Inspection on 09/07/08 for 4 Maer Lane

This inspection was carried out on 9th July 2008.

CSCI 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

4 Maer Lane 24/07/07

4 Maer Lane 24/05/06

4 Maer Lane 23/02/06

4 Maer Lane 08/09/05

4 Maer Lane 12/10/04

4 Maer Lane 06/04/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 4 Maer Lane Market Drayton Shropshire TF9 3AL Lead Inspector Rebecca Harrison Key Unannounced Inspection 9th July 2008 09:30 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 4 Maer Lane Address Market Drayton Shropshire TF9 3AL 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) 01630 698092 angelaj@tha.org.uk joannesp@trident-ha.org.uk Trident Housing Association Ms Angela Jones Care Home 10 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (1) of places 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The manager must demonstrate that the home is able to meet the individual needs of the older person accommodated through the provision of training and care planning documentation. 24th July 2007 Date of last inspection Brief Description of the Service: 4 Maer Lane is registered with the Commission for Social Care Inspection to provide accommodation and personal care for a maximum of ten people with a learning disability. At the time of the inspection the home had one vacancy. The home is purpose built and is situated in Market Drayton, Shropshire and offers access to local amenities, public transport and is in keeping with the local community. The accommodation is based over two floors providing single bedrooms, a domestic style kitchen, a dining room, two lounges, and a conservatory. Car parking is provided to the front of the building and people have access to a large enclosed garden. Equipment is available to support people with physical disabilities. Prospective service user’s and their representatives are able to gain information about this service from the Statement of Purpose and Service User Guide. An easy read version has been developed for those who may require it. Inspection reports produced by CSCI are displayed in the reception area of the home for people to read. These are also available on our website at www.csci.org.uk The current fees charged range from £1075.43 to £1425.53 per person per week. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social care inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that needs further development. This inspection was unannounced and carried out by one inspector over seven and a half hours. A range of evidence was used to make judgements about this service to include discussions with one service user, staff on duty and managers. We also did a tour of the home, reviewed the homes quality assurance processes and observed the care experienced by people using the service. We also looked at surveys we received from five staff, eight service users and two health professionals. A number of records were reviewed to include care records held on behalf of two people, complaints and protection, staff training, recruitment and health and safety records. Due to the needs of the people living at the home not all individuals were able to actively contribute to the inspection process and share their own experience of living at Maer Lane, therefore direct and indirect observation was used to inform the inspection process. Two people who live in the home were ‘case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was sent to the manager for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. By law they must complete this and return it to us within a given timescale. The inspection reviewed all twenty two of the key standards for care homes for younger adults and information to produce this report was gathered from the findings on the day and also by review of information received by CSCI prior to the inspection date. A quality rating based on each outcome area for service 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 6 users has been identified. These ratings are described as excellent/good/adequate or poor based on findings of the inspection activity. What the service does well: What has improved since the last inspection? 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 7 People now have a detailed support plan describing how their personal and healthcare needs are to be met. These are more ‘person centred’ making them more user-friendly to the people they belong to. Some new specialist equipment has been purchased to assist people with maintaining their independence and to provide comfort for example one person has a new made to measure easy chair and bed, others have new moulded wheelchairs. A new shower facility has recently been installed for one person who no longer enjoys bathing. New bedroom furniture and furnishings have been purchased that people have helped to choose. The manager is now registered with us. All of the requirements for improvement arising from the last key inspection have been met. What they could do better: Maer Lane has some areas for improvement. The manager appeared committed to improving shortfalls identified at the time of the inspection to include recruitment practices and staff training. A review of staffing levels should be undertaken to ensure they are sufficient and effective in meeting the assessed needs of people using the service at all times. All staff should be provided specialist training to include dementia, autism, makaton, and diabetes to ensure they have the appropriate skills and knowledge to effectively support individuals and their changing needs. We received a number of surveys and comments about how the service could improve to include: ‘The manager I have is the best there is. But her managers at the top do not want to help her and the care staff’ ‘Resources limit the amount of time spent with service users on one to one basis’. ‘Senior managers cut staffing levels and the needs of residents are not met’. ‘Maybe more staff to help cope and take the strain’. ‘The service does well in providing some things and other things not so good like transport and staff training needs to be looked at’ 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 9 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 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good People looking for a care home can be confident that Maer Lane can support them. This is because information about the service is made readily available to help them make an informed choice about whether the home is able to meet their individual needs. A complete assessment of their needs is undertaken