Inspection on 19/04/06 for Maltings (The)

This inspection was carried out on 19th April 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Maltings (The) 22/08/07

Maltings (The) 28/11/05

Maltings (The) 08/08/05

Maltings (The) 09/02/05

Maltings (The) 21/07/04

Maltings (The) 04/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Maltings (The) Brewers Lane Shelbourne Road Calne Wiltshire SN11 8EZ Lead Inspector Malcolm Kippax Unannounced Inspection 19th April 2006 2:55 Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 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 Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 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. Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Maltings (The) Address Brewers Lane Shelbourne Road Calne Wiltshire SN11 8EZ 01249 815377 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) Milbury Care Services Limited Allison D Turner Care Home 3 Category(ies) of Learning disability (3), Physical disability (3), registration, with number Sensory impairment (3) of places Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th November 2005 Brief Description of the Service: ‘The Maltings’ is run by Milbury Care Services Limited. The property is owned by a local housing association. The home has places for three people who have a learning disability and may also have a physical disability or sensory impairment. The Maltings is a detached bungalow providing domestic style accommodation. It is situated in a residential area of Calne. There are three single bedrooms, one of which has an en-suite bathroom. There is a lounge and a dining room. Other facilities include a sensory room, a kitchen, two toilets, a shower and a bathroom. There is a large garden around the property. There is a house vehicle for trips out. Service users attend day services in the community during the week. There is a permanent team of support workers. Relief staff and agency carers are also used on occasions. A copy of the home’s last inspection report is kept in the home. This is readily available to interested parties. The fee level as at 12 April 2006 was £1445 per week. There are some additional charges for: • • • • • Hairdressing Entrance fees / Activity costs Day trips / Holidays House vehicle – running costs Reflexology Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection involved two visits to the home. The first of these on 19 April 2006 was unannounced and took place between 2.55 pm and 7 pm. The three service users, a new relief member of staff and an agency carer were met with during the visit. Conversation with the service users was not possible and they could not verbally express their views about the home. Interactions and activities involving each service user were observed, including the evening meal. The communal areas of the home were looked at. Other information and feedback about the home has been received and taken into account as part of the inspection process: • • • • Feedback in ‘comment cards’ that was received from the service users’ close relatives. A pre-inspection questionnaire about the running of the home that was completed by the manager. Reports and notifications that have been received by the Commission since the last inspection. Survey forms that have been completed by staff members on behalf of the service users. A second visit on 24 April 2006 was made to the home at a time when the manager was present. Staffing and management issues were discussed. A sample of the home’s records was looked at during both visits to the home. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The Maltings is homely and domestic in character, with a good-sized garden. It is in a quiet location but close to the town and a range of facilities. Service users go out regularly and have well established occupation. They are encouraged to take an active role in the home, as far as they are able. Good information is available to staff, which helps to ensure that service users receive support in the way that they prefer. Guidance on needs and personal care is written from the service users’ perspectives. For example, staff members have information about ‘My best day’ and ‘Things I like’. Another form in use has two sections: ‘How I want staff to assist me’ and ‘How I don’t want staff to assist me’. The latter is a useful way of identifying things that may upset service users or put them at risk. Assessments are also being carried out as a way of reducing hazards relating to particular activities. Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 6 The service users’ needs are kept under regular review and their health is closely monitored. Meals are well prepared using fresh ingredients. Service users are well supported with seeing their families. The manager is an accredited trainer in subjects that are relevant to the staff team. There was a friendly and informal atmosphere in the home at the time of the visits. 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. Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 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 Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 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): 2 This standard did not apply at the time of the inspection. There were no vacancies and there have been no changes in the home’s occupancy during the last year. EVIDENCE: Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 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 and 9 Quality in this outcome area is good. This judgement has been made from evidence gathered during the visits to this service. Service users benefit from the information that staff members have about their personal needs and preferences. A lack of clarity about the service users’ individual goals and their monitoring may have an impact on the progress that service users achieve. Service users have limited capacity to make informed decisions but are encouraged to make their wishes known. Service users benefit from assessments that help to ensure that the risk of harm is reduced. EVIDENCE: Each service user had a personal file containing an individual plan and a range of forms about daily support and needs. Some forms included specific guidance, such as a ‘Communication Passport’ and a ‘People handling’ assessment form. Information