Inspection on 14/10/08 for Mandeville House

This inspection was carried out on 14th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mandeville House 23/10/07

Mandeville House 20/11/06

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 30/01/2009.

CARE HOME ADULTS 18-65 Mandeville House 35 Larches Road Kidderminster Worcestershire DY11 7AB Lead Inspector Jean Littler Unannounced Inspection 14 October 2008 11:00 th Mandeville House DS0000067880.V372314.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 Mandeville House DS0000067880.V372314.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. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mandeville House Address 35 Larches Road Kidderminster Worcestershire DY11 7AB 01562 752277 01562 752277 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) www.minstercaregroup.co.uk Minster Pathways Limited Manager post vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. 3. Learning disability (LD) 7 The maximum number of service users who can be accommodated is: 7 The number of service users will be reduced to 6 when a vacancy in the home occurs with the existing undersized bedroom having single occupancy. 23rd October 2007 Date of last inspection Brief Description of the Service: Mandeville House was purchased in 2006 by Minster Pathways Ltd. It is registered to provide personal care for up to seven people who have a learning disability. The current resident group are all male and have lived together at the home for several years. The house is a large detached property, situated in a quiet, residential area, approximately one mile from Kidderminster town centre. There is access to public transport and a range of amenities and facilities. The home has a people carrier to enable people to go on outings. There are five single bedrooms and one small double room. A condition has been placed on the registration that when one person leaves the number of places will be reduced to six and each person will have a single bedroom. There is a lounge, dining room, kitchen and garden. It was not possible to establish the current fees for the service as these were not included in the Service User’s Guide. Inspection reports are available in the home. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We (the Commission) carried out an inspection over six hours. The manager Ms Gething was off work. The temporary manager, Ms Martin came in and helped with the inspection. The owners had given us information about the home before we came. We looked around the house and saw some of the men’s bedrooms. We spoke with four of the men and two of the staff. Some of the men and the community nurses returned surveys to give us their views. We looked at some records such as care plans and medication. What the service does well: The men know each other well and the home is friendly and welcoming. Information about the home and how to complain is given to the men in a way that helps them understand it. Any new person wanting to move in would be able to stay for a trial to see if they liked the home. People are being encouraged to make more decisions about their lives. People like the food and have a choice over what they eat and drink. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 6 Opportunities are increasing for people to do the things they enjoy. There is a vehicle to take people to activities in the community and for day trips. People are well supported with their personal and health care. Medication is being safely managed on people’s behalf. Staff feel well supported and enjoy supporting the men. Checks are made on new staff to make sure they are right for the job. What has improved since the last inspection? What they could do better: The information about the home needs to be changed to show who the manager is, how much the service costs and tell people what they will have to pay for themselves. People could be better helped to plan their own life and support with their key-workers and at person centred planning meetings. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 7 People could access more activities and go on more day trips if 3 staff were on duty more often. Some people may benefit from having an advocate to help them make personal decisions. Staff should be better trained to meet people’s specific needs and more staff should be qualified. The house and garden can be further improved to make them more homely and accessible. The owners need to improve how they check on the service to help protect the men and make sure they are well supported. The men and staff team would benefit from having stable and competent management. 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. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information provided for people who are considering moving into the home will help them to make the right decision about their future care arrangements, however, some information is not accurate. The pre-admission assessment procedures should help to ensure that only people whose needs can be met are admitted. EVIDENCE: The Statement of Purpose and Service Users Guide are in place. The care files sampled showed that each man living in the home has been given a copy of the Service User’s Guide. This is available in an Easy Read format to aid the understanding of people with a learning disability. At the last inspection it was recommended that the Statement of Purpose should be reviewed to reflect the changes in the management arrangements. It was also not possible to collect information about the current fees and any additional charges. This information is required to be in the Guide but it is not so Ms Martin said she would add. Copies of both documents were requested from Ms Martin at the inspection but were not forwarded afterwards so we were unable to see if the changes have been made. Information in the Annual Quality Assurance Assessment reported that a full assessment would be completed on the needs of any new person before they Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 10 would be admitted. (The AQAA is information about the service that registered people have to provide to us each year). The home is currently full and there is an agreement that the number of registered places will be reduced to 6 at the first opportunity as currently two people share an undersized bedroom. It is therefore unlikely that there will be any new admissions in the near future. The current resident group are all male and are aged between 40 and 76. Three men are over 60 years of age so any future admissions would need to consider these two factors to ensure people are compatibility. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 11 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most of the men’s needs are now reflected in their care plans but some important information needs to be developed with professional support. Formal review meetings have not been held every six months and the person centred approach could be further development. The men are being supported in making choices in their lives. Person centred planning meetings and improved keyworking would further support this. EVIDENCE: Three of the men were spoken with and they said they liked the home and the staff. The surveys that some returned showed that they were pleased with the service overall. Two said they wanted to go out for more trips. Each man has a care folder. Ms Martin said she has worked hard since covering as acting manager to bring the information up to date, as it was not all accurate. She reported that when the owners took over the service in 2006 there were no care plans and for some men it has been difficult to establish past information about their families, lives, interests and needs. Two were sampled and found to contain up to date relevant information. Ms Martin has Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 12 been completing monthly care plan updates. Risk assessments have been further developed to guide staff about supporting the men whilst considering their safety. There are Emergency Grab Sheets of essential information in case a person goes into hospital. She has recently been developing Health Action Plans for the men, as these had not been set up before. The daily notes are clear and charts are being used to help monitor behaviours and health issues. Ms Martin also wants each man to have a Life Book record set up in a format they understand. Keyworkers will help the men to add photographs and information about their lives and achievements. Ms Martin was not aware that support is available in Worcestershire from the Person Centred Planning (PCP) team. She has the training DVD and template forms but the co-ordinators have not been to the home to train staff and support the implementation of PCPs. Ms Martin said she is promoting keyworking and trying to enable care staff to take a more active role in care planning and reviewing. A sample of the staff meeting minutes showed that the men are only discussed when there are concerns. The focus of meetings should be the men’s support needs and development to ensure consistency of approach and positive outcomes. Ms Martin said keyworkers are going to be asked to give feedback on the monthly summary reports they will produce. External professionals are involved. For example a nurse is revising the guidance in place regarding one man’s epilepsy. One man’s behaviour has changed and there are concerns he may have started to develop dementia. Health professionals are involved but at this early stage a care plan specifically for this has not been written. Ms Martin had removed the guidance about how staff should respond to one man when he displays certain behaviours, as she had not agreed that this was the best way to support him with his Autism. When she had taken over staff were responding to the man’s wishes when he was shouting them from the top of the stairs. She felt this was reinforcing the behaviour that was impacting on others in the home. She was planning to ask a colleague who provides training on behaviours to help develop a new protocol. Ms Martin has experience of working with people with Autism but none of the staff have had this training and no local Community Learning Disability Team professionals have been asked for advice. His care folder did state he has Autism but there was no specific plan for these needs and the information could better reflect the impairments this condition will cause him and the specific support he needs. Formal annual reviews have been arranged. These should be held at least every six months to enable joint planning to take place regularly. This is in line with good practice guidance and the National Minimum Standards. Observation of the relationship between the staff and the people they support, and talking with some of the men, provided evidence that each person is treated as an individual and their specific needs are respected. Staff seemed reasonably well informed and explained the routines of the people they Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 13 support, and their care needs. One said there are few rules and the home is relaxed. They felt there was a good balance between promoting independence and safeguarding people’s wellbeing. An example was that one man still goes to the shop alone but he is reminded about crossing the road safely. After Ms Martin had observed him shouting at car drivers from the pavement, she had arranged for him to always have a purpose to his outing, such as buying something from the shop, as this seems to help him stay focused. Ms Martin reported that the men had not been making choices, such as buying their own clothes, before the home changed hands. This has meant some have taken a while to develop skills and confidence in this area. To help with this in some