CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65
Margaret Roper House 447 Liverpool Road Southport Merseyside PR8 3BW Lead Inspector
Mr Mike Perry Key Unannounced Inspection 7th February 2007 10:00 Margaret Roper House DS0000017250.V330201.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 Margaret Roper House DS0000017250.V330201.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 Older People and 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. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Margaret Roper House Address 447 Liverpool Road Southport Merseyside PR8 3BW 01704 574348 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) mrh@nugentcare.org Nugent Care Mr Iswurdut Busgeeth Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23) of places Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 23 MD The home must at all times employ a suitably qualified and competent manager who is registered with the CSCI 17th March 2006 Date of last inspection Brief Description of the Service: Margaret Roper House is a 23 bedded purpose built home situated in the larger St Thomas Moore complex, which also incorporates a residential home. The home provides long term accommodation for people with enduring mental health needs. Care is provided on four family units on 2 floors. The home is set in its own grounds and garden areas. It is on the main Liverpool/Southport Rd with regular bus services into Southport town centre [2 - 3miles]. The home is owned by the Nugent Care Society and the Registered Manager is Mr Iswurdut [Fred] Busgeeth who is a Registered Nurse [General and Mental Health] and has long experience at this level. The current fees for the service are £451 - £639.50 Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was a ‘key’ inspection for the service and covered the core standards the home is expected to achieve. The inspection took place over a period of two days. The inspector met with residents and spoke with 3 in more depth. The inspector also spoke with members of care staff on a one to one basis and the manager and senior nurses. A tour of the premises was carried out and this covered most areas of the home including some of the resident’s rooms [not all bedrooms were seen]. Records were examined and these included four of the resident’s care plans, staff files, staff training records and health and safety records. What the service does well:
Residents are assessed prior to being offered a place at the home. Care files seen contained assessments from the Community Mental health Team including assessment of risk factors such as self-harm and neglect. The home own assessments also cover risk factors and assist in ensuring that the home are able to meet the needs of the person concerned. Residents interviewed said that the process of being introduced and admitted to the home had been managed well and that they had been made to feel comfortable from the beginning. The nursing staff draw up care plans with involvement from residents. Residents have the care plan discussed with them on a routine basis. One commented, ‘the nurse and the key worker discuss the care with me’. The care plans are easy to follow and concentrate on social skills and interaction. For example a resident with very chronic and long standing psychiatric diagnosis had a care plan which concentrated on specific needs such as memory problems, controlling smoking and the need to look after the residents glasses. Progress here would both enable more independence on a daily basis as well as improve quality of life. Over all the quality of the care planning is very good and residents feel involved in and encouraged to ‘own’ their care. A review was carried out following a recent accident involving a resident in the home. The care notes displayed good monitoring of the resident concerned
Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 6 who was presenting with various risks to his health such as deterioration in mental state and loss of weight. Both of these were highlighted in the care notes and care plan and appropriate risk assessments had been carried out. There was a good balance respecting the residents need [and right] to go out of the home with the concerns around general health. Residents interviewed were pleased with the way staff monitored their care and felt supported to live their lifestyles without any undue restrictions. There is a relaxed but ‘busy’ feel to life in the home on a daily basis. Residents were seen to be socialising in the conservatory and mixing and interacting with other residents and staff. One comment was that ‘ staff are very nice and will always talk to you and help’. Residents are supported to involve themselves in life outside the home and this was observed during the inspection. For example one resident discussed a part time local job. The dining rooms are well appointed and tables are very well presented. The general atmosphere is relaxed and sociable. The quality of the food is good. For a change the resident were able to have individual orders from the local chip shop on the second day of the inspection. The care documentation included regular reviews for residents with respect to ongoing psychiatric conditions. There is regular review with the Community Mental health Team and these are recorded. One resident has ongoing needs around managing an appropriate diet. The resident is originally not from the UK and the home have made considerable efforts to link into the cultural background in terms of diet and have tied to support the residents health through the care plan and careful monitoring. Another elderly resident receives personal care for basic needs and this is highlighted in the care plan. Staff spoken with were aware of the importance of maintaining privacy and dignity while carrying out care. Medicine administration and recording records were seen and were clear and easy to follow. Policy and procedures for the safe administration of medicines were available. Residents spoken to stated that their medicines were given on time. Residents interviewed were aware of a complaints procedure and felt that any concerns that they had would be listened to and taken seriously. One said ‘I can speak to my key worker and they can help me if I have any worries’ The home is very well maintained and is bright and airy. Residents commented on their individual bedrooms and how homely these were. There is a good choice of day space as each unit has its own lounge all of which are comfortable furnished as well as more shared communal space in the very popular conservatory. This means that there is plenty of room for residents to sit and meet and have some privacy if needed. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 7 There is a wide diversity in the age range of residents and those more elderly have had some aids and adaptations installed to assist with independence and personal care. For example one bathroom was upgraded 2 years ago to provide mechanical assistance. On the day of the inspection the home had 22 residents in the home. Staffing consisted of 1 trained nurse and 4 care staff. The manager is supernummery to these numbers. From the last inspection there has been little change in personnel in the home so that staffing is consistent. Care staff have attended appropriate training with respect to residents in the home. For example updates in care planning and abuse awareness. There are training files for staff and staff training is discussed in regular supervision sessions. Staff spoken to all had NVQ training at either level two or three and this is well supported in the home. Those staff interviewed displayed an enthusiasm to work in the home and a genuine interest in the resident group. Those residents spoken to stated that staff were helpful and supportative and easy to approach. All of the residents knew who their key worker was and found this relationship helpful. Staff files were inspected and the necessary recruitment checks prior to employment were available so that staff employed are ‘fit’ to work and residents are afforded some protection. The level of service at Mgt Roper has been consistently high over previous inspections. The Registered Manager has been in post for two years and continues to provide an effective leadership role. Feedback from all parties spoken to was positive about the way the home is run and there is a confidence in the managers abilities. There are various ways that the views of residents are sought and how their voices are listened to. This ranges from residents meetings, which are frequent, through to the residents committee, which also has some input into recruitment of staff. For example one member of staff related that as part of the interview process for her job she was interviewed by residents and feedback was used as part of the final decision to offer a job. There are appointed health and safety officers on the staff and the records seen were satisfactory and up to date. Both residents and staff felt that the home was safely maintained. What has improved since the last inspection? Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 8 Following a requirement made in the previous inspection report the home has a copy of the local Adult Protection Procedures and staff interviewed were aware that procedures were available for dealing with accusations of abuse and there has been staff training in this area. 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. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standard. Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are assessed prior to being offered a place at the home by one of the senior staff members. The home has very good links with the local Community Mental health Team [CMHT] and most referrals are through this route. Care files seen contained assessments from the CMHT including assessment of risk factors such as self-harm and neglect. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 11 The home own assessments also cover risk factors and assist in ensuring that the home are able to meet the needs of the person concerned. Residents interviewed said that the process of being introduced and admitted to the home had been managed well and that they had been made to feel comfortable from the beginning. Social workers spoken to were pleased with the way the home liaised and communicated. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices
The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The nursing staff draw up care plans with involvement from residents. The resident concerned signed all of those seen and residents also had their own copy. Residents have the care plan discussed with them on a routine basis. One commented, ‘the nurse and the key worker discuss the care with me’.
Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 13 The care plans are generally written with an accent on social skills and interaction as basic concepts rather than concentrating on medical diagnosis. For example a resident with very chronic and long standing psychiatric diagnosis had a care plan which concentrated on specific needs such as memory problems, controlling smoking and the need to look after the residents glasses. Progress here would both enable more independence on a daily basis as well as improve quality of life. Resident rights are also included in the plans so that this is highlighted. For example one resident on a legal notification under the Mental health Act had this highlighted and explained in the care plan. The care plans are reviewed and evaluated on a 3 – 4 monthly basis. The review notes did not always corresponded to the aims and objectives laid down in the care plan and the need for this was discussed with the manager. Some of the care plans were also dated 2005 and the inspector would recommend that care plans be rewritten on a more regular basis. One care plan for example still had some information on it that was now outdated. Over all the quality of the care planning is very good and residents feel involved in and encouraged to ‘own’ their care. A review was carried out following a recent accident involving a resident in the home. The accident had occurred outside the home. The care notes displayed good monitoring of the resident concerned who was presenting with various risks to his health such as deterioration in mental state and loss of weight. Both of these were highlighted in the care notes and care plan and appropriate risk assessments had been carried out involving the Community mental health team and consultant psychiatrist. The care plan was appropriate in that it balanced the residents need [and right] to go out of the home with the concerns around general health. The risk assessment carried out recommended ‘close observations’. Staff interviewed had their own understanding of this, which seemed consistent. The manager explained about the homes official policy regarding observation levels [‘levels of engagement’ policy] which staff, from their responses’ where not wholly conversant with. It is recommended that staff are updated here and that documentation recording observation levels adheres to this [very good] policy so that there is complete clarity. Residents interviewed were pleased with the way staff monitored their care and felt supported to live their lifestyles without any undue restrictions. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 14 Lifestyle
The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome are is excellent This judgement has been made using available evidence including a visit to this service.
Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 15 EVIDENCE: There is a relaxed but ‘busy’ feel to life in the home on a daily basis. Residents were seen to be socialising in the conservatory and mixing and interacting with other residents and staff. Staff were very supportative and continually reinforced positive social interactions with residents. Residents in turn see the staff as warm and friendly; ‘ staff are very nice and will always talk to you and help’. Some residents were attending the visiting hairdresser and again the atmosphere was very sociable and residents clearly felt at ease and were enjoying the experience. The conservatory showed the signs of a recent birthday celebration with balloons and decorations. Residents were able to talk about this and also the planned activities that are organised daily [there are 2 activities organisers]. Some residents were going out locally in the homes minibus and were looking forward to the trip. They also talked about the resident meetings and how it had been discussed that the summer holiday this year might be in Scotland. Some residents have been involved in local education courses and activity outside the home. For example a resident has attended art classes. One resident discussed a local part time job in the community and how this helped her to fund some social events such as a recent evening out. Residents spoken to were encouraged to use local amenities and were seen to be coming in and out of the home on regular occasions. Residents generally talked about the frequent trips organised and the positive feel of living in the home. ‘There’s a good atmosphere and you can talk to the staff’. Residents stated that family and friends and encouraged to visit and that contacts are reinforced by staff. Staff interviewed displayed a good knowledge and understanding of the resident’s life histories and their current social needs. This is reinforce by life histories and entries in the care notes Residents are asked regularly about the quality and choice of food and there is a survey form on the notice board in the dining areas on each unit. The dining rooms are well appointed and tables are very well presented. The general atmosphere is relaxed and sociable. There were two choices of dinnertime meal. During the inspection the quality of food was good. For a change the resident were able to have individual orders from the local chip shop on the second day of the inspection. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support
The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome are is excellent This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care documentation included regular reviews for residents with respect to ongoing psychiatric conditions. There is regular review with the Community Mental health Team [CMHT] and these are recorded. Residents spoken to attend the local hospital for these appointments or sometimes community staff attend the home. Residents expressed confidence in the staff to both monitor and refer for any medical support needed.
Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 17 An example of this is one resident who has ongoing needs around managing diabetes and due to lack of insight into this condition does not adhere to an appropriate diet. The resident is originally not from the UK and the home have made considerable efforts to link into the cultural background in terms of diet and have tied to support the residents health through the care plan and careful monitoring. There is good liaison with both diabetic health care support and psychiatric services The home also supports a diverse range of residents in terms of age. One very elderly resident who is now frail is supported with appropriate lifting equipment and nursing aids such as pressure relief mattress. This resident receives personal care for basic needs and this is highlighted in the care plan. Staff spoken with were aware of the importance of maintaining privacy and dignity while carrying out care. There are no residents who self medicate although the staff were able to give examples of were this had been carried out previously. Appropriate risk assessments were in place and there is a policy statement available for guidance. Medicine administration and recording records [MAR] were seen and were clear and easy to follow. Medications coming into the home are recorded on these sheets. Medications returned are recorded in a separate book. Policy and procedures for the safe administration of medicines were available. Residents spoken to stated that their medicines were given on time. The nurse spoken to was knowledgeable regarding the medicines given to residents. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection
The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents interviewed were aware of a complaints procedure and felt that any concerns that they had would be listened to and taken seriously. Residents had confidence in the staff and felt that any concerns would be listened to. One said ‘I can speak to my key worker and they can help me if I have any worries’ There is a complaints procedure on various notice boards around the home copy of the procedure is also in the residents information pack. The manager keeps a record of complaints and the file was seen but did not contain any complaints or concerns as none have been received. Following a requirement on the last inspection report the home has a copy of the local Adult Protection Procedures and staff were able to demonstrate an understanding of good care principals. There have been various training initiatives to raise the level of awareness around abuse in the past and also
Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 19 more recently. Staff interviewed were aware that procedures were available for dealing with accusations of abuse. Residents spoken to had no concerns or complaints about the service. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome are is excellent This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is very well maintained and is bright and airy. Residents commented on their individual bedrooms and how homely these were. There is a good choice of day space as each unit has its own lounge all of which are
Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 21 comfortable furnished as well as more shared communal space in the very popular conservatory. This means that there is plenty of room for residents to sit and meet and have some privacy if needed. The conservatory opens onto a garden and some residents commented on how they can get involved in the garden in the warmer weather. There is a full and ongoing maintenance plan and records seen were up to date. The home is clean and hygienic in all areas seen. Resident’s comments were that this was consistent. There is a wide diversity in the age range of residents and those more elderly have had some aids and adaptations installed to assist with independence and personal care. For example one bathroom was upgraded 2 years ago to provide mechanical assistance. One resident has had various adaptations including hoist provision and specialist mattress to avoid pressure sore risk as well a provide comfort. The agency policy is to cater for care needs for the duration of the residents life and there is a well established record of adapting the home were necessary to achieve this. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the home had 22 residents in the home. Staffing consisted of 1 trained nurse and 4 care staff. The duty rota confirmed that he minimum staffing is 3 carers. The manager is supernummery to these numbers. There were adequate ancillary staff as well as a full time
Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 23 administrator employed. From the last inspection there has been little change in personnel in the home so that staffing is consistent. The trained staff have a skill mix that includes Mental Nurse cover [RMN] and also nursing staff who are originally trained in general nursing and have had some years experience in working with people with mental illness. Care staff have attended appropriate training with respect to residents in the home. For example updates in care planning and abuse awareness. There are training files for staff and staff training is discussed in regular supervision sessions. Some staff reported that that there has not been a lot of training in specific mental health issues such as observational skills or managing and dealing with aggression. This was discussed with the manager and would be a recommendation for future training. Some staff have already identified this in supervision. Staff spoken to all had NVQ training at either level two or three and this is well supported in the home. Those staff interviewed displayed an enthusiasm to work in the home and a genuine interest in the resident group. Those residents spoken to stated that staff were helpful and supportative and easy to approach. All of the residents knew who their key worker was and found this relationship helpful. Staff files were inspected and the necessary recruitment checks prior to employment were available so that staff employed are ‘fit’ to work and residents are afforded some protection. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome are is excellent This judgement has been made using available evidence including a visit to this service. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 25 EVIDENCE: The level of service at Mgt Roper has been consistently high over previous inspections. The Registered Manager has been in post for two years and continues to provide an effective leadership role. He has many years experience working previously in the NHS at senior management level and displays an understanding of how the service should be developed. To this end there has been liaison with local mental health services and the manager has played a key role. Feedback from all parties spoken to was positive about the way the home is run and there is a confidence in the manager’s abilities. All of the residents were aware of who the manager was and the role of other key staff. There is a clear management structure. There are various ways that the views of residents are sought and how their voices are listened to. This ranges from residents meetings, which are frequent, through to the residents committee, which also has some input into recruitment of staff. For example one member of staff related that as part of the interview process for her job she was interviewed by residents and feedback was used as part of the final decision to offer a job. There are more formal auditing process such as a yearly external quality audit as well as regular monthly audits by Nugent Care, which look at care issues as well as management processes. The manager was able to discuss plans for the home over the next year. There are appointed health and safety officers on the staff and the records seen were satisfactory and up to date. Staff interviewed were clear about regular and ongoing training in this area and felt hat the home was a safe environment. There were no concerns amongst residents. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 26 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. Where there is no score against a standard it has not been looked at during this inspection. 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 N/A 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 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 4 35 3 36 X CONDUCT AND MANAGEMENT Standard No Score 37 4 38 X 39 4 40 X 41 X 42 3 43 X 3 3 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Margaret Roper House Score 3 4 3 X DS0000017250.V330201.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA6 YA9 YA35 Good Practice Recommendations Care plans should be rewritten and updated more regularly as discussed and reviews or evaluations should reflect the aims and objectives on the care plan. The homes policy ‘levels of engagement’ is reinforced with staff so that there is clarity around observation levels for residents. Training in client specific subjects such as observational skills for mental health staff and dealing with aggression should be promoted. Margaret Roper House DS0000017250.V330201.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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
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