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Inspection on 18/01/06 for Mariantonia House

Also see our care home review for Mariantonia House for more information

This inspection was carried out on 18th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

The philosophy of Mariantonia House is to promote within each individual, the belief that his or her life is as valuable and as valid as those of other people. This encourages mutual respect and consideration amongst both the resident group, and the staff, and creates the positive, stimulating environment that is enjoyed by all concerned with Mariantonia House. There is an ongoing commitment from everyone involved with the provision of care at the home, to the development of the service. The building has been sensitively extended and upgraded, and is now being maintained to a high standard. A new vehicle has been purchased specifically to provide transport for service users, which enables them to attend their day placements, colleges, and the many and varied activities of their choice.

What has improved since the last inspection?

Progress is evident in many areas of service provision due to the approach of the proprietors who are constantly seeking to improve and maintain standards. The gradual replacement of furniture continues, as it becomes necessary, together with re-decoration and renewal of furnishings. The office is being reorganised, and is now tidy and accessible. Documentation has been reviewed, and improvements implemented. The computer for the use of service users is being replaced.

What the care home could do better:

The Care Manager acknowledges her preference to be involved in the direct care of service users, rather than being buried under piles of paper. `Administration is not as important as residents`, is a view that prevents a dedicated and organised approach to that aspect of the work. The care manager is aware of the need to complete the Registered Managers Award in a timely manner. An area where further improvement is needed is the provision of a dedicated programme of training for all staff at the home.