cases only a choice of 2 things will be offered to reduce the pressure. One man had chosen a new TV for his room from a catalogue after being shown which ones he could afford. Daily notes showed choices are being offered, for example, choices between baths and showers had been given, a choice, freedom to go to bed at any time, the choice to spend time alone in bedrooms is respected. One man had declined to go to his day service that week. Although Ms Martin respected this choice she had discussed it with the man. As he seemed concerned about going in case he was knocked and fell she contacted the day centre manager to suggest a joint meeting with the man to see if arrangements could be put in place to rebuild his confidence. Two of the men use their own type of communication. Staff said once they learnt the signs communication was effective. The new digital camera and computer images should be used to provide information in a more accessible format such as staff rotas, activity plans, menus etc. to further empower the men. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 14 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): 11, 12, 13, 15, 16, 17. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The men live in a relaxed house they consider home and are supported to follow their chosen hobbies. They are being supported to develop personally and access activities they enjoy, however, opportunities could be increased if staffing levels were increased at peak times. The men are supported to stay in touch with their family and friends. They enjoy their meals and have a choice over what they eat. EVIDENCE: There is a relaxed atmosphere in the home and the men seem very comfortable with the staff and each other. Daily records showed there is flexibility about the daily routines such as the time people get up and go to bed. Ms Martin said some men had long-standing routines that were slow to change, such as getting ready for bed at 7pm and then watching evening television in their nightclothes. The men were observed to move freely about the home and take part in their own chosen hobbies such as sewing and doing Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 15 jigsaws. Most of the men enjoy music and have their own players, or will watch TV or a video with the others. The men are being encouraged to follow an ‘ordinary’ life style as far as possible, getting involved in buying their own clothes and toiletries, going food shopping, tidying their bedrooms and helping in the kitchen at mealtimes. Each person has a different weekly routine as some attend set activities such as day services. Their activity plans are in the care plans and on display for the staff in the office. Currently people do not have their own plans in a format they can understand. The individual programme of activities has been arranged with each man’s preferences in mind. Daily notes for 2 men showed that the plans are not always followed. It was not always clear what the circumstances were, for example one man spent the majority of one week in his room but he may have refused outings. If people decide they don’t want to do something or to go somewhere, then Ms Martin said this is respected. One man had tried the snoozalem but did not like it. Staff felt the men were being offered more activities and outings than they had been the previous year. Ms Martin feels the development of person centred planning will further help this area. For example, one man wants to go to a football match and another wants to go swimming. One man has autism and needs a high level of staff support to engage in activities and often has a very short interest span and needs to be supported to leave as soon as he is ready. He spends time at home helping staff around the house, which he enjoys and goes on drives in the vehicle. With staffing levels often at 2 to 7 it is difficult to see that his special needs can be fully met. Ms Martin said the local day services have stopped his attendance and it is hard to find activities that suit him. Increased staffing and professional input from a psychologist or occupational therapist may be of help. The level of outings seem to be limited because often only two staff are on duty and because the only drivers are the 3 seniors, who sometimes need to stay in the home with certain men. Two men said in their surveys that they would like to go on more trips out in the vehicle. Independent travel is being promoted and one man uses taxis alone to go to a day centre. Another man uses the bus with some safety arrangements in place. Some of the men go to a local pub unaccompanied, which they enjoy a lot. Others still like to go but now need staff support. Group activities are also organised, and visits to places of interest. Annual holidays are now being offered to each person, which is very positive. Most of the men have family actively involved. Contact is supported and some visit family regularly. Birthdays are celebrated at the home, together with the families and friends. The arrangements regarding the provision of food reflect the individual likes and dislikes of the men. Everyone is encouraged to help to prepare a menu for Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 16 that week, although there may also be a spontaneous response to a suggestion to go out for a meal or have a ‘take-away’. These changes and individual preferences are recorded. Everyone is encouraged to be involved in food shopping with staff, and they also assist with the preparation. Healthy eating is promoted for everyone, and a record is kept of the food provided. The home uses the ‘Safer Food, Better Business’ system, produced by the Food Standards Agency, which helps compliance with the regulations relating to food management. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 17 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. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The men are being appropriately supported with their personal and health care needs, however, the staff are not fully trained in all health related areas that affect the men. Medication is being safely managed on the men’s behalf but the arrangements for a controlled drug need to be improved. EVIDENCE: The information in the AQAA reported that personal care is provided in a flexible and sensitive manner in line with the guidance in the care plans. The daily records seen showed that the men were being supported to have regular baths or showers and they all looked well presented. The men are quite independent in many self care areas, only needing to be reminded or prompted by staff. The feedback from the men indicated that they were happy with staff support in this area. Staff were observed to interact with the men in a respectful and friendly way. Daily records were also written in a respectful manner. One worker reported that some of the men are now holding their own door keys to give them more control. The AQAA did not report if the recommendations to sensitively consult each man about his wishes in regard to dying and to train staff on death and bereavement had been actioned. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 18 One man was supported to attend the doctor for a regular injection by a member of staff and a community nurse who supports him. Ms Martin gave examples of recent health issues and the action that had been taken as a result. One man had had back pain so after an assessment he had insoles for his shoes and had purchased a firmer and better quality mattress. Another man had become more unsettled and challenging to staff and the other men. Ms Martin felt this was out of character and spoke to his doctor. Tests showed he had an under active thyroid. Staff were hopeful that the new medication would result in him settling down again. Another man can also get upset and be aggressive. Staff said he does respond to a verbal prompt to go to his room to calm down. No physical restraint is being used. As mentioned under care planning, Ms Martin has recently been completing Health Action Plans for each man. A nurse had been assisting with some. One GP surgery had been more helpful than the other. Known healthcare needs are included in their care plans. Ms Martin reported that she had pushed hard to get annual eye tests for those who do not wear glasses and for chiropody for all the men, not just a few. A man with epilepsy has been unwell recently and his seizures have changed and are putting him at greater risk. Blood tests have been arranged and Ms Martin has arranged for an alarm that detects nighttime seizures to be provided as well as the continued use of a listening monitor. The man’s consent was sought and it was his choice to use both devices. As mentioned previously, one man is being assessed to establish if he is showing early signs of dementia. As both these men’s needs are changing Ms Martin feels waking night staff are now needed and she has begun the process of requesting additional fees from their funding authority. The staff have attended training on epilepsy but not on autism or dementia. These should be made a priority. The weight of each person was being monitored closely, as concerns about the low body weight of some men were identified when the home changed ownership. The matter was discussed with the doctor and this is no longer a concern. Some men are being supported to slowly lose excess weight. The medication was being safely stored in a cabinet in the office and the keys held securely. Policies and procedures are in place and two staff are involved to help reduce the risk of errors. Information about medication is also provided for the men in picture format, to aid their understanding. A Monitored Dosage System is in use, and the local Pharmacist undertakes a regular check to ensure that the correct procedures are being followed. The Medication administration records that were seen were clear and showed doses had been given as prescribed. Handwritten instructions on some of the charts had been signed by the person completing them. It is considered good practice for 2 staff to sign to show the details have been double checked for accuracy. It is positive that ‘as required medication’ is not being used to manage people’s behaviours. Ms Martin said protocols are in place for medication given during Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 19 bouts of sickness or for epilepsy in an emergency. She was aware that she needed to promptly write one for the tablets a man has recently been prescribed for back pain. The epilepsy medication is now classified as a controlled drug (CD). Ms Martin was not aware of this but agreed to start recording it in the CD register and arrange for suitable CD storage to be provided on site. It is positive that one man’s wish to take his medication in his bedroom is respected and that safeguards have been put in place around this practice. Regular reviews of the medication prescribed are undertaken with the health professionals involved. Safe handling of medication training has been provided for staff. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 20 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. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to enable the men and their family or representatives to express any concerns. The men are being protected from abuse through staff training and procedures, but quality-monitoring systems have not always been implemented effectively. Those without representatives actively involved in their lives are not been enabled to have an advocate involved. EVIDENCE: The AQAA stated that a suitable complaints procedure is in place. This has been produced in an Easy Read format to assist the men to understand it. At the last inspection it was reported that discussions about the procedure had been held with the men and their families to make sure they understand the process. House meetings are held to support the men to raise any concerns they have. Ms Martin confirmed that there have been no complaints about the service since the previous inspection other than the neighbours wanting the hedge cut back. Some of the men have representatives actively involved and Ms Martin reported that they are consulted when decisions are made, such as expensive personal purchases. One has no one involved and for others the contact is limited. Ms Martin thought advocacy services in the area are well developed but these are currently not being accessed. A procedure is in place in relation to abuse and the protection of vulnerable adults. All staff receive training as part of their induction process. Discussions with staff showed they have an awareness of these issues, and also an understanding of their individual role as an advocate for the people they support. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 21 An allegation about financial abuse was being investigated by the police at the time of the last inspection. This process was concluded in July 08 when the exemployee was convicted of stealing approximately three thousand pounds from people living in the home. None of the men were directly affected by the situation as the Company ensured the money was replaced. Ms Martin and the Company co-operated with the investigation under the local multi-agency protocol and referred the man to be placed on the Protection of Vulnerable Adults List (POVA). It is concerning, however, that the internal audit systems did not pick up the irregularities more quickly. We are aware that there has also been a recent disciplinary investigation regarding financial procedures. The Company needs to ensure it has learnt from both these events and made any necessary organisational changes to better protect people. There was no mention of this in the AQAA but Ms Martin said she monitors the men’s finances closely. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 22 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, 25, 28, 30. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The men live in a pleasant environment that is clean and comfortable. It is better suited to accommodate fewer people, particularly when some people can become upset and be aggressive. EVIDENCE: Mandeville House is a large detached property, situated in a quiet, residential area, approximately one mile from Kidderminster town centre. The home is within easy walking distance of several local amenities, and there is access to public transport, although the home also provides a vehicle. There is a raised flowerbed at the front of the property and limited car parking facilities are available. The communal areas of the house include a kitchen, dining area and lounge. The lounge is nicely decorated and new furniture has been purchased to better meet individual’s seating requirements. The size of the communal space is adequate but it cannot accommodate enough seating for all 7 men and staff. Fortunately some of the men prefer to spend quite a lot of time in their bedrooms. The dining area is also cramped with all 7 men having to share the Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 23 same table with no room for staff. There are five single bedrooms and one shared room within the home. Two single bedrooms are located on the ground floor and the other four rooms are on the first floor. There are no en suite facilities provided but each room has a sink. There is no facility in the shared room for privacy to be provided when the sink is used so one of the men washes in the communal bathroom. As mentioned under the brief description of the service the number of people accommodated will be reduced to 6 when a vacancy occurs, as the shared bedroom is undersized. Ms Martin reported that the 2 men have shared for many years and like the arrangement. The gardens are not well used and have not been developed to provide any activities for the men. There is a narrow patio area on the back of the house high above the garden that is accessed via a concrete staircase that is unprotected and beginning to crumble. The steps are very deep and wide and not easy to climb. As the men are aging some are becoming less mobile and this arrangement is going to pose greater risks and prevent people from safely accessing their garden. Ms Martin reported that they hope to employ a gardener throughout the year so the garden can be improved. The property has been improved significantly since the ownership changed hands. Ms Martin reported that there were still things that needed to be changed but the overall impression is now more presentable. The home was found to be reasonably clean. Staff carry out the cleaning and cleaning schedules are in place. Ms Martin agreed to ensure that ceilings and lampshades were included in the schedule so cobwebs were cleaned away. Hand washing facilities have been improved by a sink being fitted in the small laundry room. A soap and towel dispenser are still due to be put up. The laundry equipment has been replaced. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 24 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, 36. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The men are being supported by a small stable staff team who know them quite well. The staff are being supported and trained but both these areas can be further improved. The unstable management has not been helpful in these areas. The men have been protected by the recruitment practices. EVIDENCE: Staff confirmed that there are usually two staff on duty. Some staff work long days and others shorter shifts. There is sometimes a third person on but this is usually only when the manager is on duty. As for most of the last year the home has been managed on a part time basis this has been limited to 2 or 3 days a week. Ms Martin confirmed that it would be preferable for a third person on at peak times. Two of the men need 2 staff to support them when they go into the community so without a third worker outings are limited. The staff team is small with only 5 staff. The team has been quite stable this year with only one worker leaving. There are currently 3 seniors, one of whom has recently become part time. There is always a senior on duty during the day. All the staff are female except the maintenance worker who is also a Relief Bank carer and sometimes covers gaps in the rota. There is one vacancy Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 25 and a male has applied so Ms Martin was hopeful he would be suitable. She felt the salary did not encourage men to apply. Gaps in the rota are covered by staff from the other home Ms Martin manages or from the Company’s Domiciliary Care Agency. As mentioned earlier in the report Ms Martin thinks two of the men now require waking night staff. A record of the times sleep-in staff are disturbed is being kept and professionals are involved from the funding authority to assess the situation. A sample of 2 recruitment files were seen. These showed that the relevant information had been sought before the staff started in post. In one case as the date the references had been received had not been recorded so it was difficult to prove they were returned before the worker took up their post. A new worker who is only 18 years old said she was extra to numbers for several weeks when she started and was not put under any pressure to take on responsibilities. She now does take some of the men out alone but does not do sleep-in duties. She was shown personal care routines and how to treat the men with respect and dignity. She had been through an induction and attended a 2 days course on behaviours and managing aggression, which was helpful. She had seen 1 incident and felt it was handled well by her colleague. She had not yet attended epilepsy training or first aid and the fire course was cancelled. She was aware of her duty to report any abuse. Ms Martin said when she had returned to manage the service she found gaps in this workers induction, which she went through with her. Another worker who had been in post longer had attended all the standard courses and was working towards an NVQ 3. Both felt training on autism would be helpful for one man’s needs. Ms Martin said the adult protection training is run by Solihull social services and it is a very good course. She was aware that there were some gaps in staff’s training records. She had booked person centred planning course, some staff need fire-training refreshers, and 2 need epilepsy and emergency epilepsy medication administration. She plans to arrange training on the Mental Capacity Act and agreed the team would benefit from autism and dementia awareness courses. The Company are currently not putting staff through the Learning Disability Qualification. This is a National Minimum Standard and should be part of the baseline training for the service. Ms Martin agreed to look into this. Only one worker has a qualification but it is positive that the other 4 have started an NVQ award. Staff said they attend staff meetings and these are open to ideas. Only four meetings had been held in 2008. Gaps seemed to be linked to the changing in the management arrangements. Both workers felt generally well supported in their roles and had been given supervision. A worker in post for 5 months had only had 1 session. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 26 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in the service the men receive in the last year, but more progress could have been made if stable fulltime management arrangements had been provided. There are still shortfalls in some areas such as quality monitoring. The men’s health, safety and welfare are promoted, however, the safety issues highlighted need to be followed up. EVIDENCE: At the time of the last inspection in October 07 the deputy manager had been responsible for the day to day running of the home for several months before he resigned. Ms Martin, who is the Registered Manager at The Brinton Care Home, started providing support and supervision to the staff team. The concerns about the unsatisfactory management arrangements were discussed with Mr Colin Farebrother, the Responsible Individual. He said that the Company would be recruiting a new manager in the near future. This did not Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 27 happen and Ms Martin continued to run both care homes without applying for registration as the manager of Mandeville. Managing a home without applying for registration is an offence under the Care Standards Act. We wrote to Mr Farebrother to remind him of the Company’s legal responsibilities and in May 2008 Ms Gething was appointed as manager. Prior to taking up her post at Mandeville House, Ms Gething had been the manager of another service but was returning after a period of extended leave. She was in post for a few weeks and then went off sick. Ms Gethings return to work was delayed due to an investigation by the provider about issues to do with the management of the home. During this period Ms Martin again managed both homes. Ms Gething returned to her post in October after the inspection having received a warning. The providers need to ensure that standards are closely monitored and that an application for registration is submitted promptly. A quality monitoring system was due to be implemented at the last inspection. Ms Martin reported that the monthly audits, that are meant to be carried out to monitor if all checks and records are up to date, have not been implemented. This is because of the lack of stability in the management arrangements. The Company surveys to consult people using the service and their representatives have also not been issued in