was being updated over time and a number of assessments and plans had been reviewed in March 2006. The agency carer Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 10 said that the plans and the home’s daily communication book were a good way of keeping informed of the service users’ needs. ‘Monthly Summary Sheets’ had been completed in respect of each service user. These were up to date and the manager has said that they are the way in which the individual plans are kept under review. The summary sheets include section headings, such as Individual Support Requirements and Achieved goals and future planning. The latter section referred to some new individual needs and wishes that had been identified, although there was inconsistent information about how these were being followed up. Space on the monthly sheets for this information is very limited. The manager acknowledged that this was an area that would benefit from further attention. Guidance generally showed that the service users require support from staff in many areas of daily living and personal care. This includes support with making decisions and with making their views known. Some forms in the service users’ files, such as ‘My Life now’ and ‘Things I Like’ have been written from the service users’ perspectives, which gives a personal account of their needs and wishes. During the inspection, choice and decision-making was evident through service users being able to spend their time in different areas of the home. This was because they had either been asked by staff where they wanted to be, or the service user was able to show this. Staff knew how the service users liked their drinks prepared and when they wanted to have them after returning home. In the case of one service user this was their immediate priority. During tea, it was suggested to one service user that they could be accompanied to the kitchen to help decide what to have for the sweet course. Some of the service users’ individual activities, for example having a manicure, had been the subject of a risk assessment. Hazards associated with the particular activity were recorded on the assessment forms, although the benefits to the service user of a particular activity were not shown. The manager said that this was discussed as part of the assessment process. Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 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): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visits to this service. Service users have well established occupation outside the home. There are a range of activities available within the home although the benefits for service users may be inconsistent. Service users have links with the local community. One service user is enjoying a new activity in the community and further opportunities would be beneficial. Service users are well supported in their contact with family members and have relationships that are important to them. Service users are encouraged to be involved in the home but there are limitations on how independent they can be. Service users benefit from varied and freshly prepared meals, although these have not been the subject of an nutritional assessment. Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 12 EVIDENCE: The service users attended a resource centre on the days that the visits took place (other than one service user who was not well on one of the days). This was their usual occupation for four or five days a week. Information was recorded on the service users’ files about things they like to do. This was well shown under headings such as ‘My best … weekday’. Pictures have been used to illustrate some of the activities. ‘Social Diary’ and ‘Activities’ sections are included on the monthly summary sheets. The manager and staff said that service users participate in some domestic tasks and that the garden is well used. There is a television in the main lounge and there is a separate dining room. There is space for arts and craft activities and some of the service users’ artwork was displayed in the dining room. The home’s sensory room was being used during the visit. The staff said that one service user in particular enjoyed using this room. In their comment card, a relative has written that that the level of stimulation and support that service users receive with activities depends upon which staff are working at the time. A service user was spending time in the kitchen during the visit and liked to help with baking. The kitchen is not accessible to the service user who uses a wheelchair and the lay out generally creates limitations on the activities that this service user can participate in and the ease in which some rooms can be reached. The manager said that she had identified a way in which the layout could be altered so that the kitchen would be accessible to the wheelchair user, but there were no plans to do the necessary work. Service users attend regular activities in the community. The staff member said that one service user had started a new drumming session, which was going well. Family members provide a link with the wider community and each service user sees a close relative on a regular basis. In their comment cards, the relatives of the three service users confirmed that they can visit at any time. One relative wrote that staff provide support with visits to her and her husband. Following a complaint made since the last inspection, there has been a need to clarify the guidance that is given to staff about visitors coming to the home. Information about relationships was recorded in the service users’ files under headings, ‘About My Family’ and ‘How I would like my family and friends to be involved in my life’. There was also guidance about some limitations that apply in the service users’ lives, primarily because of the need for safety and supervision. Although the accommodation has limitations, some risk assessments were promoting Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 13 independent activity, such as a service user being in the garden unaccompanied. Each service user has the privacy of their own room and the different communal areas mean that service users can ‘do their own thing’ for much of the time. A menu is written for the week ahead for the main meals. The menus showed a varied range of meals