Inspection on 26/10/07 for Malvern View

This inspection was carried out on 26th October 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Malvern View 28/07/06

Malvern View 26/01/06

Malvern View 03/08/05

Malvern View 14/03/05

Malvern View 03/02/05

Malvern View 17/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Malvern View Malvern View 573 Birmingham Road Lydiate Ash Worcestershire B61 0HX Lead Inspector Christina Lavelle Unannounced Inspection 26 September & 1 October 2007 1-6pm & 2.30th st Malvern View DS0000041385.V345747.R01.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 Malvern View DS0000041385.V345747.R01.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. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 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 7757 mviewlr@tiscali.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) Malvern View (Lydiate) Ltd Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 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. 28th July & 11th August 2007 Date of last inspection Brief Description of the Service: Malvern View provides accommodation and personal care for eight adults (men and women). Service users must need care primarily due to learning disabilities and may also have a mental health disorder or a physical disability associated with their learning disability. People who live at the home can therefore have complex needs and may also use behaviours that are challenging. One of the main stated aims of the service is to provide a homely environment in which continuous encouragement; education and stimulation are the core elements of the daily lives of people who live there. Another is to help them achieve their personal goals, develop independence and integrate in the local community. The home does not have a registered manager currently although there is a manager in post. Mrs Julie Mogg is already registered in respect of another of the providers care homes and will be applying for registration in due course. Malvern View is situated on the outskirts of Bromsgrove on the public transport route between Bromsgrove and Birmingham. There are local shops and pubs within a reasonable walking distance and the home has two vehicles to provide transport into town and for outings and activities. The house is large, detached and located in a residential area. The original building had five bedrooms and was extended to provide another three bedrooms. All the bedrooms are single; two in the extension are bed-sits and four have en-suite facilities. There is a large and secure garden at the back and a patio and enclosed courtyard area at the front. The home has one large sitting/dining room, a separate dining room, one bathroom, two showers and four toilets for everyone to use. The fee for the service started at £1550 per week and the level is dependant on the needs of individual service users, as agreed between the provider and their funding authority. This fee is stated to include a structured programme of day care activities designed around each individual’s needs and interests. Additional payments include such as hairdressing, personal toiletries & effects, private chiropody, newspapers & magazines and additional transport e.g. taxis. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a key inspection of the service provided by Malvern View. This means all the Standards that can be most important to people who live in care homes were checked. The first visit was made without telling anyone at the home beforehand. Some of this time was spent with people who live there and staff. The second visit was arranged at the first visit to discuss with the managers how the home is being run and any changes made since the last inspection. It is not possible to discuss the home and their lifestyle with most people who live there because of their communication difficulties. One new staff member was asked about their job, experience, training and the support they receive. Surveys about the service were left at the home for some staff and two people living there. Eight surveys were also sent to their relatives and to seven health or social care professionals who are involved with their care. Twelve surveys were sent back and their comments are referred to in this report. An annual self-assessment form had been completed before these visits. This asks managers to say what they think their home does well, what it could do better, what has improved and about their plans to improve the service. It also has information about people living there, staff and other aspects of the home. Various records kept by the home were checked and the house looked around. All other information received by the Commission about Malvern View since the last inspection is also considered, such as events affecting people living there. What the service does well: The manager and staff visit people who might want to live at Malvern View to assess their needs. Before moving in they can visit and stay at the home to meet everyone to check it would be suitable and they wish to live there. Each person living at the home has a care plan. Plans show their needs, skills, and possible risks. They help staff know how to support and keep them safe. Staff support people living at the home with activities they like and to mix in the community. They can make some choices about what they do each day. Relatives of people who live at the home think they have good care and staff tell them when important things happen. One says “X is always well cared for. The carers are very supportive and helpful and he is very happy there”. Staff ensure the personal and health care needs of people living at the home are met properly. The home also manages their medicines safely for them. Malvern View offers people who live there a safe, well-kept and comfortable home. It is an ordinary house that fits in well with the local community. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 6 The home has enough staff to care for people who live there and they are trained to help them keep the home safe and support them with their needs. The quality of the service is regularly checked and plans are made to keep on making it better for the people who live there. 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. The summary of this inspection report can be made available in other formats on request. Malvern View DS0000041385.V345747.R01.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 Malvern View DS0000041385.V345747.R01.