the last year. The AQAA was returned to us on time in August and contained sufficient information about the service. It confirmed that all company policies had been recently reviewed and that appropriate checks have been carried out on equipment such as the electrical circuit. Ms Martin reported that all routine checks are completed such as water and fridge temperature tests. The home has a policy that details how health and safety matters are to be addressed, and all staff are trained in safe working practices. The requirement made at the last inspection to assess the hazards of unrestricted first floor windows and uncovered radiators has been met. The reassessment led to radiator covers and window restrictors being fitted. Ms Martin reported that in the past the men did not go outside when the fire alarm rang but regular drills have improved their response. The fire risk assessment should be reviewed now there are concerns about two of the men’s needs changing. Staff were not aware of a night time drill ever being conducted to assess reactions and currently one worker is responsible for assisting 7 people to safety. One man is wandering at night and has been found at the front door. The situation is being monitored, however, consideration should be given to fitting a door alarm while waking night staff are not provided. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 28 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 2 2 2 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 2 25 2 26 X 27 X 28 2 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 x LIFESTYLES Standard No Score 11 2 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 1 X X 3 X Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 29 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. 1 Standard YA39 Regulation 24 Requirement The quality assurance system must be implemented fully to ensure that the home is run in the best interests of the people who live there. This must include consultation with the people who use the service and their supporters and evidence that their views have been used to help the service develop, and a system of monitoring the standards in the home to help protect people. 2 YA37 YA43 Section 11(1) of the Care Standards Act 2000. The manager must apply to be registered with the Commission. This is to ensure that people using the service benefit from the protection that registration provides. 31/12/08 Timescale for action 30/11/08 Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 30 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 Further review the Statement of Purpose so the information about the management arrangements is accurate. Revise Service Users Guide so it includes clear information about the fees and any additional charges people living in the home will be expected to pay. 2. YA6 Seek input from the Worcestershire Person Centred Planning team in the further development of a person centred service and care planning approach. Implement key-working systems fully so the men benefit from more personalised support and staff develop their care-planning skills. 3. YA6 Hold full care reviews at least every six months and where possible join this process up with person centred planning sessions. Ensure clear guidance is in place for people who demonstrate complex behaviours so staff know how to respond consistently and effectively to these. Keep the strategies under review at staff meetings. Request local professional support in the development or approval of positive behavioural support plans when expert knowledge is not available in the home or Company. 5. YA14 YA12 YA22 Opportunities for involvement in more activities in the local community should be provided to further increase people’s quality of life. Advocacy services for men without family members or other representatives actively involved should be arranged to ensure that any decisions are made in their best interest. Brought forward. 4. YA6 6. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 31 7. YA20 The controlled drugs register should be used in regard to one medicine and controlled drug storage provided and used. Two staff should sign to show any handwritten instructions on the administration charts accurately reflect the doctor’s instructions. Training should be provided for staff on death and bereavement to ensure their understanding of the issues, and enable them to respond to the situation effectively. Brought forward. Seek the advice of an occupational therapist in regard to the adaptations that could be made to the patio and garden to promote safer access. Develop the grounds so the men benefit from them. 8. YA21 9. YA24 10. YA28 Further work should be undertaken to the areas of the house and garden that need attention, to improve the facilities that are available. All staff should attend training on the Mental Capacity Act, autism, aging, dying and bereavement and dementia to help them better support the men. Training should be arranged to fill the gaps in some staffs training records. Staff should be supported to gain the Learning Disability Qualification. 11. YA32 YA35 12. YA33 Provide three staff at peak times each day to enable a more flexible and personalised service to be provided. Provide waking night staff to meet the changing needs of some of the men. Try to fill any future vacancies with male workers to provide a gender balance to the team. 13. YA42 Review the fire risk assessment to ensure one worker can safely assist 7 people to safety. Consider the benefit of carrying out a night time fire evacuation as part of the reassessment. Fit a door alarm to the front door while waking night staff are not provided. Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 32 Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Mandeville House DS0000067880.V372314.R01.S.doc Version 5.2 Page 34 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!