CARE HOME ADULTS 18-65
Markyes Close 1 & 2 Edde Cross Street Ross-on-wye Herefordshire HR9 7BZ Lead Inspector
Christina Lavelle Unannounced Inspection 3rd November 2005 3:15 Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Markyes Close 1 & 2 Address Edde Cross Street Ross-on-wye Herefordshire HR9 7BZ 01989 769034 01989 769034 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) Aspire Living Mrs Elizabeth Linda Watkins Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8) of places Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residents may also have a physical disability in addition to a learning disability 6th May 2005 Date of last inspection Brief Description of the Service: 1 & 2 Markyes Close was first registered as a care home in 1992. The service provider is Aspire Living and Choices Limited, which is a voluntary organisation and a registered charity that operates in Herefordshire. Aspire’s head office is The Fred Bulmer Centre, Wall Street, Hereford, HR4 9HP. The property is owned by the Health Authority and leased to the provider organisation. The home provides accomodation and personal care for eight adults (men and women) who can be aged over sixty five. Service users must require care due to learning disabilities and may also have associated physical disabilities and/or sensory impairments. Their disabilities are likely to be profound and some service users may also use behaviour that can be challenging to the service. Markyes Close is located in a convenient place, within a short, walking distance of Ross-on-Wye centre. So providing easy access for the towns services and facilities. Suitable transport is also provided by the home for service users to go out into the local community and further afield. The home consists of two self-contained purpose-built bungalows, that are next to each other. They have a shared, secure garden area and can accommodate four people. Service users have single bedrooms, which do not have en-suite facilities. Each bungalow has a lounge, a separate dining room, an assisted shower, toilet and bathing facilities, a kitchen, laundry room and an office. Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection, which was carried out in two and a half hours on a Thursday afternoon in the autumn. One aim was to review any action taken to deal with a number of matters raised following the last inspection. Another aim was to check if the home still gave good quality care to service users. The following ways were used to assess the service provided. Although it was not possible to obtain service users’ views of life at Markyes Close directly, time was spent in their company to gain an impression of how comfortable they seemed to be in the home and with staff on duty. Service users’ care needs and their daily lives and activities, staff experience and training were discussed with the deputy manager and staff on duty. Comment cards were left at the home for service users’ relatives and health care professionals who are involved with the home and/or individual service users, asking for their views of the service. Unfortunately none were returned to the Commission and so their feedback cannot be referred to in this report Various records about service users’ care, staffing and how it is ensured the home is kept safe were checked. The two bungalows were looked around. All the correspondence between the home and the Commission since the previous inspection (including reports made by Aspire on the conduct of the home following their required monthly visits) were also taken into consideration. What the service does well:
Markyes Close provides a secure, very comfortable and homely environment that is suitably adapted and equipped to meet service users’ special needs. The home offers service users the opportunity to live in ordinary, domestic housing, which has helped them to become part of the local community. The home provides stability and personalised care for service users. Staff knew each person and their needs well and service users responded positively to staff. Good care planning ensures staff know how to meet service users’ needs better and keyworkers that their individual preferences are taken into account. Staff supported service users to lead as active and interesting a life as they were able to and responded to their daily needs and routines flexibly, according to their mood and behaviour. Staff ensured service users’ personal and health care needs were met, with specialist help when appropriate. The home and service users benefit from a relatively stable and full staff team. Aspire require staff to undertake all relevant health and safety training as well as other training in respect of care practice and service users’ special needs. So staff should have the knowledge and skills needed to do their job properly.
Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4 Information is provided to help prospective service users and/or their families and representatives decide if Markyes Close is where they may like to live and if the home would be able to meet all their needs. Appropriate assessment and admission procedures are in place to ensure that the home could suitably meet the needs of new service users. EVIDENCE: The home provides appropriate information, including a Statement of Purpose, Service Users’ Guide and a Terms & Conditions of Residence. It was previously confirmed these documents had been made available to current service users and/or their relatives and representatives. The Service Users’ Guide includes a photograph of the home and pictures and is also written in simple language so that it is more likely to be understood by people with learning disabilities. There was a vacancy at the home at this time and the assessment process being followed for a prospective service user was discussed with the deputy manager. This appropriately included staff visiting to assess the prospective person’s needs at their current residence. They had also arranged for them to have introductory visits to the home and if successful they would then have a trial stay before the placement was confirmed. This had all included involving other relevant people, such as their family, social worker and staff at the care home where they were now living, to obtain as much information as possible. Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9 Service users’ needs had been appropriately assessed and reviewed and a plan drawn up so staff know their needs and help they needed to give them better. Whilst service users’ ability to make decisions and choices was limited, staff ensured they had flexible daily routines and that their lifestyles suited them. A risk assessment process ensures any risks to service users arre minimised. EVIDENCE: A sample of service users’ care records was checked. Their care plans covered all relevant areas of need (including social and emotional) and summarised the action staff needed to take to meet those needs identified. Staff also made comprehensive daily reports including activities each person had taken part in. The home’s approach to care planning is appropriately person centred and so should focus on service users’ own goals and wishes. Although the extent to which service users can express their views and decisions is very limited staff had involved relatives or advocates in reviews of service users’ care and their plans. Plans seen had been reviewed and updated to reflect their current and changing needs at least six monthly (as expected) following review meetings.
Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 10 Keyworkers allocated to particular service users from the staff team helped to ensure their preferences were sought and known, and also that the care and support given was more personal. Staffing and daily routines were arranged to meet with service users’ needs and as their behaviour and mood indicated. Relevant risk assessments had been carried out. A new risk assessment format was being introduced which identified all possible risk areas and will include behaviour management plans to help staff to deal more consistently with aggressive and other challenging behaviour from service users. Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 14 Staff enabled service users to participate in activities they enjoyed and to integrate within the wider community to the extent they are able and wish to. EVIDENCE: Each service user had a weekly activities programme and records were kept of the day services they had attended and social and leisure activities undertaken Activities included riding for the disabled, swimming and a snoezelen (sensory centre). Staff tried to involve service users in the local community by taking them shopping or out for walks and to cafes etc. The extent was dependant on each individuals’ behaviour and preferences. Another option being explored to provide stimulation was a music therapist to take sessions at the home. Staffing was provided specifically to facilitate activities and/or extra hours were allocated to keyworkers for supporting service users individually with activities. The home has suitable vehicles for outings. Three service users had recently been on holiday to Newquay for five days and a few others were soon to go to Blackpool to a hotel adapted to accommodate people with physical disabilities.
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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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 19 Appropriate arrangements were in place to ensure the personal and health care needs of service users were met. EVIDENCE: Service users all needed a high level of assistance with their personal care and this was recorded in their plans. Service users were all observed to be well presented and appropriately dressed. Information was seen in care records about service users’ health history, their medical condition and medication. Records were also kept of physical checks made and/or monitored by staff to promote service users’ good health e.g. bowel, weight and mood charts. Input from health care professionals e.g. a Psychiatrist, had been accessed appropriately and assessments requested from Occupational Therapists in relation to wheelchairs and other equipment. Routine health checks e.g. “well man” clinic, Optician, Dentist and for flu jabs were routinely arranged. Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Although these Standards were not fully assessed, the Commission had not received any complaints and no issues had been raised about the protection and safety of the vulnerable service users since previous inspections. Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Markyes Close is conveniently located and provides a suitable, safe, homely and comfortable environment for service users. Arrangements to improve the accommodation, to deal with repairs and maintain cleanliness and hygiene in the home appeared to be working effectively. EVIDENCE: Markyes Close is conveniently located and was purpose built for people who may need a secure environment due to their learning disabilities and/or use challenging behaviour and who may also have profound physical disabilities. Overall the premises were in a good state of repair, furnishings and décor. The office in bungalow 1 was being redecorated and new storage and flooring fitted. One bedroom and the shower room had been refurbished since the last inspection. In bungalow 2 some rooms had been upgraded and a new kitchen fitted. New carpetting was to be laid in the lounge and dining room soon. Both bungalows were found to be clean, tidy, fresh, and airy. There was evidence that due attention was paid by staff to maintain good hygiene and infection control. There was anti-bacterial liquid soap, paper towels and disposable gloves available in bathrooms and suitable arrangements for clinical waste disposal. The home provides an infection control policy and procedures.
Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 35 Markyes Close was appropriately staffed by a suitably trained and stable staff team. This reflects positively on staff competence and helps ensure staff know and understand service users’ care needs and how to meet them properly. EVIDENCE: A suitable number of staff were on duty today, which had included a separate activities co-ordinator during the daytime to facilitate service users’ activities. Staff rotas confirmed that appropriate staffing levels were being maintained. It was good the home was now fully staffed and that agency staff were only being used very occasionally to cover leave and one staff member duties who was currently on long term sick. This reflects positively on consistency of care delivery and a stable staff team are more likely to know service users better. Staff spoken with clearly knew the service users very well and expressed a commitment to meeting their needs and to providing a good quality service. Some staff had received a training update on managing challenging behaviour and training was planned for the others. Staff had attended a total communication training session and an update on epilepsy was planned. About eight staff already had an NVQ care qualification and another five were currently doing NVQ at this time. This programme of training should continue so that at least half of the staff team achieve NVQ as soon as possible
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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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 41 & 42 It would better ensure the service continually develops in the best interests of service users and in accordance with their, and relevant other peoples views, when a formal quality assurance and monitoring system is implemented. The processing of service users’ finances should be more personal to ensure their rights are safeguarded. Overall the evidence indicated the environment and working practices in the home promoted the welfare and safety of staff and service users. This would be enhanced when the possible hazard from uncovered radiators are risk assessed and action taken to cover them if deemed necessary. EVIDENCE: These Standards were not assessed in full, although the deputy manager confirmed progress had been made to set up a formal quality assurance system. Home managers had attended training sessions to enable them to operate the system effectively and it will appropriately involve obtaining input from service users and other relevant stakeholders and tie in with the National
Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 17 Minimum Standards for care homes. This process must also result in periodic reports sent to the Commission and made available to other interested parties. It was noted some service users’ benefits were paid directly to Aspire and the home then requested their personal allowance money as and when needed. It is acknowledged the home has had difficulties in opening individual savings accounts for service users. However an account just for service users would make the processing of their money more personal and be in line with the Care Home Regulations. The only possible health and safety hazard identified during this inspection was that some radiations were uncovered and although they all had individual thermostatic controls two radiators in bungalow 2 felt rather hot. This must be risk assessed and action taken to deal with any possible hazard to the service users. Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Markyes Close 1 & 2 Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X X 2 X 2 2 X DS0000024681.V262880.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA42 Regulation 13(4)(a) Requirement Uncovered radiators in the home must be risk assessed and any action deemed necessary to ensure service users safety must be taken. An effective Quality Assurance system must be implemented. Results of reviews must be reported and circulated to participants, other stakeholders and The Commission. Previous timescales have been made and the latest of the 31/07/05 is brought forward as it has not yet been fully actioned. Timescale for action 31/12/05 2 YA39 24 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA41 Good Practice Recommendations Consideration should be given to the way service users’ money is processed to ensure this is as person centred as possible and meets with Care Home Regulation no. 20. Markyes Close 1 & 2 DS0000024681.V262880.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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