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 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Thorough assessment and admission procedures are in place to help to ensure that the home could meet the needs and wishes of potential service users. EVIDENCE: Information about the home is provided for prospective service users and their representatives. The service user guide is also available in a more userfriendly format, including symbols and simple language, so that people with learning disabilities should be able to understand it better. Assessment and admission processes were discussed with the manager and relevant records checked. The home had appropriately received a copy of a possible new service user’s community care assessment made by their social worker. The manager and deputy manager had also carried out their own needs assessment by visiting this person at their previous care home to meet them and discuss their needs with this home’s staff. It is good some staff from Malvern View also spent time there daily for a week to work alongside the staff team to help them understand the prospective service user’s special needs. Also so this person could become familiar with them and an initial care plan could be set up with objectives relating to their individual needs. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 9 Introductory visits and a trial stay were then arranged. Their next of kin also spent time at Malvern View and had chosen the colour and furniture in their bedroom and helped to ensure the layout of the room was suitable and would promote their safety. After this person had moved in for the trial stay staff spent 4-6 weeks helping them to get used to the building and find their way around. After their trial period their family, social worker, the manager and staff attended a review meeting to discuss how they were settling in. During this time records had also been kept of their progress, skills, needs, preferred routines, community activities and their ability to make choices and give their consent. This also reflected on any challenges and possible impact of the new person on those people who were already living at the home. A decision was made in this review about the suitability and continuation of the placement. The social worker commented “The placement has been very successful and the home been very supportive to the service user and parent”. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to the service. People living at the home all have a care plan showing their needs and how to meet them. There are also risk assessments and management plans in place to minimise safety risks. Whilst they can make some choices in their daily lives and routines plans should focus more on identifying their personal goals and how staff should support them to achieve their goals and an individual lifestyle. EVIDENCE: Some care records kept for people who live at the home were looked at. They include their photograph, a pen picture, background information and important events in their lives. They all have a care plan showing their strengths and assessed needs in relevant areas, with objectives and how these can be met. Whilst plans reflect their current and changing needs the home has not fully implemented a “person centred” (PC) approach to care planning. Plans should also focus on each person’s wishes and individual goals and they should be as involved in making choices and planning their own care as possible. When not able to do this the input of other people such as relatives should be sought. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 11 Some staff had received training on person centred planning (and more was planned) and the home had started to set up PC plans some time ago. This process includes developing life books, one of which is being completed by the individual’s keyworker and their family. This should lead on to setting goals that are based on their likes & dislikes and what they would like to happen in their life. Plans should also show how their goals may be achieved with timescales. Although this person’s verbal communication is limited pictures, photographs, objects of reference etc could be used to enable them to make choices and be more involved in drawing up their plan. Staff training relating to effective communication methods would therefore be of benefit. Keyworkers from the care staff team are allocated to particular people who live at the home. They try and spend more time helping them with such as their clothes & personal toiletries, keeping their bedrooms tidy etc. and arranging outings and health care checks. Keyworkers are also being encouraged to take more responsibility for care planning and reviews, which is good as they should get to know them and their preferences better. They are also expected to help review plans and risk assessments monthly and to advocate for their allocated service users, which some were seen doing at a service user meeting. Risk assessments are being carried out that primarily relate to minimising any safety hazards and to providing behavioural management plans to guide staff about diffusing and/or dealing positively with any aggressive or self-harming behaviours. Risks management should however be directly linked to their PC plans and also focus on promoting a more individual and independent lifestyle. Regarding issues relating to equality and diversity the home’s philosophy and stated purpose aims to focus on individual needs, which should develop with a PC approach. One care manager comments that Malvern View “Appears to be a service that is very flexible to service users’ individual needs”. The induction programme for new staff does appropriately include values and principles that should underlie care; however the manager is aware that some issues relating to respect and dignity need to be addressed. Furthermore, whilst there are no specific ethnic or cultural differences within the group who currently live at the home (and they all have learning disabilities) issues such as gender should always be considered in respect of staff supporting them with personal care. In addition some people have sensory and mobility difficulties and staff need to undertake moving & handling training so they can give any assistance needed safely. The home should also be aware about the process of best interests groups and how they ensure that decisions and any limitations to freedom are made in consultation with relevant others when a person is unable to make informed choices. This includes the requirements of the Mental Capacity Act. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. People living at the home are supported to participate in activities they enjoy and to maintain links with their families. With more staff time opportunities to pursue their individual interests and go out in the community could increase. Whilst their involvement in household tasks is encouraged goals should be set to develop their independent life skills and more attention be given to respect. The home provides food that people like and healthier options are promoted. EVIDENCE: Everyone living at the home has a list of activities they like and some take part in regularly such as life skills sessions at college and going to a relaxation and hydrotherapy facility. Scope for work placements and day services is limited for most people however due to their complex needs and the level of support they require. Staff aim to take them all out every day if they wish and are seeking new opportunities such as music therapy and trying to increase their community integration by supporting them to go to local events and through a Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 13 travel training system using public transport. Daily trips out are arranged using the home’s vehicles e.g. shopping, to pubs and cafes etc. or local walks. The home plans to set up more flexible and individualised activity schedules, and consider individual holidays. This would be good as activities should be person centred and so based on each person’s social & developmental needs and goals. The manager also plans to review how the home’s activities budget is spent and how one to one time is allocated to staff in the home to support individuals with activities and encourage their involvement in domestic tasks, cooking etc. This does however depend on staffing levels as staff say activity programmes are sometimes being affected by lack of staff. The impression is that more staff time and better planning is needed and so hopefully the new schedules should achieve this and when the staff situation is more stable. A service user meeting was being held and it is good that they are now regular and that everyone was encouraged to participate. Issues such as trips, plans for the garden and holidays were discussed and one person talked about their college course and how she was learning how to manage money and buy her own toiletries. This is a positive a way of involving them in choosing activities etc and making decisions about the day-to-day running of the home. However as mentioned previously a couple of matters relating to a lack of respect for individuals’ dignity were observed and brought to the manager’s attention. It is confirmed that families of people who live at the home are made welcome by staff and efforts are made by keyworkers to maintain contacts. Most people who live in the home have regular input from their family and relatives indicate that staff always keep them up to date about important matters. They are also invited to socials and to attend and take part in annual care reviews. Regarding food provided by the home menus are drawn up by staff and include a variety of wholesome meals. Staff try to promote healthier food options and the meal seen during one visit was a jacket potato with homemade lasagne. Food stocks included fresh fruit & vegetables, yoghurts etc. and the manager is considering reducing food with additives and plans to consult a Dietician. Staff know the preferences and particular dietary needs of people living at the home and provide alternatives to main meals accordingly and on request. Care plans include guidelines for staff when anyone has special needs, such as food being cut up and supervision required when eating due to risk of choking. It is also expected that people living at the home would be involved in menu planning, which for some could be achieved using pictures of food and meals. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. Staff support people who live at the home to meet all their personal and health care needs and are managing their medicines safely on their behalf. EVIDENCE: Plans show any support and/or guidance each person living at the home needs with their personal care and also that developing self-care skills is encouraged. Whenever possible they are supported to choose and go shopping for their own clothes and toiletries etc. Some staff have received training on basic foot and nail care to help them provide this aspect of physical care. Care records include information about general health related matters and any particular conditions, such as epilepsy. Each person has a Health Action Plan (HAP), as recommended by the Department of Health for people with learning disabilities. HAPs include all aspects of their general health and welfare that need to be monitored such as skincare, hearing, feet, nutrition, continence and mobility with details of any special needs and how they should be managed. They are also used to make sure that they receive regular and specialist health care check-ups at the expected frequency, or as their particular needs require. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 15 When one person moved to the home from another area recently it is good that a new patient visit was arranged by the home to the local GP practice for a review of their condition and current medication. Two GPs gave positive feedback about the home indicating that staff communicate clearly with them; there is always a senior to confer with; staff appear to understand service users’ needs and that any specialist advice they give is taken up. They had no complaints about the service and were satisfied with the overall care provided. Regarding medication prescribed for the people living at the home there is a detailed policy reflecting how medicines are to be handled safely by the home. Audits are carried out regularly to check all the procedures are being operated properly. The receipt, administration and disposal of medicines are recorded and being maintained appropriately. Medicines are suitably and securely stored with external preparations (creams & ointments) kept separately. A monitored dosage system is used and bottles of medicines etc are dated when opened. There are protocols in place for medication prescribed as and when needed for behaviour control and also for medication errors. There is a list of signatures of those staff authorised to administer and a photograph of each person who is prescribed medicines with information for staff about what it is for; any possible side effects etc. For one special type of medication there are specific guidelines for staff with pictures of how it should be administered. All staff designated to administer receive training on the safe handling of medicines. No one currently living at the home is able to self medicate and consent forms have been signed for them by their next of kin when they are unable to do so. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. People living at the home are supported to express their views. There are also systems in place to protect them and to manage complaints about the service. EVIDENCE: The home has a written complaints procedure, which is in a format people with learning disabilities should understand better. There is a record kept by the home of complaints, with details of investigations and outcomes, to show they are dealt with effectively. Relatives confirm that they know how to make a complaint and feel any concerns would be dealt with appropriately. The home has now introduced a comments book for visitors and promotes an “open door” philosophy. The importance of enabling people living at the home to express their views is recognised and promoted through their keyworkers & meetings. It is good the home plans to develop self-advocacy through staff training. There had been no complaints made to the Commission, or adult protection issues referred under the multi-agency Protection of Vulnerable Adults (POVA) procedures, since the last inspection. Policies & procedures are provided for staff in relation to identifying and responding to any suspicion or incidence of abuse or neglect of people living at the home (including whistle blowing) and they receive relevant training. Systems are operated to ensure individuals’ personal money is managed safely on their behalf and any money spent has been agreed and is recorded with receipts kept. Managers oversee and audit these processes and it is positive one issue raised was dealt with immediately. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. The accommodation provided at Malvern View offers the people who live there a secure, comfortable and well-kept home. Appropriate arrangements are in place to promote good hygiene and keep the house safe, clean, tidy and fresh. EVIDENCE: Malvern View is compatible with housing around it and so gives the people who live there the opportunity to become part of a local community. There are facilities such as shops and pubs within a reasonable walking distance and it is on a main bus route. The home has two vehicles for transport into local towns and further afield and public transport is also used to provide a life experience. During the last year there has been a major refurbishment to the property, including an extension that will increase the number of bedrooms to ten. The main sitting room has been enlarged to include dining space, although new furniture and furnishings were still awaited and the sooner the better as the sofas were rather low and one person especially clearly had difficulty getting Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 18 up from them. The manager has confirmed since the inspection visits that new and more suitable furniture is now in situ. It is good that some easy chairs are to be put in the separate dining room to provide another sitting area, as a second sitting room has been converted to a bedroom as part of the changes that were made to the house. The kitchen has been completely refitted and other redecoration and upgrading to bathrooms etc is ongoing. The garden has been totally cleared and fences repaired for security and will be completely re-landscaped by Spring. It now also has a much larger paved patio area. The overall impression is of a comfortable environment, which is of good quality. Bedrooms are furnished and fitted to meet the particular needs of individuals that occupy them and are well personalised. Those people able to hold their own keys and lock their doors if they wish. They can choose the colour of the décor and furnishings and furniture they want, or their relatives are involved. There are comprehensive health & safety policies and procedures in place that include food hygiene and infection control. Cleaning schedules are made with records kept. Those areas seen were all clean, tidy and fresh. Disposable gloves and aprons are provided for staff and liquid soap and paper towels are available in all communal bathrooms. They all promote better infection control. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 19 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 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including these visits to this service. Staffing levels are sufficient to meet the personal needs of people who live at the home, although support should be more consistent with scope to facilitate individualised activities, when the staffing situation is stable. Whilst the staff team receive appropriate training to help them meet the needs of people at the home and keep them safe, their knowledge and skills would increase if new staff complete an accredited training programme and all staff other relevant training. People living at the home would be better protected from unsuitable staff caring for them if more thorough recruitment procedures were operated. EVIDENCE: There is a relatively large care staff team at Malvern View due to the complex needs of the people for whom the home provides a service. The aim to deploy at least six staff during mornings, five in afternoon/evenings and two waking night staff is normally met. In addition the managers (and some of the deputy managers hours) are over and above those necessary for direct care for their management duties. Since the last inspection there has been a fairly high staff turnover however, which clearly can affect the consistency of care. It can also have an impact on staff training and time as new staff have to go though an Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 20 induction and receive core training, which can restrict the time available for existing staff to attend training. There are relief staff on the team who have provided cover and although it is good that the home has not had to deploy agency staff it will be better for the staff team and people who live in the home when the team becomes more stable. There has been extensive recruitment and when five new staff have completed their induction the manager is confident the situation will settle down. There is a good ratio of male and female staff and an age range within the team. Regarding recruitment potential staff are invited to the home for an informal meeting with the manager, staff and people living there. They then have to complete an application form and attend for interview and necessary checks are taken up. Staff records include relevant documents and checks i.e. two written references and a CRB (police check). It had not been possible however for the home to obtain a reference from the last employer of a staff member from overseas. One reference was from a college tutor but others were from a relative and friend. This is not acceptable as a more creditable source should be sought. In addition a full employment history must be obtained (with gaps explained) and not just the last ten years as the application form requests. The provider has produced a comprehensive induction programme that new staff must go through during their first six