Inspection on 04/09/07 for Maltreath

This inspection was carried out on 4th September 2007.

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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Maltreath 28/07/08

Maltreath 08/09/06

Maltreath 02/11/05

Maltreath 03/05/05

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 Maltreath 23/25 Warwick Road Cliftonville Margate Kent CT9 2JU Lead Inspector Joseph Harris Unannounced Inspection 4th September 2007 10:00 Maltreath DS0000062087.V346188.R02.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 Maltreath DS0000062087.V346188.R02.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. Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maltreath Address 23/25 Warwick Road Cliftonville Margate Kent CT9 2JU 01843 221677 01843 296644 info@temperancecare.co.uk 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) Temperance Care Limited Stella Oludotuh Okesola Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (3) Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th September 2006 Brief Description of the Service: Maltreath is located within Cliftonville on the outskirts of Margate. The home is situated close to the local shops, post office, pharmacy and health centre. There is limited parking on the street directly outside the home. Maltreath provides 24 hour personal care and support for up to 11 service users with mental health needs. Due to the lay out of the home, it is unsuitable for individuals with poor or limited mobility. Fees are:£373.44-£491.43 per week. Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection process culminated in a site visit to the home on 4th september2007. During the course of the visit a tour of the premises was undertaken and discussions were held with the registered manager, owner, staff members, service users and visiting relatives. A range of documentation was examined relating to the residents, staff, medication, health and safety and the day-to-day running of the home. The home also returned the Annual Quality Assurance Assessment (AQAA), which provides information to inform the inspection process. What the service does well: What has improved since the last inspection? What they could do better: 2 requirements and 4 recommendations have been made as a result of this inspection process. Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 Page 6 The home needs to continue to develop care planning processes ensuring action are clearly identified and plans are kept under review. The home should take a more proactive approach with regard to liaising with Community Mental Health Services and promoting regular reviews of care. A greater emphasis needs to be placed on activities and developing independent living skills with the service users. The registered manager should also review appointee arrangements and ensure resident finances are managed independently of the home accounts. Risk assessments could be further developed to provide clearer guidance for staff to minimise perceived risks. The registered manager is also advised to develop competency assessments for staff in the areas of medication, adult protection mental health awareness and fire safety to underpin knowledge gained through external training. 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. Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 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 Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4. Quality in this outcome area is good. The needs of service users are assessed prior to being admitted to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the service since the last inspection. However, it was reported by the registered manager that prior to admission a visit is arranged to see the prospective service user in their own home. Discussions are held with the individual and relevant family and professionals. The home requests Care programme Approach documentation from the care manager and other background information. If appropriate a trial visit to the home is then arranged starting with a short day visit and ranging to overnight stays. The home completes assessment information throughout this process, which is later used to inform the care plan and risk assessment. It was not possible to fully assess how these processes are implemented and the experience of service users due to the lack of recent referrals. Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is adequate. Service users needs are assessed, although further development would be beneficial with regard to care planning. Residents are able to make decisions about their lives, but could be encouraged to participate more in the running of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home develops an individual service users plan for each resident, a number of which were examined during the inspection. The files are kept in a very organised and well managed manner with information clearly set out and accessible. However, it was noted that aspects of the care planning process were vague and ambiguous, especially regarding the guidelines and actions for staff to meet service user needs. The home should also concentrate on developing plans that constructively promote independent living skills, address Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 Page 10 mental health issues and encourage meaningful leisure and occupational pursuits. The service user plans are reviewed every 6 months or as needs changed according to the registered manager, however the dates of plans being implemented and reviewed were not always clear. The majority of service users are under the CPA process, but amongst the files examined many residents have not had a CPA review in the past year. Although this is not the direct responsibility of the home, the registered manager should take a more pro-active approach with care managers to ensure that reviews are held at reasonably regular intervals. Refer to requirement 1. The home encourages service users to retain control of their finances and make decisions about their daily lives wherever possible. The majority of residents have appointees who are independent of the service, but the home does act as appointee for two service users. The finances for these residents is paid directly into a bank account for the home, then withdrawn and given in cash to the service users concerned. The registered manager was advised that efforts should be made to ensure that all personal allowances are paid into a bank account separate from the business account or an independent appointee is found through care management. It was reported that some efforts have been made with regard to this, but have been ultimately fruitless. Safeguards need to be put in place to ensure that accounts are audited and are solely for the use of service users monies. Refer to recommendation 1. Service users have some involvement in the day-to-day running of the home, although there are opportunities to develop this further. Residents confirmed that they have some input into deciding menus and that resident meetings take place. However, residents could be supported and encouraged to take greater control of aspects of life such as organising activities; planning, preparing and cooking meals; household chores and promoting involvement in the running of the home through staff interviews, etc. Refer to recommendation 2. The home develops risk assessments for each individual service user. These assessments provide a reasonable level of detail surrounding perceived risks and are linked to the home’s assessment information. The risk assessments could provide a little more detail in how staff should be guided to minimise risks. Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is adequate. The home could develop a wider range of activities and support service users in the community. Visitors are welcome in the home. A healthy, balanced diet is provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager and staff in the home were able to cite a number of examples of activities that take place in the home such as playing board games and going out for walks. One resident said, “We do lots of things. There are games, chats and other activities”. However another person said, “There could be more going on, it’s a bit boring sometimes.” It is acknowledged that there is an important balance to be struck with regard to activities, but a creative outlook is required by the staff team and a range of possible opportunities should be offered both in and out of the home. A couple of residents attend Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 Page 12 outside groups, one doing voluntary work and another attends a walk and talk group at the local community mental health centre. Throughout the course of the site visit, the inspector noted that the home was quiet and staff were not seen to engage a great deal with residents. One staff member said, “we do most activities in the afternoon, but lots of residents like to do their own thing.” Refer to requirement 2. Visitors are welcomed into the home and there was the opportunity to speak to two relatives who confirmed that they visit regularly and are encouraged to do so. A rolling 4-week menu is in operation that provides a choice at the main meal time each day. The food storage facilities are suitable for the needs of the home and stocks of food were adequate with a reasonable range of frozen, tinned, packet and fresh goods. Service users made varying comments relating to the quality of meals, one person said, “The portions are too small and there is not enough fresh fruit.” However, another resident stated, “The food is very nice.” Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. Resident’s personal and healthcare needs are met. Medication is managed and administrated safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of service users are fully self-caring in relation to their personal support needs and generally only require encouragement to address personal hygiene issues. Residents confirmed that staff treat them with dignity and respect and assist individuals to attend to any personal care issues in a sensitive and thoughtful manner. The home retains good records in relation to service user’s healthcare needs. Residents are all registered with local GPs and the majority have relatively regular contact with the local community mental health services. However, it was noted that a number of service users do not have an active care manager and have not had a CPA review in excess of 2 years. The home should make reasonable efforts to remind relevant mental health services to maintain Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 Page 14 regular input and hold regular care reviews. Refer to requirement 1. Complimentary healthcare is provided as required, through chiropodists, dentists and opticians, etc. The home records all health care appointments and consultations including any relevant outcomes that may impact on the support given in the home. Medication administration records are clear and well maintained. Storage facilities are satisfactory for the needs of the home. None of the service users are self-medicating, which is an aspect of care that could be reviewed dependent on suitable assessment. The registered manager was also advised to provide clear instructions for the use of as required medication. The home reported that they receive good support from the community pharmacist. Adequate policies and procedures are in place and staff administering medication have received adequate training to enable them to perform these tasks. The registered manager is advised to develop additional competency assessments for staff to ensure on-going awareness of medication issues. Refer to recommendation 3. Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. Service users views are listened to and they are protected from forms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an adequate complaints process in place, which is made available to all new and prospective service users and relatives. A record of complaints is maintained and the book was examined containing a range of issues and concerns, which showed evidence of outcomes and actions. One resident said, “You won’t get any complaints from me! This is a lovely place to live. The staff are nice. We have our disagreements, but we always manage to sort them out.” The Commission for Social Care Inspection has received no complaints or concerns regarding Maltreath since the last inspection. The home has suitable and adequate adult abuse and awareness policies and procedures in place. All staff have received training in adult protection issues from an external training provider and these issues are also addressed through the induction programme. The registered manager, owner and staff demonstrated a good working knowledge of these issues. There have been no reported Adult Protection concerns raised since the last inspection. Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. The home is clean, hygienic and suitable for the individual and collective needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises demonstrated that Maltreath is a well-cared for, conducive environment for the service users. The present owners have made significant improvements to the home to good effect. The house is on a residential street close to the centre of Cliftonville, Margate. There is adequate parking outside the home on the street. The premises are bright and airy throughout. The owners have replaced the flooring in large parts of the home to maximise the brightness. There is a large, comfortable lounge and a goodsized dining room. There are additional communal spaces in the home if people require some quiet time, including a smoking room. There is a domestic style Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 Page 17 kitchen and separate laundry area, both are well-fitted. All bedrooms are ensuite and single occupancy and the owners are considering plans to develop one area of the house to provide semi-independent living accommodation. To the rear of the house there is a reasonably sized courtyard garden with some outdoor furniture, a shed, pot plants and a washing line. There are toilets and bathrooms appropriately sited throughout the house and suitable for the needs of the service users. The home was clean and hygienic throughout. Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area is good. Service users are supported by a well trained staff team in adequate numbers who have been appropriately recruited. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home owners have invested well in staff training and, in discussion with carers, it was evident that there was a reasonable working knowledge of the issues that affect the service users. The registered manager encourages and supports staff to work towards National Vocational Qualifications (NVQ) and over 50 of the staff team have achieved level 2 in care or above. One staff member said, “I’ve finished my NVQ 2, which is something I’m really proud of.” The registered manager was advised to introduce competency assessments in core training areas such as medication, adult protection, fire safety and mental health to underpin knowledge gained through external training. There are 2 staff on duty at all times throughout the day and 2 sleep-in staff at night. The registered manager and the owner work 9-5 office hours and Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 Page 19 undertake some shift work also. Service users stated that there are enough staff on duty and that they feel appropriately supported. The staffing numbers in the home should remain under review as the numbers and needs of service users change. A number of staff personnel files were examined, all of which contained relevant and appropriate information including 2 written references, a completed application form, proof of identity and CRB checks. The registered manager was advised on a number of points with regard to recruitment. The home could use the facility of POVA first checks prior to obtaining CRB clearance. Also the need to ensure that a full and seamless employment history should be ensured at the interview stage for new staff. The home has recently introduced the Common Induction Standards to support the internal induction programme. The management team have also invested heavily in staff training and, according to the training matrix and certificates on file, staff have completed all required mandatory training within the first 6 months of appointment. Additional courses have also been provided including medication, adult protection, mental health awareness and care planning and risk assessment training. Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is adequate. The home is well run, although Quality Monitoring processes should be developed. The health, safety and welfare of service users is protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has completed her NVQ level 4 and Registered Manager’s Award. Prior to purchasing the home she had worked in managerial roles in care home settings for a number of years. She is supported by the coowner who takes a hands-on role in the home. One member of staff said, “I’ve been here for 6 years, it’s a lovely place to work, everyone is friendly. I get on well with the owners.” Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 Page 21 The home has begun to develop a number of measures to ensure quality within the home and to review levels of satisfaction, but this is an area that would benefit from further attention and growth. The owner has sent out satisfaction questionnaires to service users, relative and professionals involved in the home. The next stage is to widen that process out to include staff and then compile a summary of the information returned providing points of action into an annual quality report. The home does hold staff and resident meetings on a relatively regular basis. These should be used to encourage participation in the service as well as provide another form of feedback. Refer to recommendation 4. A range of documentation was viewed in relation to health and safety issues including fire safety logs, accident records, service certificates and maintenance and in-house audits reports. All of the information had been kept up to date and appropriately maintained. Staff have been provided with the necessary training and safe working practices are underpinned by policies and procedures. Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 3 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Maltreath DS0000062087.V346188.R02.S.doc Version 5.2 Page 23 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 YA6 Regulation 15(1) Requirement To update service user plans ensuring that actions are clearly defined to enable staff to meet individual needs. To develop plans with a greater emphasis on independent living skills, leisure and occupational pursuits and mental health needs. To ensure that there is evidence of regular review. To develop a range of activities, both recreational and occupational, providing service users with opportunities to develop their skills and participate in chosen leisure pursuits. Timescale for action 01/11/07 2. YA14 16(2) 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Maltreath Refer to Good Practice Recommendations DS0000062087.V346188.R02.S.doc Version 5.2 Page 24 1. Standard YA7 2. 3. YA8 YA20 To ensure that where the home acts as an appointee for a service user all finances for those individuals are paid into an account not related to the running of the business or an independent appointee is identified. To encourage and develop greater levels of service user participation within the home. To develop competency assessments for staff administering medication to underpin on-going development. To promote service user’s independence through selfadministration of medication subject to appropriate assessment. To continue to develop quality monitoring processes. 4. 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