served. Some dietary advice is recorded in the service users’ files, together with information about particular likes and dislikes. The manager said that she had not yet been able to obtain advice from a dietician about the content of the menus and nutritional needs. Tea was observed during the first visit to the home. This was a freshly cooked meal and staff said that one of the main changes during the last year was a move to healthy eating and an increase in home prepared meals, in preference to convenience and high fat dishes. The service user who used a wheelchair had tea in the lounge and the two other service users were in the dining room. Before the meal, staff members spoke about the way each service user liked to be supported and required help with eating. This was evident during the meal, with each service user requiring some support, either physical assistance or verbal prompting. A television was on in the dining room, which staff said was the choice of one of the service users. However, the volume of music from a radio on in the kitchen meant that the television could not be clearly heard. The radio was turned down after staff were asked how the service users might feel about this. Details of individual meals taken were recorded on the service users’ daily record forms. There is a section on the form for the recording of drinks and food taken during the day. Details on one of the current forms had not been recorded since 8 am on the previous day. Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visits to this service. Guidance has been produced which helps to ensure that service users receive support in the way they prefer. The health needs of the service users are met with the involvement of outside professionals. The systems for the administration of medicine are good and individual service user needs are met. EVIDENCE: An ‘Individual Support Requirements’ form was seen on the service users’ files. These are written from the service users’ perspectives and include details of the support that is needed in a number of areas. The form has two sections: ‘How I want staff to assist me’ and ‘How I don’t want staff to assist me’. The latter was a useful way of identifying things that may upset service users or put them at risk. This format looked original and was an example of good practice. Other records provide specific guidelines in areas such as moving & handling and bathing. The staff present appeared confident in their dealings with the service users and knowing how they liked to be supported. There are Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 15 female and male service users. In their comment card, one relative has written that the recent employment of a male carer, in the role of keyworker, has been beneficial. Each service user has a record of healthcare information and interventions from healthcare professionals. There was evidence of recent appointments and check ups with health professionals. The involvement of a psychiatrist and specialist services was also recorded. The agency carer said that she felt the manager and staff team were ‘health conscious’ and monitored the service users’ health needs well. During the first visit, the manager rang the home to check on the arrangements being made for supporting a service user who was due to have some major dental work the next day. Health needs and appointments were being recorded each month on the monthly summary sheets. No service users were able to manage their own medication. The medication procedures were discussed with the agency carer who said she would be giving out medication later in the day. The relief member of staff said that she had not yet completed the training that would enable her to administer medication. A ‘Medical Assessment Observation’ form was seen. This was in use for recording the training that had been received to date. There were suitable storage arrangements in place and relevant records are kept. The administration of medication records were up to date. It was reported at the last inspection that community nurses train staff in the use of enemas, but as these are complex and very infrequently used, they should be administered by the nurses when required. The manager confirmed that this advice from the pharmacist inspector was being followed. Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 16 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): 22 and 23 Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visits to this service. Milbury Care Services encourage comments about the service although service users are dependant on others to raise any concerns and complaints on their behalf. Service users benefit from the information that staff receive about protection & abuse. EVIDENCE: Milbury Care has produced a leaflet covering concerns and suggestions. This is not in a format that service users understand and they are dependant upon others to raise concerns on their behalf. In their comment cards, each relative stated that they are aware of the home’s complaints procedure. Details of a complaint from a neighbour have been recorded. The manager said that this has been investigated and satisfactorily concluded since the last inspection. Another complaint, which the Commission was aware of, has been investigated and responded to within an appropriate timescale. Milbury Care Services has produced guidance on abuse and the responsibilities of staff. Copies of the March 2006 ‘No Secrets’ booklet had been obtained for distribution for staff. The agency carer met with said that she had received training from her employer in adult protection. The relief member of staff said that she was due to receive vulnerable adults training as part of her induction. The manager later confirmed the date on which this would take place. There have no adult protection referrals during the last year. Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 17 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 and 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both before and during the visits to this service. Service users benefit from a homely and domestic style environment. However there are limitations for a wheelchair user and there is a lack of improvements to the premises that would be of benefit to all service users. The accommodation is kept clean and tidy. EVIDENCE: Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 18 The Maltings is in a residential area and fits in well with the neighbouring properties. There is a good size garden, which is well established and has a sun house and patio areas. It would benefit from some cutting back and tidying up. As reported at previous inspections, some of the décor looks dated and the manager has said that she is keen for the environment to reflect the needs of service users better. This includes making the accommodation and grounds more easily accessible and using colour and texture in ways that will benefit service users. These areas have been the subject of previous inspection recommendations. The service user who used a wheelchair cannot access the front and side doors of the home and entered the home using a ramp to patio doors in the lounge. The manager said that decoration was planned to take place later in the year but she was trying to bring this forward. It has also previously been recommended that some paving in one area of the garden is levelled, although the manager thought that this was not a priority because other areas of the garden are used. One of the three single bedrooms measures 9.3 square metres and continues to be occupied by the service user who uses a wheelchair. As recommended at the last inspection, consideration should be given to enlarging the room for this person. The manager said that this was still something that she would like to happen although did not feel that it would happen, at least in the short term. During the visit, the service users were using different rooms in the areas of the home. The service user who used a wheelchair spent time in the lounge. The other two service users were able to use other areas, including the kitchen, dining room, sensory room and their own bedroom. The communal and domestic areas of the home were seen. These were clean and had no unpleasant odours. An environmental health officer inspected the home in August 2005 and this was reported to be satisfactory. Radiator covers have been fitted other than in one bathroom. There was a requirement at the last inspection for a cover to be fitted to this radiator or for a new ‘cool touch’ type of radiator to be installed. The manager said that the housing association had agreed to the fitting of a new radiator although there was a delay in getting the work done. The uncovered radiator had been the subject of a risk assessment The home’s fire risk assessment was looked at. The manager has reported that the home met the requirements of the local fire service when last inspected in 2004. However, as part of the home’s fire risk assessment, she had identified some work that she wanted to take place to improve and upgrade the some of the fire precautions, including the fitting of fire doors to replace ordinary ones. The manager said that this work has been raised with the relevant parties, but a timescale had not yet been agreed. Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 19 There is a policy for C.O.S.H.H. and the assessments were reviewed in January 2006. There is a contract in place for the removal of clinical waste. Staff members have received training in infection control. Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 20 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): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both before and during the visits to this service. Recent changes within the staff team have benefited service users. Service users are supported by staff members who have achieved, or are due to undertake, relevant qualifications. There are recruitment checks that help to protect service users, however the outcome of one particular check was not adequately recorded in the home. There is a staff training programme that meets the needs of the service users, although staff members are at different stages in completing this. EVIDENCE: There is a staff team of five permanent support workers and one relief support worker. Three support workers have obtained NVQ level 2 or above. The manager said that other staff are now due to start their N.V.Q. or will be continuing at level 3. The staff rota for a four-week period showed that it was very unusual for a relief member of staff to be working alongside an agency carer, rather than a permanent member of staff. The agency carer said that she had previous experience of working in the home and knew people well, but the employment Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 21 of new staff had meant that there was now less need for agency carers. The agency carer thought that there was good team spirit at the present time. Examples of the daily reports written by staff were seen. These showed variation in the objectivity and the detail of recording. The recruitment records for two staff members were looked at. Both had been appointed since the last inspection. The recruitment files included application forms and records relating to equal opportunity monitoring, proof of identity and health. Checks on the staff members’ suitability had included the taking up of references and CRB disclosures prior to appointment. Information had also been received via an agency that recruited staff from abroad. This was discussed with the manager, as the information received about a staff member indicated that a risk assessment would have been needed in order to make an informed decision about their suitability. Evidence of this assessment was not available in the home. The manager is following up the action that was taken at the time about this. The relief staff member was in her third month of employment. She said that she was completing her L.D.A.F. training and since starting had received training in moving & handling, first aid and health & safety. Training in medication and protection / abuse was next to take place. A matrix is kept of the training that staff members have received in various subjects. All staff members have received first aid training during the last three years. The manager said that since coming into post the priority had been on statutory areas of training. It was now intended to focus on other areas, such as person centred planning, communication and the key worker role. The manager has received accreditation as a trainer in first aid, moving & handling, the protection of vulnerable adults and food hygiene. Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made from evidence gathered both before and during the visits to this service. Service users benefit from the manager’s experience and how the home is run. An annual review has helped to identify areas for improvement although the benefits for service users have yet to be seen. Systems are in place which help to ensure that service users are not at risk. EVIDENCE: The registered manager, Allison Turner, has a nurse qualification (RNMH) and holds other qualifications that are relevant to the running of the home. As reported under Standard 35, she is also an approved trainer in a number of subjects. The manager is currently undertaking the Registered Managers Award and said that she was expecting to complete this by August 2006. The manager has previous work experience in other residential settings and as a local authority care manager. In their comment card, one relative wrote that Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 23 she was pleased with the way that the manager has ‘pulled things together’, since coming into post. The manager combines her work as manager (part-time), with the training that she provides with Milbury Care Services. She acknowledged that some further management time would help in the running of the home and monitoring standards. This is being looked at further. Before the last inspection the Commission had received an ‘Annual Review’ report for 2005 –2006. This is the report of a quality assurance system that uses a scoring system to show the service users’ level of satisfaction with the home in a number of areas. A summary of the relatives and staff members’ views was included and the system also looked at practices within the home and at the condition of the environment. As a method of quality assurance, the system is beneficial in highlighting the views of service users and other people who know the home. However it is not clear from the review report how the feedback has been obtained and what methodology was used to produce a summary of their views. Recommendations were made at the last inspection in connection with this. The findings of the annual review contribute to an annual development plan. Timescales, such as ‘3 months’ and ‘1 year’ have been identified for completion of some improvements to the environment. However, the manager said that none of these improvements had yet been carried out. The development plan also identifies some changes in the service that would benefit individual service users. It is not evident how several changes will be implemented and there is no ‘achieve by’ date shown. The need for service users to have care managers has been identified in the plan. Prior to the visit the manager had informed the Commission that a complaint had been made to the placing authority about this. During the visit the manager said that this matter had not yet been concluded. Information about maintenance and equipment servicing was received from the manager prior to the visits. There was evidence in the home of risk assessments having been undertaken. This included an assessment of the risk of Legionella that has been carried out by a specialist company. Some preventative work was identified in connection with this, which the manager said had not yet been undertaken. Up to date records were seen for a monthly ‘health, safety and welfare’ inspection and for checks of the bathroom hot water temperature. Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 N/A 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 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 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 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 25 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 YA24 Regulation 13 Requirement An appropriate cover must be fitted to the existing radiator in the bathroom, or a new ‘cool touch’ type of radiator installed. (Requirement outstanding from the last inspection). The staff employment records must include evidence that appropriate assessments have been undertaken where necessary in connection with a prospective staff member’s suitability. Timescale for action 31/05/06 2. YA34 19 09/06/06 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 YA6 Good Practice Recommendations That the action taken to support service users with their goals and future plans (as referred to in the monthly summary sheets) is more fully recorded. A separate form for the recording of the service users’ progress with achieving their goals may be beneficial. Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 26 2. YA9 That the risk assessment forms include a record of the potential benefits of a particular activity, in addition to the hazards and the risk of harm that may arise. That advice is obtained from a dietician about the content of the menus and the nutritional needs of individual service users (recommendation outstanding from last inspection). That food and fluid intake is recorded as soon as possible after the event. That the upkeep of the garden is improved. That the improvements are made to the home’s fire precautions, as identified by the manager and timescales produced for completion of the work. That the use of colour and texture within the home environment is developed in ways that will benefit service users who have a sensory impairment (recommendation outstanding from last inspection). The paved areas in the garden should be levelled so that the service users can access the garden safely (recommendation outstanding from last inspection). That plans are drawn up for enlarging the room occupied by the person who uses a wheelchair. That a consistently good standard of daily recording is maintained, with supervision and training provided where necessary. That ‘achieve by’ dates are used to identify the timescales for the completion of improvement works and for developments arising from the system of quality assurance. 3. YA17 4. 5. 6. YA17 YA24 YA24 7. YA24 8. YA24 9. 10. YA25 YA32 11. YA39 Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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 Maltings (The) DS0000036134.V290210.R01.S.doc Version 5.1 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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