months. The home has still not arranged however for them to undertake the Learning Disabilities Accredited Training Framework induction programme (LDAF) which is now the expectation for staff who work caring for people who have learning disabilities. There is a programme of NVQ training, which they should move onto following LDAF and it is good that over half the staff team have already achieved this qualification. Staff also complete training in most required health & safety training areas. They also receive training in care related topics, such as abuse awareness for vulnerable adults and in respect of service users’ special needs, e.g. autism, epilepsy and positive interventions for management of challenging behaviour. As previously discussed in this report however training in moving & handling and effective communication would also provide staff with knowledge and skills that would help them to support people in the home better. The new manager clearly recognises the importance of teamwork in providing a good service from a committed team. She plans to make sure that meetings are held monthly and aims to improve communication through overlapped shift handovers. A new individual supervision format has also been introduced that covers relevant areas, including work performance and training & development goals, which should result in a new staff team development programme. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 21 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 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to this service. There are suitable management arrangements in place to make sure the home still runs well in the absence of a registered manager and an open and positive management approach is being promoted. There are systems to monitor and review the quality of the service so it continually develops for the benefit of the people who live there. The home’s policies, procedures and working practices promote safety in the home to safeguard the people living and working there. EVIDENCE: The new manager (Mrs Julie Mogg) and deputy manager both have a nursing qualification in the field of learning disabilities and the manager also has an NVQ (National Vocational Qualification) at level 4 in care & management. Mrs Mogg is already registered as manager in respect of another of the providers care homes and her application for this home will be considered in due course. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 22 There are plans to delegate more management tasks within the home and for the manager to share supervising support workers with the deputy and team leaders. The deputy has allocated responsibilities, such as oversight over the health, medication and care reviews of people who live at the home. Staff are positive about the management approach and committed to further developing a more person centred approach and about plans to improve communication within the team and staff team development. The manager confirms she and the home also feel they are well supported by the provider and it is positive that she is to be given more direct responsibility for managing budgets. The provider operates thorough processes to monitor the quality of the service. This includes the required monthly visits from their operations manager when all aspects of the home are checked and an audit checklist is completed that includes information from talking to staff, relatives and people who live in the home and inspecting the premises and records. This results in a monthly action plan (with timescales), which becomes part of their annual development plan. The manager also carries out monthly audits, which are signed off by external management. As part of quality assurance and monitoring all the home’s policies were reviewed earlier this year and the views of people who live in the home (as obtained from their relatives through questionnaires) are obtained. It is also intended to extend this to other stakeholders of the service. Regarding health & safety the home has comprehensive policies & procedures. Staff training is arranged in mandatory topics, including first aid, food hygiene, fire safety and infection control, although moving & handling needs addressing. The information received confirms that the home has an emergency evacuation plan and a fire risk assessment. Fire tests and checks are also being carried out at the specified intervals. In addition electrical checks & portable electrical appliance tests are undertaken; the fire safety system and equipment are serviced regularly; the heating system & gas installations are maintained and COSHH risk assessments are in place. There were no safety hazards identified in the environment during these visits. Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 23 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 X 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 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X 2 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered persons meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard 1. YA34 Regulation 19 Requirement Potential staff must submit a full employment history (with any gaps explored and a satisfactory explanation given) before their appointment is confirmed. References must be also from a creditable source including their most recent employer. This is to help to ensure that suitable staff are employed to work at the home to protect the people living there. Timescale for action 30/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations A person centred (PC) approach to care planning should be fully implemented. This would help staff to focus more on the wishes and personal goals of individuals who live in the home and how they can be supported to achieve them. More staff should have training in person centred planning and the home should liaise with the local person centred planning facilitators to obtain their input and/or to help the home set up person centred plans for everyone living there 2 YA6 Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 25 3 YA35 Training should be sought and arranged in values, moving & handling and effective communication. This would help staff to understand and so be able to meet the special and individual needs of people who live at the home better. Also to use methods such as using pictures, symbols and objects of reference in care planning and promoting choices. The home should introduce LDAF-accredited induction training for all new staff as a matter of priority. 4 YA35 Malvern View DS0000041385.V345747.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V345747.R01.S.doc Version 5.2 Page 27 - 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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