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Inspection on 26/01/06 for Malvern View

Also see our care home review for Malvern View for more information

This inspection was carried out on 26th January 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Malvern View provides a secure and comfortable home for the service users. The house was clean and is very well decorated, furnished and equipped. There was a relaxed and friendly atmosphere and staff were seen to be caring and kindly towards service users. The two service users spoken with said they were happy living at Malvern View. They liked the staff and knew who their keyworkers were and clearly valued their support. They also enjoyed their various activities and outings with staff; their holidays and visits to relatives. Staff supported service users to go out in the community as much as possible, depending on their behaviour, ability and preferences. Their individual interests were known to staff and activities arranged to suit them, such as swimming, walks, bowling and shopping. Two were on life skills courses at a local college. Good care planning helps staff know service users` needs, goals and wishes and how to meet them. Risks to service users` and other`s safety were also assessed and plans put in place for staff to manage risks and protect them. Staff receive relevant training so they have the skills and knowledge to care for people with learning disabilities and to keep service users and the home safe.

What has improved since the last inspection?

It was good that most matters raised in the last inspection had or were being addressed. Parts of the house had been redecorated and had new carpet or flooring fitted, which looked very nice. There was also some new furniture and equipment such as a heating boiler, a three piece suite and fittings for one bathroom. It was good that handrails had been fitted in corridors to help one service user to get about more easily. More training had been arranged for staff, such as fire safety and to help them to deal with service users` behaviour better. The home`s written fire risk assessment had been reviewed and updated. This should mean any risks areas are known and provide better protection for the home and to service users from fire.

What the care home could do better:

It would benefit the service users when staff have the opportunity to undertake training to learn more about autism. Also when the training that new staff have to do is especially for staff who care for people with learning disabilities.

