Inspection on 28/11/05 for Maltings (The)

This inspection was carried out on 28th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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) 19/04/06

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 28th November 2005 1:30 Maltings (The) DS0000036134.V264814.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 Maltings (The) DS0000036134.V264814.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. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 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.V264814.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th August 2005 Brief Description of the Service: The Maltings is run by Milbury Care Services Limited. The three people who live at the home have a learning disability, but may also have a physical disability or sensory impairment. The Maltings is a detached bungalow situated in a residential area of Calne. It provides domestic style accommodation in a community setting. There are three single bedrooms, one of which has ensuite facilities. There is a spacious lounge and a separate dining room. The other facilities include a sensory room, a kitchen, two toilets, a shower and a bathroom. There is a large garden at the front of the property. The home has its own vehicle for trips out. Service users attend day services in the community during the week. In addition to the manager there are an assistant manager and four support workers. Agency carers are also used on a regular basis. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 1.30pm and 6.05pm and was arranged at short notice with the home’s manager. The inspection focused on a number of key standards that were not looked at during the previous inspection of the home in August 2005. One service user was having a home-based day. The other two service users returned from their day activities later in the afternoon. There were meetings with the assistant manager and with an agency carer. The home’s manager was available throughout the inspection. Conversation with the service users was not possible and service users cannot verbally express their views about the home. Prior to the inspection, the Commission received three comment cards from relatives. Three comment cards were sent on behalf of the service users, who were reported to like the home and to feel well cared for. A selection of records was looked at, including medication, personal support, quality assurance and staff training. The medication and healthcare arrangements (Standards 19 and 20) were looked at by a pharmacist inspector from the Commission. What the service does well: What has improved since the last inspection? The position of assistant manager has been filled and arrangements are being made for some new staff to start. Two parents have commented that the care has improved since the current manager started. New guidelines for staff have been written about how the service users like to be supported. There is a better focus on the need for service users to participate in community events and some new activities have been tried. It was reported at the last inspection that the garden is well used by service users. There has been an improvement in the upkeep of the garden since then. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 6 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.V264814.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 Maltings (The) DS0000036134.V264814.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): 2 and 5 Terms and conditions statements have not been agreed by the appropriate parties. (Standards 1 and 5 were inspected and almost met at the last inspection). EVIDENCE: Standard 2 did not apply at this time. There were no vacancies in the home and the current service users have lived together for several years. The manager said that there was a block contract with the local authority, which covered the three service users. This was not available in the home. Milbury Care Services has produced a terms and conditions agreement for each service user. The manager, on behalf of Milbury Care Services has signed the agreements. As reported at the last inspection, the agreements have not been signed by an appropriate person who is independent of the service. The manager said that it was the intention to refer these agreements to the service users’ care managers. The service user’s guide has been updated since the last inspection. The manager is looking at ways in which the guide can be made more accessible to service users. Maltings (The) DS0000036134.V264814.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): 7 and 9 Service users have limited capacity to make informed decisions but are encouraged to make their wishes known. They benefit from the information that staff have about their needs and lifestyle. (Standard 6 was inspected and met at the last inspection). EVIDENCE: The service users’ personal records showed that the services users require support from staff in many areas of daily living and personal care. This includes support with making decisions and making their views known. Guidelines for support from staff have been produced based on the service users’ known preferences and usual routines. The manager said that one service user liked to go clothes shopping and it was known that touch and the texture of material were important factors in the service user’s decision about what she would like to buy. Two service users have parents who are in the position of appointee. The third service user has an appointee from within the service. As far as possible, arrangements should be made for service users to have an appointee who is independent of the service. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 10 During the inspection, decision making was evident in 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 decide this themselves. Service users were spending time in the lounge, the kitchen and the sensory room. Service users were also asked about their choice of drinks. The assistant manager said that service users were helped to decide what to wear in the mornings by being shown a choice of outfits. Risk assessments have been undertaken where the service users’ activities and routines may involve a degree of risk. Maltings (The) DS0000036134.V264814.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): 12, 13 and 16 Service users enjoy a range of activities within the home. They participate in activities outside the home but would benefit from some new opportunities. Service users are encouraged to be involved in the home but there are limitations on how independent they can be. (Standards 15 and 17 were inspected and met at the last inspection). EVIDENCE: Service users have their own rooms and there are communal rooms that can be used for different activities. There is a television in the main lounge and there is a separate dining room. There is space for arts and craft activities and the service users have recently made some paintings, which were displayed in the dining room. A sensory room has been created where there was originally a garage. One service user used this room for a short time during the inspection. The service user was also spending time in the kitchen, something she is able to do when staff are present. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 12 It was reported at the last inspection that the manager is keen for the environment to better reflect the needs of service users. See Standard 24. A weekly programme was seen on the service users’ files. This showed the main activities that are attended throughout the week. Pictures had been used to illustrate some of the activities. Service users attend a day centre for most of the week. The assistant manager said that new activities for service users were being looked at, particularly involving the community as it is felt that this is currently at a low level. One service user had recently enjoyed visiting a steam museum. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 13 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 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 including 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. The manager said that these had been completed since the last inspection. They are written from a service user’s perspective 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 was original and an example of good practice. Each service user has a record of healthcare information and record of interventions from healthcare professionals. There is evidence of involvement of the community nursing service, psychiatrists, dentists and opticians as well as the local GP in their care. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 14 No service users are able to self-medicate and the drugs are administered to them by care staff in accordance with home policies. The medication is held securely and all relevant records are kept. Staff receive training before they are able to administer medicines and further training is booked for the new year. 