although staff need to be vigilant to ensure substances hazardous to health are handled safely. Evidence: Mary House has been without a registered manager since January 2009. The Organisation has been unsuccessful with a recruitment drive to replace this management post. A deputy manager was appointed in March 2009 and has been in charge of the day to day management of the home overseen by the Organisations nursing director. The deputy manager was made the appointed manager in February 2010. The nursing director is currently applying to be the registered manager with the the Care Quality Commission. The Commission has requested a clear management structure from the Organisation as the lines of accountability and responsibility are not clear, and are not currently reflected in the homes statement of purpose. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Systems for monitoring the quality of the care and services in the home are not robust. There was no evidence that the required regulation 26 visits had been completed over the past year. There was no quality monitoring report completed and evidence of thorough auditing of practice in the home was not robust. The appointed manager advised that surveys to residents /representatives had been sent out and returned, but had not been audited yet. The AQAA recorded that the necessary safety checks have been completed on equipment and services to the home, and that there are systems within the home to ensure the health and safety of staff and residents. The home has a full time maintenance man who attends to the safety of the home and its equipment. As previously mentioned in this report cleaning substances were not locked away when not in use. Suitable health and safety measures must be implemented in respect of the Control of Substances Hazardous to Health. Care Homes for Adults (18-65 years) Page 26 of 30 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 30 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 1 35 18 The registered person must ensure that all staff receive appropriate training to the work they are to perform. This will ensure staff are able to under take the work and care required in a safe and competent way. 13/08/2010 2 37 8 That suitable and clear 01/07/2010 management arrangements are established, to provide a strong leadership to the home. This will ensure clear lines of accountability and responsibility are maintained. 3 39 24 That a suitable and effective quality monitoring systems are maintained, including the required regulation 26 visits. To ensure the quality of the 01/07/2010 Care Homes for Adults (18-65 years) Page 28 of 30 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 service and care is under constant review and subject to ongoing improvement. Taking into account residents and their representatives views. 4 42 13 That suitable safety arrangements for the Control of Substances Hazardous to Health are in place at all times. This will ensure no one is put at risk by having access to hazardous substances. 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 01/07/2010 Care Homes for Adults (18-65 years) Page 29 of 30 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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