CARE HOME ADULTS 18-65
Malvern House 139 Heysham Road Heysham Lancashire LA3 1DE Lead Inspector
Mrs Jennifer Dunkeld Unannounced Inspection 2nd December 2005 10:00 Malvern House DS0000041790.V270573.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 Malvern House DS0000041790.V270573.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. Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 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.V270573.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service can accommodate a maximum of 8 service users in the category LD (Learning Disability) 20th October 2005 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, eight 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.V270573.R01.S.doc Version 5.1 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 homes manager. 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. 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. Training is an area that has developed well including specialised training in a number of areas including autism and physical intervention are now being provided to staff.
Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 Page 6 The inspector observed the manner in which a potentially difficult situation was diffused in a professional manner by the manager and one of the carers, much to the satisfaction of one of the residents. 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. Malvern House DS0000041790.V270573.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 Malvern House DS0000041790.V270573.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): None of the above Standards were assessed during this inspection. However the Key Standard was assessed and met during the previous inspection in December 2005. EVIDENCE: Malvern House DS0000041790.V270573.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&8 People’s individual plans of care are not up to date, which could lead to inconsistency of care. The residents are consulted about various aspects of their life. EVIDENCE: Four residents files were viewed as part of the case-tracking process and only one of them had an up-to-date plan of care. Indeed one man, resident for a year had never had a plan of care drawn up by the home. The residents must be consulted about their plan of care in order that their needs and wishes are met and that all staff are aware of the needs of the individuals. The manager was aware of the need to do this but stated that she had been so busy with other necessary work. At the current time the manager is working as one of the carers due to a shortage of staff. During the last inspection the inspector recommended that consideration be given to using alternative formats of care plans, such as audio or video, which would be of great benefit to those residents who do not read. This has not been acted upon as yet.
Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 Page 10 Throughout the inspection, residents were observed moving freely around the home. In discussion, it was confirmed that there are no undue restrictions placed on residents unless a risk assessment indicates otherwise. The residents made positive statements such as, “We can do what we want, the staff help us” “The staff are good and we get taken out shopping and to the pub” 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.V270573.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): 13 Residents are able to regularly take part in activities of their own choice within the community. However the current shortage of staff is affecting this. EVIDENCE: The manager explained that they try to get people out of the home to enjoy activities within the community, however the current situation of 3 staff vacancies is affecting the frequency of outings. People who are able to go out by themselves do so, however a number of the current residents require staff support to meet their social needs. During this inspection one resident was in need of one-one support and a carer offered to stay on duty to enable the resident to go out socialising. This diffused the situation and was good practice. Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 Page 12 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): 19 & 20 Residents’ health care needs are addressed and when necessary, advice from other professionals is sought. Medication is appropriately administered. The residents benefit from the homes policies and procedures for dealing with medication. 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. The records of administration of medication and the storage of drugs were professionally maintained. The home uses a monitored dose system provided by a local pharmacist. One resident part administers her own medication. The other residents who are prescribed medication have their medication administered by the staff.
Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 Page 13 There is a need for the residents on medication to sign a ‘declaration of wishes’ the inspector will forward an example of one of these to the homes manager. The monitoring of people’s weight is sometimes necessary as part of ensuring a persons health and as such the home should have a set of weighing scales available. Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 Page 14 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): None of these standards were assessed during this inspection as both were met during the previous inspection. However the people who live at Malvern House would benefit from having a stamped addressed postcard ready to send to the Commission for Social Care Inspection should they have any issues they wish to discuss with the inspector. EVIDENCE: Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 Page 15 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 Malvern House is a large house and provides comfortable accommodation for the residents. The home is clean and hygienic. EVIDENCE: Each resident has an individual bedroom with en-suite facilities. When touring the home, the residents that were at home were happy to show their rooms to the inspector. Each room was well decorated and had personal affects about which reflected the personality of each individual. The communal areas were spacious and homely. The residents stated that they liked living at Malvern House. Some residents had moved to Malvern House from other homes, one man said that his new home is far better than where he previously lived and that the manager and staff were kind. The physical needs of one resident have changed making it impossible for her to access some of the facilities in the home or to exit the building unaided. The provider has had plans drawn up to provide this resident with the facilities she requires. The work is to commence upon the ensuite facilities at the end of this month. The resident is going to have a two week holiday at a local home for
Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 Page 16 older people, while the work is carried out. The resident said she was looking forward to the holiday and to returning to her new bathroom. All parts of the home were clean and in good decorative order. Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 Page 17 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): 34 The recruitment procedure of the home is good and ensures that people are protected from unsavoury characters. The calibre of staff is good. A dedicated staff team cares for the residents. However the current staff vacancies are affecting the stability of the residents. EVIDENCE: One resident kept asking if she will have to leave if the home closes due to having no staff. The staff were endeavouring to reassure her. The management team have produced a recruitment policy. Anyone applying for employment at the home is required to undergo a rigorous and robust recruitment process, which includes filling out application forms, providing a minimum of two referees and undertaking a police check. In addition the candidate will participate in a formal interview. These processes are carried out under Equal Opportunities and are intended to ensure the applicant is of good character and fit for the job. All appointments are initially on a temporary basis until a successful appraisal has been carried out. The views of the service users are sought during the induction periods of new staff. The inspector was pleased to see that there are systems in place to enable residents to be involved in staff interviews and appraisals.
Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 Page 18 The residents spoke well about all the care staff and the homes manager. Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 Page 19 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 & 42 There is currently conflict between the service provider and the registered manager, which is having an effect upon the quality of service on offer. EVIDENCE: There appears to be a conflict of management styles indeed the registered manager spoke of the differences of opinion between herself and one of the providers. It is unfortunate that the residents are aware of this conflict, which is adding to their uncertainty about the future. There is a requirement at the end of this report to seek a resolve to these differences. The manager of this home is currently offering support to the Snr carer of a Dom care Scheme managed by the service provider which is not acceptable to the Commission for Social Care Inspection as the working time of the homes Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 Page 20 manager must be concentrating on Malvern House, the needs of the residents and the supervision of the staff. The health and safety of the residents is promoted and risk assessments are carried out as necessary. The work to be carried out in the near future will enhance the health and safety of the resident whose room is to be adapted. The planned ramp to the front door of the home will enhance access to the building for disabled people. Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 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 Standard No Score 1 x 2 x 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 x 23 x 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 x 33 x 34 3 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x LIFESTYLES Standard No Score 11 x 12 x 13 2 14 x 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 3 x 2 x x x x 3 x Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 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. Standard YA37 Regulation 9 Requirement The registered manager must complete the relevant qualifications. The registered providers and registered manager must maintain good personal and professional relationships with each other and with the residents and staff The manager must produce a care plan along with the resident himself or herself and update the plans of care on a regular basis. The registered manager must ensure that the staffing levels meet the needs of the residents at all times. The manager must ensure that the homes environment meets the needs of the people they offer a service to The manager must ensure that the weight of people can be monitored, particularly if there are issues around their weight adversely affecting their health. The home needs a set of weighing scales. Timescale for action 30/02/06 2. YA38 5(a) 31/01/06 3 YA6 15(2)(a) 10/02/06 4 YA33 18(1)(a) 31/01/06 5 YA29 23(2) 01/04/06 6 YA19 12(1)(a) 31/01/06 Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 Page 23 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 YA23 Good Practice Recommendations The manager should give consideration to offering each resident a stamped addressed postcard to each resident to be able to post to the Commission for Social Care Inspection should he/she have any concerns they would like to discuss with an inspector. 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. 2 3 4 YA6 YA22 YA39 Malvern House DS0000041790.V270573.R01.S.doc Version 5.1 Page 24 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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