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. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 15 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): 23 Service users benefit from the information that staff receive about abuse. (Standard 22 was inspected and met at the last inspection). EVIDENCE: Milbury Care Services has produced guidance on abuse and the responsibilities of staff. A copy of the ‘No Secrets’ booklet was kept in the office where it was readily available to staff. The agency carer met with said that she had received training from her employer in adult protection. The assistant manager was due to receive P.O.V.A. training on the day after the inspection. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 16 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 Service users live in familiar and domestic type surroundings. However there are a number of improvements that can be made. The accommodation is kept clean and tidy. (Standards 24 and 25 were inspected at the last inspection. Standard 24 was almost met and standard 25 was met). EVIDENCE: The areas of the home seen during the inspection looked clean. Bedrooms were not seen on this occasion. An environmental health officer recently inspected the home and there are reported to be no outstanding requirements. There is a policy for C.O.S.H.H. and the assessments were reviewed in July 2005. There is a contract in place for the removal of clinical waste. Standard 24 was not inspected in full at this inspection, although the previous inspection’s recommendations were discussed with the manager. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 17 The manager has said that she is keen for the environment to better reflect the needs of service users. This would include making the accommodation and grounds more easily accessible and using colour and texture in ways that will benefit service users who have a sensory impairment. This work has not progressed since the last inspection. Some paintings done by service users have been used to decorate the dining room. The upkeep of the garden has improved since the last inspection and some conifer hedging reduced in height. The hedge had been complained about by a neighbour. A recommendation made at the previous inspection about levelling a paved area of the garden has not been met. One bedroom, which measures 9.3 square metres continues to be occupied by a person who uses a wheelchair. The person has been living in the room since before the introduction of National Minimum Standards. As recommended at the last inspection, consideration should be given to enlarging the room for this person. The manager said that the feasibility of this was still being looked at. There was a requirement at the last inspection for a cover to be fitted to the radiator in the bathroom. The manager said that this had been looked at but a decision had been made that it was not practical because of the way the door opened against the radiator. Instead, a decision has been made to fit a new ‘cool touch’ radiator and a timescale for this was agreed with the manager. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 18 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 and 35 Staff members’ individual skills are being developed. However, vacancies and the use of agency carers have an impact on the support that service users receive. (Standards 34 and 36 were inspected and met at the last inspection). EVIDENCE: An assistant manager has been appointed since the last inspection, although agency carers continue to be needed on a regular and frequent basis. The comment cards completed by relatives included the comment that the care is improving, but things will only really get better when the staff team is at fullstrength. The assistant manager said that she had done a LDAF accredited induction and foundation and was about to enrol on NVQ at level 4. Since coming into post, the assistant manager has received training in the areas of fire, risk assessment, moving and handling and first aid. A food hygiene course was due to be attended. The manager has received accreditation as a trainer in first aid, moving & handling and the protection of vulnerable adults. The manager has recently Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 19 completed the advanced food hygiene course and expects to become a health & safety trainer in the near future. Staff members have an Individual Training Record on their employment files. Training in autism has been arranged for February 2006. Three staff members have achieved NVQ at level 2 or above. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 20 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 and 39 Service users benefit from the management of the home. An annual review is helping to identify areas for improvement although some further information would be beneficial. (Standard 42 was inspected and almost met at the last inspection). EVIDENCE: The manager is qualified as a nurse (RNMH) and holds other qualifications that are relevant to the running of the home. Her experience includes work in a range of residential settings and as a care manager with a local authority. As reported under Standard 35, the manager is an approved trainer for a number of subjects. The manager is currently undertaking the Registered Managers Award. In the comment cards from parents, two people specifically mentioned that the care had improved since the current manager was appointed. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 21 Prior to the inspection, the Commission was sent a copy of an ‘Annual Review’ report, 2005 –2006. This is a system of quality assurance that uses a scoring system to show the service users’ level of satisfaction with the home in a number of areas. In addition, a summary of the relatives and staff members’ views are also included. The system also looks 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 the methodology used to produce a summary of their views. The findings of the 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 date on which these timescales become due is not clear. The development plan includes some changes in the service that would benefit individual service users. These are well identified although it is not evident how the changes and developments will be implemented and there is no ‘achieve by’ date shown. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 22 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 X N/A X X 2 Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X X 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Maltings (The) Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X X X DS0000036134.V264814.R01.S.doc Version 5.0 Page 23 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 YA55 Regulation 5(3) Requirement A copy of the contractual arrangements in respect of each service user must be kept in the home. An appropriate cover must be fitted to the existing radiator in the bathroom, or a new ‘cool touch’ type of radiator installed. Timescale for action 31/01/06 2. YA24 13 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. 2. 3. Refer to Standard YA1 YA5 YA6 Good Practice Recommendations That work continues to produce information for service users in formats that best meet the service users individual needs. The service user agreements should be signed on the service users’ behalf by an appropriate person (recommendation outstanding from the last inspection). That the service users personal goals & objectives, and their progress with achieving these, are more clearly identified in their personal records (met in part since the last inspection). That advice is obtained from a dietician about the content DS0000036134.V264814.R01.S.doc Version 5.0 Page 24 4. YA17 Maltings (The) 5. YA20 6. YA24 7. 8. 9. YA24 YA25 YA39 10. YA39 of the menus and the nutritional needs of individual service users (recommendation outstanding from last inspection). Enemas, which are used very rarely, should be administered by the district nurse rather than care staff as the length of time between uses means that staff are not sufficiently familiar with the process. 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) Consideration should be given to enlarging the room occupied by the person who uses a wheelchair (recommendation made at the last inspection) That the system of quality assurance includes information about how the views of service users and others have been gained and about the methodology used in carrying out the annual review. 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. Maltings (The) DS0000036134.V264814.R01.S.doc Version 5.0 Page 25 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.V264814.R01.S.doc Version 5.0 Page 26 - 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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