CARE HOME ADULTS 18-65 Malvern View Malvern View 573 Birmingham Road Lydiate Ash Worcestershire B61 0HX Lead Inspector Christina Lavelle Unannounced Inspection 26th January 2006 1.40pm Malvern View DS0000041385.V280274.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 View DS0000041385.V280274.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 View DS0000041385.V280274.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Malvern View Address Malvern View 573 Birmingham Road Lydiate Ash Worcestershire B61 0HX 0121 453 7727 0121 453 7727 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) Malvern View (Lydiate) Ltd Mrs Lynda Read Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users may also have a mental health disorder, which is associated with their learning disability. Service users may also have a physical disability, which is associated with their learning disability. 3rd August 2005 Date of last inspection Brief Description of the Service: Malvern View provides accommodation with personal care for eight adults (men and women) who must be aged less than sixty-five. Service users must require care due to learning disabilities. They may also have a mental health disorder or a physical disability, which are associated with their learning disability. Service users may also use behaviour that can be challenging to the service. The main stated aims of the home are to provide a homely environment for service users in which continual encouragement; education and stimulation are the core elements of service users’ daily lives. Also to help them achieve their personal goals, develop independence and integrate in the local community. Malvern View is situated on the outskirts of Bromsgrove and is on the public transport route to Bromsgrove and Birmingham. There are local shops within walking distance, although the home has its own vehicles for transport into Bromsgrove town (which is a few miles away) and for outings further afield. The house is large and detached and is located in a residential area. The original part of the building can accommodate five service users and was extended to provide space for three more service users. All the bedrooms are single; the three in the extension are bed-sits and have en-suite facilities. The home has a fairly large and secure garden at the rear of the house with a patio. There is also an internal courtyard area, with chairs and tables, at the front of the home. Two sitting rooms, a separate dining room, one bathroom, two showers and four toilets are available for all the service users to use. Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection was carried out in just under three hours on a Thursday afternoon in the winter. One aim was to obtain an impression of the quality of service users’ lives as provided by Malvern View. Also to review if action had been taken to deal with matters arising from the last inspection and check if the home was meeting it’s stated aims. For more detailed information about the service and facilities provided you should also read the report of the fuller inspection, which was undertaken on the 3rd of August 2005. All the service users were at home and some time was spent in their company, talking individually with two of them (one privately in their bedroom). Senior staff on duty were spoken with about the service users and their care and their own role and training. The manager returned from a training course during the inspection and also discussed the service users, staffing and management related issues. They were all very helpful with the inspection process. Some parts of the premises were seen and various records about service users’ care, staff and safety were checked. All correspondence and contacts between the home and the Commission since the last inspection were taken into consideration. This included the reports made following monthly visits by the provider to check how the home is running. Also the monthly audits of the service and notifications of events in the home that had affected service users. What the service does well: Malvern View provides a secure and comfortable home for the service users. The house was clean and is very well decorated, furnished and equipped. There was a relaxed and friendly atmosphere and staff were seen to be caring and kindly towards service users. The two service users spoken with said they were happy living at Malvern View. They liked the staff and knew who their keyworkers were and clearly valued their support. They also enjoyed their various activities and outings with staff; their holidays and visits to relatives. Staff supported service users to go out in the community as much as possible, depending on their behaviour, ability and preferences. Their individual interests were known to staff and activities arranged to suit them, such as swimming, walks, bowling and shopping. Two were on life skills courses at a local college. Good care planning helps staff know service users’ needs, goals and wishes and how to meet them. Risks to service users’ and other’s safety were also assessed and plans put in place for staff to manage risks and protect them. Staff receive relevant training so they have the skills and knowledge to care for people with learning disabilities and to keep service users and the home safe. Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 Page 6 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 View DS0000041385.V280274.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 View DS0000041385.V280274.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): EVIDENCE: These Standards were not fully assessed, as there had not been anyone admitted to the home since the last inspection and for some time before this. However it was previously confirmed that appropriate information documents are provided for the home, including a statement of purpose, a service users’ guide and terms & conditions of residence (contract). A format for the guide is being produced in a more suitable format for people with learning disabilities. One service user had been given notice to leave the home some months ago. Social Services were involved in finding them a suitable alternative placement, although they had not been able to do so as yet due to their complex needs. This would be of concern to the Commission if the home was not able to meet all this service user’s needs as this could adversely affect the person themself, other service users and staff. However the manager assured the inspector that Malvern View was meeting their needs appropriately and that other factors had led to the notice being issued. Malvern View DS0000041385.V280274.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&9 A thorough “person centred” care planning system ensures that staff know all the service users’ individual needs and wishes and how to meet them. A risk assessment process helps to identify any possible risks to service users and other people’s safety and results in management plans to protect them. EVIDENCE: Some of these Standards are not fully assessed. However a sample of service users’ care records seen in the last inspection confirmed they all had a plan, which detailed their care needs and action staff needed to take to meet these. The home had introduced an appropriately “person-centred” care plan format. So (as far as possible) service users are involved in drawing up and reviewing their own plans, including their goals and preferences. The care records of one service user were checked and showed this approach had been followed. Keyworkers are allocated to each service user from the staff team. They are involved in the assessment and review of these service users’ needs and are expected to review the care plans and risk assessments at least monthly. Two service users confirmed they valued the personal support they receive from Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 Page 10 their keyworker. It was also good that the home has obtained input from an independent advocacy service to support some service users. Relevant risk assessments were carried out to identify safety hazards, whilst encouraging service users’ independence to the extent they are able. Risk assessments included moving and handling, bathing, and nutritional needs. In view that some service users have complex needs, management plans had also put into place for those who may use challenging behaviour. The care records seen included an individual physical intervention policy with positive response options (such as diffusion and distraction) to deal with this person’s aggressive and/or destructive behaviour. When any incidents of challenging behaviour occurred records were made of the behaviour and its antecedents by the staff involved, which were then reviewed by senior staff. The home also kept records of any physical restraint used by staff, as is required. The manager said that whenever staff had dealt with challenging behaviour (and always when using restraint techniques) that a “de-briefing” session was arranged with them by senior staff. Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 14 Staff supported the service users to take part in appropriate leisure activities (some in the community) to make their lives more interesting and to develop their social and/or life skills. EVIDENCE: The home’s statement of purpose describes how “each service user will have a structured programme of day care activities designed around their individual needs and interests”. Activities sheets were available for individual service users, although staff said that whether they could always be followed for some service users was dependant on their mood and behaviour at any time. Service users were all at home this afternoon; a few had been shopping or for a walk with staff earlier. Two service users attended a life skills development course at college three weekdays. Others were unable to take up any training opportunities or day services because of their behaviour and difficulties mixing with other people. It was good therefore that staff had taken advice about low stimulation activities and how they could be occupied whilst at home. Foot spas and manicure sessions were arranged by staff to help them relax. Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 Page 12 Service users enjoyed a range of leisure activities within the wider community, including swimming, using a snoezelen sensory centre, shopping, bowling, walks, going to the cinema and out for meals. The home has two vehicles, which provide transport for the outings and holidays. Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 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): EVIDENCE: These Standards were not fully assessed in this inspection. However the following evidence supports the previous judgement that due attention was being paid to monitoring and promoting service users’ good health. The one service user’s care file looked at included records kept of visits made to their GP and to other health care Specialists. Also records were made by staff of relevant physical checks (such as their weight). The home employs the services of a Consultant Psychiatrist who visits the home at least monthly to take clinical sessions and is available at other times to provide advice and support, and in emergency situations. About twelve staff were soon to attend a safe handling of medicines training session soon, which is the training care staff are now expected to undertake. Malvern View DS0000041385.V280274.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): EVIDENCE: These Standards were not fully assessed. However it was previously confirmed that the home provides a suitable written complaints procedure and policies procedures for the protection of service users, including whistle blowing. Several complaints and/or vulnerable adults concerns had been raised with the home or Commission since the last inspection. Most involved allegations about staff conduct that had adversely affected service users and/or staff. Following investigation disciplinary action was taken in one situation and others were still being dealt with. Whilst the Commission had been notified by the home about these matters as required, the provider must continue to closely monitor staff dynamics and how service users’ needs are being managed to ensure that staff are working together effectively, and in the best interests of service users. Service users generally have complex needs due to mental health/autistic disorders associated with their learning disability. Many of the notifications received by the Commission did relate to particular service users’ challenging, agitated and/or aggressive behaviour. This had sometimes required physical intervention from staff and/or medication being administered to that person. It is good therefore the home provides policies and procedures in respect of behaviour management for staff. These cover them trying diffusion and distraction techniques and reiterate appropriately restraint must only be used as a last resort. As already described in this report some service users had a behaviour management plan, which include guidance for medication “as and when required” to calm them. Clearly the monitoring of challenging behaviour and how staff are dealing with it is essential to ensure service users protection. Malvern View DS0000041385.V280274.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 & 28 Malvern View provides suitable accommodation for service users. The home offers them a secure and very comfortable environment, with appropriate arrangements in place to ensure it is well maintained and continually improved EVIDENCE: The property is compatible with the community and although not very near to local amenities is situated on a main bus route and the home has two vehicles. There are sufficient and various communal rooms and outdoor space available. The overall impression of the home is very comfortable, warm and safe. Work to upgrade the décor, furnishings, fittings and equipment was ongoing Today the flooring and toilet in a ground floor bathroom were being replaced. Since the last inspection new carpet had been fitted in the hallway and corridor and one sitting room had a new three piece suite. A new boiler was recently installed due to heating problems and a handrail fitted to help a service user. Only one bedroom was seen, which the service user had personalised and held their own key for. The manager confirmed some service users know the codes for keypad door locks, so they can access areas of the home that are normally kept locked for the safety of other service users. This is good as whilst some people need a secure environment this must not restrict those who do not. Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 Page 16 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): 33, 34 & 35 Suitable staffing levels were being maintained, although staff could support service users better if they had more training related to their special needs. Thorough recruitment procedures were operated, which helps to ensure that unsuitable people do not work at the home, for the protection of service users. EVIDENCE: It was confirmed there was always at least four care staff on duty during the daytime; often there were six plus the manager’s hours weekdays. A minimum of four staff was previously agreed as adequate to support service users and is in line with the staffing levels as described in the home’s statement of purpose. On the inspector’s arrival a team leader appropriately had senior responsibility for the home. A deputy manager from another of the providers’ homes was also there supporting the home on secondment four days a week for the last few weeks due to the absence of two senior staff from the Malvern View team. This was helpful, as clearly such a gap in senior staffing could affect the time available for the management task, senior staff cover and so the service itself. It was positive that the home did not currently need to deploy agency staff, although there was a care and a team leader post vacancies. Contracted parttime staff were able to cover the hours whilst new staff were being recruited. Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 Page 17 The team leader confirmed he had completed all the required health and safety training areas and also attended training sessions on Person Centred Planning, epilepsy and for the management of challenging behaviour. Few of the satff team had received training about autism however and the manager confirmed that training covering this topic was being sought and would be arranged. The home had yet to implement LDAF accredited induction/foundation training for new staff (as the National Minimum Standards now specify), although the home has its own detailed induction programme in place. Two senior staff had recently completed the Mentor course, which is needed to support staff through LDAF induction, and so this training should start as soon as possible. The records of a fairly new staff member were seen. Copies had appropriately been retained confirming their personal information e.g. a photograph, birth certificate and passport. The home had also obtained two written references and a satisfactory CRB/POVA check before they had started work at the home. This reflects a thorough recruitment process. Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 Page 18 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): EVIDENCE: These Standards were not fully assessed, however the management arrangements have not changed. The manager is suitably qualified and experienced and continues to update her training periodically. For example she had completed a three day Physical Intervention course this week The home appropriately operates a Quality Assurance system as is required. This includes a comprehensive audit and monthly visits from the provider to check and report on the conduct of the home. The fire log was checked and showed the required weekly test on the fire alarm system was recorded as having been carried out. The home’s fire risk assessment had been updated within the last few months and should now be reviewed regularly and/or updated as any changes occur. Regular fire drills had also taken place, appropriately involving staff and service users. Fire safety training sessions had been arranged for most of the staff team and a maintenance engineer regularly serviced the system and equipment. Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 Page 19 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 3 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X N/A X X X X X X X Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 YA1 Good Practice Recommendations The homes statement of purpose should be revised to ensure all relevant information is detailed. Also the guide should be available in a format more suited to the needs of service users and include service users views of the home. Not reviewed in this inspection and so carried forward. Learning Disability Award Framework (LDAF) accredited training should be introduced and staff expected to complete this training as soon as possible. 2 YA35 Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN 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 Malvern View DS0000041385.V280274.R01.S.doc Version 5.1 Page 22 - 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. 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