with them and others close to them, and people are given the opportunity to visit the home and “test drive” it to ensure the service is right for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about the service is readily available in the Statement of Purpose and Service User Guide. Both documents provide people with information to help them understand the services that Maer Lane provides. The documents have recently been reviewed and updated as required by our previous inspection. The home provides An easy read version for those who may require it. There have been no new admissions to the service for a number of years however the home now has one vacancy and has received an expression of interest from a person requiring a service. We received eight surveys from 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 11 people currently living at the home and most people said that they were not provided with sufficient choice or information about moving into this home when it originally opened. The manager fully acknowledged this and is aware of ways to offer choice and provide information to any future prospective service users and this was shared during the inspection. The home has a detailed admissions procedure, which is clearly documented in the Statement of Purpose and Service User Guide. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good People living at Maer Lane have a detailed support plan, which informs staff about their individual needs and how they prefer these to be met. Individuals are able to make decisions about their life, 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People are supported by their designated key workers to make decisions and choices about their lives through their involvement in their person centred plan and their support plan. New support plans have been developed with each individual and are very detailed and focus on outcomes for people using the service and help the staff meet their needs more effectively. The two support 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 13 plans we looked at were well documented and were an accurate reflection of peoples’ assessed needs as confirmed in discussions with staff on duty. Although not everyone at the home is able to express their needs verbally they can be confident that staff are familiar with their preferred communication styles such as signs, symbols, photographs and a range of pictorial formats used to aid communication. These were seen displayed around the home. Staff spoken with considered the team would benefit from receiving training in communication such as Makaton. Designated key workers who have a clear understanding of peoples needs work closely with the individuals they support to involve people with making decisions and choices, for example people have been involved in choosing the colour and furnishings for their bedrooms which are all very personalised. Residents meetings are held regularly and throughout the inspection people were offered a choice of activities and refreshments. It was reported that two people have an advocate to represent their best interests. People living at Maer Lane are supported to take responsible risks to maintain and develop their independence. Risk management plans have recently been introduced to support people and these were detailed on the two files sampled and include the environment, accessing the community, activities, daily living tasks, health, specialist equipment, and the use of transport ensuring risks are minimised. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17 Quality in this outcome area is good People living at Maer Lane have some 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 leisure activities based on their preferences, they are able to keep in touch with family and friends and are provided with healthy, well-presented meals according to their dietary needs and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The self-assessment completed by the manager states ‘People are encouraged and supported to be involved in daily routines and maintain their skill levels. Personal choices, hobbies and preferences are reflected in the activities undertaken’. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 15 The two support plans sampled detailed the activities the people liked and disliked which is essential given their limited verbal communication. We were told that three people access external day service provision but that no one currently attends college. One person spoken with said ‘I like living here, I go to the day centre three times per week, I like going into town to do the shopping. Sometimes I make my dinner and I like to help with the cleaning and washing my clothes. I see my mum a lot and the staff here are nice and they help me’ A pictorial activities board is displayed in the home to help people know what activities are planned. During the inspection we saw people engaged with various activities to include the sensory room, hand massage and relaxation. Two people observed lunch being prepared and two people were supported to go for a walk on separate occasions. Two people remained in bed for health reasons and two people were out at day services and returned home midafternoon. We were informed that people are supported to get out into the community as much as possible but on some days due to a reduction in staffing levels not everyone is given the opportunity to get out. All activities undertaken are recorded on an ‘opportunity plan’ and these were seen on the two files sampled and suggest that people may benefit from greater opportunities to access their local community or engage is more structured activity. This is also supported by a survey that we received which states: ‘The residents need to do more. Sitting someone in a chair and leaving them there to watch TV is not the right way. Getting the residents to church was hard because we had no mini bus for nine months, this was down to upper management not coming up with the money’ People living at Maer Lane are supported to maintain contact with their friends and families through home visits and telephone calls as confirmed in discussion with one person who uses the service and records seen on the files sampled. The manager reported that families are supportive and are invited to attend reviews and social events held in the home to include parties and barbeques. A summer fayre has been arranged for this month and discussions held with one service user indicated that he was very much looking forward to the event. Although people have complex needs observations made evidence that staff engage individuals with daily living tasks as much as possible. For example two people were sat in the kitchen watching a member of staff prepare lunch and were being involved with the activity. One person told us they help clean, do their laundry and help with the cooking. Another person helped lay the tables for lunch. People are offered a balanced diet and staff are aware of people’s personal preferences and dietary needs and these are taken into consideration when planning menus. Alternatives are made available if someone chooses otherwise. The home has sought professional advice for individuals at risk of choking. Likes and dislikes were seen recorded in the support plans sampled. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 16 The main meal served at lunchtime was well presented and staff were observed to make the mealtime a social and enjoyable experience. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because there is good evidence of multi agency working in the best interests of the people living at the home. Staff effectively support people with the management of their medication safeguarding their health. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff are aware of how individuals prefer to be supported with their personal care needs because these are clearly recorded in people’s support plans. Observations made and discussions held with staff evidence that staff respect people’s privacy and dignity. One person who uses the service said ‘Staff always knock on my door’. A member of staff spoken with stated ‘People here are treated as individuals, they are provided with choice and their dignity is upheld…everybody is cared for really well’. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 18 People’s health needs are well monitored and individuals are supported to access health appointments as and when required and outcomes are well recorded. Everyone living at Maer Lane has a Health Action Plan which is a plan developed by key workers and states what an individual needs to do in order to stay healthy. Due to recent changes in one person’s health and wellbeing the home has sought input from various health professionals and a review has been held in the persons best interests. Discussions held with staff indicate they are confident they are able to continue to meet the individual needs of the person concerned and training has been sourced for staff close to her. We received positive feedback from two healthcare professionals one person said ‘Of the homes I visit Maer Lane stands out for giving a warm and friendly service’. Medication procedures were discussed with the manager who demonstrated a clear understanding of how people are supported with the management of their medication. The medication policy and procedure has been reviewed and updated since the last inspection and an audit of the homes medication systems has recently been undertaken by the community pharmacist and found satisfactory. Only designated shift leaders administer medication and it was reported that seven staff have completed a distance-learning course in the safe administration of medication and the manager undertakes ongoing competency assessments annually. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate People living at Maer Lane have access to a complaints procedure, which is accessible to people who live at the home and their representatives if they need to make a complaint. Procedures are in place to safeguard people using the service from potential abuse however people would be better protected if staff were provided with training in adult protection and gained a greater awareness of the referral process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at Maer Lane are issued with a copy of an easy to follow complaints procedure, which they keep in their own rooms. The home or CSCI have not received any concerns or complaints since the last inspection. Very few staff have received training in the protection of vulnerable adults, which was fully acknowledged by the manager. This needs to be given priority to ensure all staff are familiar with safeguarding procedures and the referral process. The manager made a safeguarding referral last September in relation to one person living at the home however this was made to the funding authority and not the ‘host’ authority, which led to a considerable delay in dealing with the referral. The manager fully acknowledged that local procedures were not followed appropriately and is due to attend Protection of Vulnerable Adults 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 20 training for managers shortly. Although an advocate was instructed to act in the person’s best interests and a planning meeting held, the situation still remains unresolved. Following the inspection we spoke with the Chair of Adult Protection and Social Services as managers informed us that they had not received any formal notification about the outcome of the referral. We have since been informed that the concerns raised in the initial referral would be resolved as part of a meeting between those concerned and not be part of the adult protection process and that the placing authority should take a lead to resolve the outstanding issues. A further referral was made on behalf of another service user and a strategy meeting held and measures have been put in place to safeguard the person concerned and the case since closed. People who live at Maer Lane are supported to manage their money. The home has systems in place to ensure people are protected and daily checks are undertaken in addition to weekly audits by managers. This ensures that all money is accounted for protecting service users and the staff who support them. Staff spoken with told us that they were happy with these procedures and that they work well. A survey we received said the following ‘Money for clothes and money for the residents seem very hard to get because there has been problem with upper management signing cheques’. Training records show that five staff have received training in the Management of Actual and Potential Aggression (MAPA). This helps staff in supporting people whose behaviours may challenge the service. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,29 and 30 Quality in this outcome area is good People are provided with a homely, clean and comfortable place to live where they feel safe and secure. The home makes sure they have the right specialist equipment that encourages and promotes their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The self-assessment completed by the manager states the home provides ‘A lovely purpose built home to support up to ten service users. The property is well maintained and decorated to a high standard. Service users rooms are all individualised to demonstrate their own personalities and preferences’ One person told us that he likes living at the home and that he likes his room and his new bedroom furniture that he helped to choose. People were happy to show us their rooms all of which have been very personalised. The bedrooms of the two people we ‘case tracked’ were furnished appropriately to their needs. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 22 People living at the home are provided with a range of communal areas to use to include a domestic style kitchen, a dining room, two lounges, and a conservatory. Staff spoken with considered that people have access to appropriate equipment based on their individual assessed needs. A range of specialist equipment is available to assist people with maintaining their independence as much as is possible to include a passenger lift, a manual hoist, a made to measure easy chair and bed, moulded wheelchairs and overhead tracking hoists installed in two bedrooms linked to en suite facilities. A new shower facility has recently been installed for one person who no longer enjoys bathing. People are provided with a large fully enclosed garden and there are plans to develop this area in the forthcoming year with the help of an external organisation to create more seating areas, a sensory garden and decking. A service users spoken with indicated that he was looking forward to this improvement. The home was found clean and free from offensive odours. Products hazardous to health are appropriately stored and new data assessments have been obtained for all substances used and made accessible to staff. Training records show that seven staff have received training on infection control procedures since the last inspection and personal protective equipment together with a clinical waste removal contract are in place. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,35 and 35 Quality in this outcome area is adequate People living at Maer Lane are supported by a committed and dedicated staff team however they may benefit from staff receiving more specialist training to enable them to be more knowledgeable offering better support. Current recruitment procedures do not fully ensure that people are safeguarded from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The self-assessment completed by the manager states ‘We have a dedicated and experienced team of support workers who know the service users well. Many have worked here for six or seven years showing loyalty to service users and the company’. As part of the inspection we spoke with staff and managers and observed them working with and supporting the people who live at the home. Staff spoke positively about the service and of their roles and responsibilities. They demonstrated an excellent understanding of the individual needs of the people in their care. People using the service looked relaxed in the company of 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 24 the staff and it is evident that good working relationships have been developed. One service user said ‘I like the staff, they are nice and help me’. Of the eighteen support staff employed it was reported that ten have obtained a care qualification known as NVQ at level 2 and above. One member of staff said ‘People get a good level of support, the use of agency staff has reduced and it’s home from home here’. Another staff member said ‘I love my job, everybody is really well cared for’. The manager stated ‘I have a well established, loyal and dedicated staff team who are very familiar with service users needs’. The rota reflected the numbers of staff on duty. Staffing levels have been reduced from to four support staff on duty during the day following the loss of one service user. Managers reported that are trying to review this and seeking additional funding with placing authorities given the changing needs of some individuals. Staff told us that although staffing levels are currently acceptable people’s needs are changing with more people requiring a higher staffing ratio to attend to their personal care needs. One survey said ‘the residents needs are not met because we have lost one staff off each shift. At night we have one waking and one sleeping-in staff member which I would say is very dangerous…’ Personnel files were readily available for inspection however it was reported that these files would be returned to the head office following the inspection as these are now held centrally. The provider must ensure that the information required to comply with the Care Homes Regulations 2001 as amended is made available within the care home for inspection at all times. People using the service and their representatives must have reassurance that the appropriate checks have been done to make sure that staff are suitable to care for them. Since our last inspection one new member of staff has been appointed and we reviewed the records held. The file contained all of the required documentation with the exception of a recent photograph, health statement and copies of certificates to evidence previous training, for example NVQ qualifications and training courses attended as stated on the application form. Staff told us about some of the training courses they have attended since the last inspection to include the Mental Capacity Act, Mental Health, Medication, Adult Protection, Infection Control, Epilepsy, Person Centred Approaches and First Aid. Discussions with staff, surveys received and a review of the training matrix evidence that staff are not in receipt of training in safe working practices to include food hygiene, fire, medication, first aid, moving and handling and adult protection at the required frequency which potentially places both people using the service and staff at risk. Shortfalls in training were identified at the previous inspection and continue to remain a concern. The key workers of one person we ‘case tracked’ are due to receive training in dementia shortly to help equip them with the knowledge and skills to meet her needs. Staff reported that the team would benefit from receiving training in 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 25 makaton, dementia, Parkinson’s, nutrition and autism in order to be better equipped to meet people’s needs. An Employee Induction Workbook was available on the file on the person most recently employed however this