CARE HOME ADULTS 18-65 Mariantonia House 17 Comberton Road Kidderminster Worcestershire DY10 1UA Lead Inspector R McGorman Unannounced Inspection 18th January 2006 14:30 Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Mariantonia House Address 17 Comberton Road Kidderminster Worcestershire DY10 1UA 01562 69445 01562 864042 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) Mr Antonio Magro Mrs Emanuela Magro Mrs Emanuela Magro Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This service is primarily for people with a learning disability under 65 years of age. The Home may also accommodate people who have additional mental health needs. The Home may also accommodate one person over 65 years with a physical disability. 1st September 2005 Date of last inspection Brief Description of the Service: Mariantonia House is registered to provide residential care for up to thirteen adults who have a learning disability. Situated in a prime location, near to the town centre and occupying an extensive corner site, the two-storey building has been sensitively developed over several years to provide a high standard of accommodation. The building now has a listed status. The Home was first registered in 1996 for five adults, since when there has been a phased development to achieve its current registration for thirteen, with completion of the planned programme originally submitted by the proprietors. The home is owned and managed by Mr and Mrs Magro who are personally involved, on a daily basis, with the provision of care to service users. Their stated aim is to provide a comfortable and happy home, where service users feel secure and receive support and encouragement from staff. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this routine, unannounced inspection was to check on previous requirements and recommendations, and to monitor the care provision at the home in relation to the stated aims and objectives. The inspection took approximately 3 hours. Time was spent with service users, and talking to staff, to ascertain their views on living and working at the home, and also with the care manager, checking documentation and discussing the organisational arrangements. Care records were seen, including Health Action Plans, and staff records were also checked. Several areas of the home were seen. The records kept in respect of the maintenance of equipment and safe working practices, including the Fire Log Book, were checked during the inspection. What the service does well: The philosophy of Mariantonia House is to promote within each individual, the belief that his or her life is as valuable and as valid as those of other people. This encourages mutual respect and consideration amongst both the resident group, and the staff, and creates the positive, stimulating environment that is enjoyed by all concerned with Mariantonia House. There is an ongoing commitment from everyone involved with the provision of care at the home, to the development of the service. The building has been sensitively extended and upgraded, and is now being maintained to a high standard. A new vehicle has been purchased specifically to provide transport for service users, which enables them to attend their day placements, colleges, and the many and varied activities of their choice. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 4 The information provided by the home ensures that service users and their families are able to make an informed choice about their future care needs. A detailed assessment is undertaken, and all proposed admissions to the home are planned very thoroughly, over several weeks, to ensure an appropriate decision is made, both by the home and the service user. EVIDENCE: A statement of purpose and a service users’ guide have been produced, and service users and their families are provided with a copy. A Statement of the Terms and Conditions of Residence is also given to each service user, and these documents can all be produced in a symbolised format, if required. In addition, an Agreement of Care is entered into with each service user, and this also covers accommodation and financial arrangements. The Care Manager is able to demonstrate an awareness of the importance of the initial assessment, and also of the impact of change on the existing group of service users. Evidence was seen to confirm that appropriate procedures were followed in regard to a recent admission to the home. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 & 10 The service users plan of care is based on the initial assessment, which clearly identifies their assessed needs, and how these will be met. The policy on Confidentiality reassures service users that information about them is handled appropriately. EVIDENCE: Care planning procedures have been developed at the home, and those seen during the inspection were detailed and informative. A Person Centred Action Plan is developed with each service user, who is enabled by their key-worker to decide how they wish to live their life, and the goals they want to achieve. These documents are entitled, ‘This is my Life’. Care planning involves the service users family or an advocate, and they are reviewed regularly. The frequency is determined by the needs of the service user, although they are updated at least every month, and reviewed formally every six months. A policy on confidentiality has been produced and staff are able to demonstrate an understanding of the principles, which are based on the development of mutual trust between all concerned. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 10 Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,15 & 17 The opportunities made available to service users, and their regular involvement with family and friends, enables them to live as fulfilling a life as possible. The meals are good and wholesome, offering choice and variety, and also catering for individual preferences. EVIDENCE: Service users living at the home are encouraged to follow an ‘ordinary’ life style as far as possible, by using the same facilities as other members of the community, and being involved in a range of leisure activities. These include anything and everything that the service user wants to do, within reason. Conversely, when one service user expresses the wish not to do anything, from time to time, this is also respected. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 12 Staff supervise learning within the Home in basic life skills, budgeting and the development of social skills. Visitors were always made welcome at Mariantonia House, and the Inspector is able to confirm this from personal experience. There are no specific visiting times and family and friends’ involvement is actively encouraged. Visitors are usually enjoyed by everyone, as part of the family life of the Home, although service users can meet with them in private, if this is their wish. Service users are involved in food shopping with the Care manager, and help in the preparation of snacks/light meals with the staff. The main meals are usually prepared by the care manager or staff, and service users will help with clearing the dishes and washing up. The food is greatly enjoyed and service users spoke very positively about their meals, but also felt able to say if there was something they did not like or want, and this too is respected. A menu is produced, and a record maintained of the food provided. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 21 Support and encouragement is provided to each service user, in order to promote independence in respect of their personal and healthcare needs. Procedures are in place for managing the ageing process and possible illness and death of service users, to ensure that dignity and respect is maintained. EVIDENCE: The personal and healthcare needs of service users are closely monitored, and additional specialist support and advice is sought from the primary health care team, and other health professionals, when necessary. Various programmes are implemented from time to time, for example, to improve standards of personal hygiene, or to provide specific dietary advice, and these have produced some quite remarkable results. A policy relating to the ageing, illness and death of service users has been implemented at the home, and discussions held with service users and their families to determine their wishes concerning terminal illness and death. The outcome is recorded on their individual plan of care. A recent death at the home, although very traumatic was managed appropriately, but further training on death and bereavement is to be organised for staff in the near future. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 14 Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23 A satisfactory complaints procedure is in place at the home, and enables everyone to express any concerns, views, opinions, and compliments. The management and staff demonstrated an awareness of the issues relating to abuse, which ensures the protection of service users, although the need for amendments to further training for some staff was identified. EVIDENCE: A clear procedure for the investigation of complaints has been produced and any issues are dealt with immediately. There have been no complaints to the home, since the last inspection. Policies and procedures for the protection of service users have been produced, and include all aspects of abuse. A procedure regarding the Protection of Vulnerable Adults (POVA) is in place, but amendments are needed to reflect changing legislation, in regard to staff who may be unsuitable to work with vulnerable adults. Training for staff remains outstanding, although some enquiries have been made by the care manager in order to identify the most appropriate training course. The need for this to be progressed without further delay was discussed with the care manager. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 26 The building is maintained to a high standard, and is suitable for its purpose, being safe, comfortable and warm. The communal and individual facilities have been designed to meet the needs of service users and to enhance their quality of life. EVIDENCE: Mariantonia House is an imposing, detached Victorian house, occupying a corner position in a residential area of Kidderminster, and within easy walking distance of the town centre. The building has recently acquired listed status, specifically in regard to the original entrance and turret. There are a total of twelve bedrooms throughout the home, eleven of these being single rooms, each with an en suite shower, and eight of which are on the ground floor. There is one shared bedroom, and a further three single bedrooms located on the first floor. Each bedroom is tastefully decorated and furnished to a high standard, and reflects the individuality of the service users, who are each encouraged to personalise their rooms. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 17 Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34,35 & 36 The staff team at the home have skills relative to the work they are doing, which enables the effective delivery of care. Recruitment and selection procedures are detailed and thorough, and help to ensure the protection of residents. Training is provided, but the provision of additional care related courses will assist staff to be more competent in their work . Supervision of staff ensures that they receive support from management, but this needs to be organised more regularly. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 19 EVIDENCE: There is an experienced staff team at Mariantonia House, although there have been two recent changes. A formal recruitment policy is in place, and evidence was seen to confirm that procedures are followed appropriately. Further consideration is to be given to the application form for prospective employees, to ensure that it contains adequate information in relation to disclosure regarding any criminal convictions. Training is made available to staff at the home, but the training and development programme needs to be implemented consistently, and in line with the Learning Disability Award Framework (LDAF). Details are to be submitted to the Commission when available. Basic ‘core’ training is provided for staff, and a training course on dementia is currently being undertaken by several staff. A more formal approach to the management of the staff team has now been implemented, and additional responsibilities have been given senior staff, to enable the Care Manager to spend more time on the administration of the home, which has become increasingly demanding. Formal supervision sessions have been introduced, but these need to be undertaken more regularly, by the care manager, to ensure compliance with the National minimum Standards. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39, 40, 41 & 43 Management arrangements at Mariantonia House are satisfactory, and residents and staff benefit from the positive leadership they receive. The quality assurance system enables the management to monitor the extent to which the aims and objectives of the home are being achieved. The policies, procedures and records maintained at the home, comply with legislative requirements and therefore help to safeguard the rights of service users. The high level of commitment from all concerned with the home, helps to ensure that it is financially viable, with obvious benefit to service users. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 21 EVIDENCE: The Care Manager has extensive experience of working with this client group and has availed herself of many training opportunities. She is now undertaking NVQ level 4, and is hoping to complete the care elements of the course within the next few weeks. A formal system for monitoring care provision is in place, and the feedback received is encouraging, although rather minimal. The need for an audit of the results to be produced, was discussed with the Care Manager, and a copy should also be submitted to the Commission. The policies and procedures implemented at Mariantonia House, are reviewed when necessary, and staff ensure that service users understand those which are relevant to them. The opinions and views of service users are said to be valued and are taken into consideration when amending and developing policies. Records are maintained to a satisfactory standard at the home. They are up to date, and now in good order, having recently been reorganized. Service users are aware that they can access their records, and they are also involved in their development. The financial viability of the business was confirmed by the Proprietors. Insurance cover to the appropriate level is maintained, and the certificate is available for inspection. Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 22 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 3 2 X 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X X 2 2 X 2 3 3 X 3 Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13 Requirement Arrangements must be made for staff to receive training, to prevent service users being placed at risk of harm or abuse. All staff must receive a minimum of five days paid training per year, and have an individual training and development assessment and profile Timescale for action 31/03/06 2. YA35 18 31/03/06 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 YA10 YA21 YA23 Good Practice Recommendations A copy of the policy on confidentiality should be submitted to the Commission Arrangements should be made for staff to receive training on death and bereavement A policy and procedure should be produced in relation to staff who may be unsuitable to work with vulnerable adults, and who may need to be considered for inclusion on the POVA register Consideration should be given to amending the application DS0000018512.V274929.R01.S.doc Version 5.1 Page 24 4. YA34 Mariantonia House 5. 6. 7. 8. 9. YA35 YA35 YA36 YA37 YA39 form in regard to criminal disclosure information The Learning Disability Award Framework accredited training should be provided for staff Details of the training programme should be submitted to the Commission when organised Care staff should be given regular formal supervision at least six times a year The Care Manager should complete the Registered Managers Award without further delay The results of the quality audit should be published and a copy submitted to the Commission Mariantonia House DS0000018512.V274929.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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