CARE HOME ADULTS 18-65
Malvern House 139 Heysham Road Heysham Lancashire LA3 1DE Lead Inspector
Mrs Marie Cordingley Unannounced Inspection 20th October 2005 12:00 Malvern House DS0000041790.V255532.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 Malvern House DS0000041790.V255532.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. Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Malvern House Address 139 Heysham Road Heysham Lancashire LA3 1DE 01524 417846 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) Mrs Brenda Christine Emmerson Mr Ronald Emmerson Mrs Keran Farrow Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service can accommodate a maximum of 8 service users in the category LD (Learning Disability) 4th November 2004 Date of last inspection Brief Description of the Service: Malvern House is a small home registered with the Commission for Social Care Inspection to provide care and accommodation for up to 8 young adults who have a learning disability. The home is a situated in Heysham close to a number of facilities and amenities. All accommodation at the home is provided on a single room basis, four of the bedrooms have en-suite facilities. Care is provided on a 24-hour basis. Some of the carers have National Vocational Qualifications in care at level 2 or above. Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection which meant that the residents, staff and manager did not know it would be taking place until the inspector arrived. During the visit, the inspector was able to consult with several of the residents at the home. In addition, discussions were held with several staff members and the registered manager. A tour of the home was undertaken and a variety of paperwork was examined. As part of the inspection, a case tracking exercise was undertaken. This involved the inspector closely examining the care of selected residents from the point of their admission to the home. What the service does well:
During the visit the inspector consulted a number of residents who were all very positive about life at Malvern House. All the residents said that they liked living at the home and spoke highly of staff and the manager. One resident said the staff were ‘always nice’ and commented ‘’They say what do you need love? And then you tell them and they help you.’’ Another resident said of the carers at the home, ‘’They look after you and they get the doctor for you if you are not well.’’ Through discussion and through viewing care plans, the inspector was able to determine that residents at Malvern House are enabled to take part in a number of activities both inside and outside the home. When the inspector arrived, several residents were out at the local swimming baths and another resident was getting ready to go to college. He told the inspector that he enjoyed his college course very much. Another resident spoke of how she had been supported to purchase an aviary. She had a number of birds which she enjoyed looking after. She commented that the care of the birds was her responsibility but the staff helped her to look after them. When carrying out the case tracking exercise, the inspector examined the care of one resident who at times displayed some complex challenging behaviours. The resident’s care plan contained some very good guidelines for staff in how to best respond to these behaviours. Having such comprehensive guidelines in place means that staff are enabled to deal with situations confidently and the resident benefits from a consistent approach. Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 6 The inspector consulted one staff member who was new to the home. She was able to confirm that she had been provided with a thorough induction at the start of her employment which included learning about her role as a carer and the home’s policies and procedures in all areas. It was confirmed during this inspection that over half of the carers employed at the home have now obtained National Vocational Qualification in care at level 2 or above. This is a good achievement and means that the home are now meeting the National Minimum Standard in this area. All staff consulted felt that the manager of the home was very approachable and would always be available to discuss any concerns they may have. Staff also confirmed that they were provided with regular opportunity to formally meet with the manager on a one-to-one basis to discuss areas such as training and career development (supervision). During this inspection, it was determined that residents at Malvern House are enabled to participate in the home’s everyday running in a number of ways. For example, the inspector was advised that residents are routinely involved in the interviewing of potential staff members as well as their ongoing appraisals. What has improved since the last inspection? What they could do better:
In discussion, the manager explained that she was hoping to improve the care planning systems within the home. Currently, all the residents have care plans which provide a good picture of their needs and how the home will go about meeting these needs. The manager is hoping to improve systems for reviewing each resident’s care plan making them more user friendly and effective. Currently, care plans are only completed in a written format. The inspector advised the manager to consider making care plans available in alternative formats such as audio or video, for the benefit of those residents who do not read. Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 7 The manager of the home has not yet completed the Registered Managers Award. However, she is currently in the process of doing so. Whilst there are good guidelines in place in relation to supporting individual residents with behavioural needs, there was no policy or general written procedures in relation to physical intervention. These should be developed and implemented as soon as possible. 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. Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 8 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 Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 9 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 Enough information is obtained about prospective residents to ensure that their needs can be met properly at the home. EVIDENCE: The inspector tracked the care of one resident who had recently been admitted to the home. It was apparent that the home had gained a lot of information about her care needs prior to her arrival. There was evidence that the manager of the home had liased closely with the resident’s family and other workers involved in her care, for example her social worker. It was also confirmed that the resident had visited the home on a number of occasions prior to her admission, sometimes with her mum and other times with her social worker. Staff consulted during the visit felt that they had been given enough information about the resident to ensure that they could support her well, from the point that she moved to the home. Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 10 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, 8 & 9. Residents’ individual strengths, needs and wishes are taken into account when planning their care. Residents are supported to take well-managed risks. EVIDENCE: Written plans of care were in place for all the residents. These documents listed each person’s needs and told staff what they needed to do to meet their needs. In discussion, the manager told the inspector that she was planning to update the system used for care planning. She felt that better systems for reviewing care plans would mean that they were more helpful to staff. At the time of the visit care plans were only being completed in a written format. The inspector recommended that consideration be given to using alternative formats such as audio or video, which would be of great benefit to those residents who do not read. Throughout the inspection, residents were observed moving freely around the home. One resident was observed making himself a snack and drink in the kitchen. In discussion, it was confirmed that there are no undue restrictions placed on residents.
Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 11 One resident told the inspector that he was able to make his own decisions but that staff were always available to support him if he needed them to. He said ‘’The staff help me, but if I want them to leave me alone then they do.’’ Where it had been identified that a resident may be at risk, a written statement about what the risk may be and how to reduce it had been completed. These records are known as risk assessments and there were a number available to view on residents’ care plans in areas such as going out alone or carrying out certain activities. The inspector found a number of ways in which residents were included in the running of the home. Regular meetings take place during which residents have the opportunity to express their views on things such as meals or activities. The inspector was also pleased to see that residents are regularly involved in the recruitment and ongoing appraisal of staff. Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 12 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, 14, 15, 16 & 17 Daily routines at the home are designed to fit in with the wishes of the residents. Residents are able to regularly take part in activities of their own choice. EVIDENCE: When the inspector arrived some residents were out swimming and one resident was getting ready for college. He told the inspector that he enjoyed going to college and was doing some interesting lessons there. In discussion, it was apparent that residents were enabled to access lots of different activities both in the community and at home. The inspector was advised that activities such as pub visits, bowling and cinema trips were regularly provided. At home, residents enjoyed various pastimes including baking and watching DVDs. One resident told the inspector about her bird-keeping hobby. She had started with just two birds but this number had risen to eleven. She said she had found watching her new birds hatch very exciting. The resident told the inspector that it was her responsibility to look after the birds, but that staff always helped her to do so.
Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 13 Staffing levels within the home were adequate to ensure that support was available for residents to carry out their preferred activities throughout the day but evening staffing levels did not generally allow for this. However, the inspector was advised that additional staff were available in the evening for any resident who wished to carry out an activity at this time. It was confirmed that residents are able to have friends visit at any time and that there were no undue restrictions on having visitors. The care plan of one resident also addressed the need for her to be supported to maintain contact with her family members. Menus viewed confirmed that residents are provided with a varied and nutritious diet. In discussion, residents expressed satisfaction with the food provided. One resident said ‘’I always have something I like.’’ Menus are developed on a weekly basis and this is done in consultation with residents. In addition, residents take turns in accompanying carers to obtain the weekly grocery shop. Staff explained that they tried to develop menus that would cater for all residents’ individual preferences. In addition it was confirmed that meals are served in a flexible manner to fit in with residents’ individual needs. Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 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. Residents’ health care needs are addressed and when necessary, advice from other professionals is sought. EVIDENCE: In tracking the care of one resident it was apparent that her care had been well planned to meet her individual needs. This particular resident had some complex behavioural needs and there were very comprehensive guidelines in place to assist staff in supporting her. It was also evident that the home had worked very closely with other professionals when drawing up the guidelines. Liaison with other workers such as behavioural specialists, social workers and psychologists were well documented. Good guidelines were in place for another resident at the home who had epilepsy. Again, liaison with other professionals, such as health care workers was evident. The inspector was able to confirm that residents were provided with good advice and support in all health related matters. One resident was being provided with advice on good diet and exercise and as a result was getting nearer to a healthy weight.
Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 15 In discussion, the inspector was advised that any resident who required advice in relation to sexual health would be supported to access it from the relevant services. Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 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 & 23. Staff have a good understanding of their responsibilities to protect residents from all forms of abuse. Residents will be further protected by the development of a policy and procedures in relation to physical intervention. EVIDENCE: The home have a complaints procedure in place which explains how to go about making a complaint and how long it should take for the home to deal with it. Currently this procedure is only available in a written format and the inspector recommended that this be developed in an audio or video format. In viewing records held within the home the inspector found that one resident had recently made a formal complaint. In discussion, the inspector was able to confirm that the manager had dealt with this complaint in an appropriate and timely fashion. The inspector was advised that all staff are provided with training in how to respond to an allegation or suspicion of abuse. This training includes information about the home’s whistle blowing policy and their commitment to protect any staff member who raises a concern. As earlier stated, there were very good guidelines in place in relation to individual residents with complex behavioural needs. In addition, it was confirmed that all staff were due to take part in physical intervention training. However, the home does not have a formal policy and procedures in relation to physical intervention. These should be developed to further protect residents. Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 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): None of the above standards were assessed during this inspection. EVIDENCE: Malvern House DS0000041790.V255532.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, 35 & 36. Staffing levels at the home are adequate to meet the needs of residents. Residents are supported by a well-managed and supported staff team. EVIDENCE: The inspector was pleased to see that there are systems in place to enable residents to be involved in staff interviews and appraisals. One staff member explained that she thought this was very beneficial to both staff and residents alike. All staff consulted confirmed that they had been given a job description and demonstrated a good understanding of their role. Staff observed at the time of the visit were professional and clearly shared good relationships with the residents. One staff member who was consulted confirmed that she had been provided with thorough training at the start of her employment which covered areas such as good care practices and the home’s policies and procedures (induction). The home have now met National Minimum Standards for NVQ training, with 50 of the staff team now holding the qualification at level 2 or above. Those staff who have not yet obtained the NVQ are working towards it. Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 19 Staff at the home also benefit from specialist training in a number of relevant areas such as epilepsy and autism. The inspector was advised that the manager uses the Residential Staffing Forum formula to decide staffing levels. This is a new system which directs the user to take account of residents’ individual needs when working out staffing hours. In viewing rotas, there appeared to be adequate numbers of staff on duty at all times. Staff consulted confirmed this and also said that they felt staffing levels were adequate to ensure that residents were enabled to choose activities of their choice. Staffing levels were lower in the evenings with the majority of hours being provided throughout the day. However, the inspector was advised that this was due to the fact that the residents generally preferred to carry out their activities in the day and that staff could be provided for evening activities if the residents requested. Staff consulted confirmed that they had regular opportunity to meet with their manager and discuss issues such as training and personal development (supervision). In addition, all staff consulted said that they felt the manager was very approachable and always available to discuss any concerns they had. Malvern House DS0000041790.V255532.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 & 39. The home benefits from a suitably experienced and competent manager. Residents are enabled to express their views about the running of the home. EVIDENCE: Throughout the visit the manager of the home demonstrated that she had the skills and abilities to exercise effective leadership. The manager has not yet obtained the relevant qualification but is currently working toward it. There are a number of systems in place to enable residents to express their views about the running of the home. Such systems include regular meetings for residents and the involvement of residents in the interviewing and appraisal of staff. The manager should consider developing quality assurance systems within the home. Formal procedures, for instance questionnaires to obtain the views of residents, their families and visiting professionals would be of benefit. Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 21 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 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X X 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Malvern House Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score 2 X 3 X X X x DS0000041790.V255532.R01.S.doc Version 5.0 Page 22 yes 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. 2. Standard YA37 YA40 Regulation 9 18 Requirement The registered manager must complete the relevant qualifications. A policy and procedures in relation to physical intervention must be developed. Timescale for action 30/06/05 31/12/05 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 YA6 YA22 YA39 Good Practice Recommendations Residents’ care plans should be developed in audio and/or video format. The home’s complaints procedure should be made available in audio and/or video format. Satisfaction questionnaires should be developed and provided to residents, their families and visiting professionals on a regular basis. Malvern House DS0000041790.V255532.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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