was found blank. This indicates that new staff are not being encouraged to start and complete the induction within required timescales, which was an area of concern raised at previous inspections. Staff surveys we received indicate induction needs to improve one person said ‘I had to pick things up when I had the time to do so. Things need to improve with all aspects’ 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate People living at Maer Lane benefit from having a management team who are committed to meet their care needs however some systems are making people potentially vulnerable and action taken to improve processes will improve the overall quality of the service. Quality assurance requires further development to assess performance and evaluate outcomes for people using the service. The health and safety of people living at the home is not fully promoted failing to ensure people are safe and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 27 The manager of the home is experienced and is knowledgeable of the individual support needs of the people living at Maer Lane. She is now registered with us and although she is a qualified nurse she has chosen not to renew her first level nurse registration. We have recently received confirmation from the organisation that they will support her to undertake the Registered Managers Award including the care component commencing September 2008. We received a mixed response to how this service is managed and supported by the organisation comments include: ‘We have a brilliant manager who is very service user focused, supportive, good listener’ ‘The manager is approachable and the home is run really well’ ‘The manager I have is the best there is. But her managers at the top do not want to help her and the care staff…They do not seem interested in the residents needs, money, well being and so on…They have cut staffing and the needs of residents are not met’. ‘The manager and deputy are very informative to all the staff. We have good hand over on shifts’ The Annual Quality Assurance Assessment (AQAA) completed by the manager could have been completed in more depth. Many areas were incomplete and the AQAA failed to focus on some areas of improvements made, outcomes and the future development of the service, which was fully acknowledged by the management team during the inspection. Satisfaction surveys to gain the views of people using the service, their relatives, staff and stakeholders have recently been distributed. Completed surveys from people using the service were available and comments include ‘I can do what I want to do within my limits’ ‘I like the staff team and my friends’. The manager stated that a report based on the findings of all surveys is due to be completed by the organisation shortly and will be made available. The former area manager has recently been appointed to the post of a Senior Practitioner across Birmingham and Shropshire and her role is to provide advice and support to managers. Discussions with this person who visited the home during the inspection evidence that a full assessment of the service is to be undertaken shortly and an improvement plan produced. An annual development plan, which reflects aims and outcomes for people using the service has yet to be undertaken but a Business Plan is in the process of being updated. Monthly visits required under Regulation 26 are undertaken and detailed reports held in the home with actions required. One of the actions for June 2008 was for the training records to be updated however this has yet to be undertaken. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 28 Health and safety and maintenance checks are undertaken in the home to ensure that the equipment is safe and in full working order. Water temperature checks are recorded and this assists in the prevention of people accidentally scalding themselves. However records show that monthly emergency lighting checks are not being carried out routinely which was also raised at the previous inspection. Concerns raised at the previous inspection in relation to unrestricted windows on the ground floor in the dining room, safe storage of aerosols, fire drills and electrical hard wiring within the premises have been addressed in addition to the fire risk assessment following consultation with the Fire Service. Staff are not in receipt of training in safe working practices at the required frequency, which potentially places both people using the service and staff at risk. It is of concern that this was raised at the previous inspection and such shortfalls still remain. It was reported that a training company has been sourced to address shortfalls in training. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 3 28 x 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 x x 2 x 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA42 Regulation Requirement Timescale for action 30/09/08 13(4)(5)(6) Mandatory training in areas to include food hygiene, first aid, manual handling, fire etc must be kept up to date supporting the safety of people using the service and the staff. 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 2 Refer to Standard YA23 YA34 Good Practice Recommendations Staff should be provided with training in safeguarding adults at the earliest opportunity to ensure they are fully conversant with the vulnerable adult procedures. Staff files must contain all of the information required by Regulation so we can assess the robustness of the provider’s practice in the recruitment, selection and retention of staff to ensure people are not placed at risk. A review of staffing levels should be undertaken to ensure they are sufficient and effective in meeting the assessed needs of people using the service at all times. All new staff should receive structured induction training within the required timescales including safe working practices, the principles of care, the experiences and needs DS0000020766.V367239.R01.S.doc Version 5.2 Page 31 3 4 YA33 YA35 4 Maer Lane 5 YA35 of the service user group and the particular requirements. of the service setting to ensure they are equipped to meet the needs of the people living at the home. All staff should be provided specialist training to include dementia, autism, makaton, and diabetes to ensure they have the appropriate skills and knowledge to effectively support individuals and their changing needs. 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 4 Maer Lane DS0000020766.V367239.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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