Inspection on 09/12/08 for Mariantonia House

This inspection was carried out on 9th December 2008.

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

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

Other inspections for this house

Mariantonia House 17/12/07

Mariantonia House 23/01/07

Mariantonia House 18/01/06

Mariantonia House 01/09/05

Mariantonia House 17/03/05

Mariantonia House 06/08/04

Mariantonia House 10/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Mariantonia House 17 Comberton Road Kidderminster Worcestershire DY10 1UA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christina Lavelle     Date: 0 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Mariantonia House 17 Comberton Road Kidderminster Worcestershire DY10 1UA 0156269445 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Emanuela Magro Type of registration: Number of places registered: Mrs Emanuela Magro,Mr Antonio Magro care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: One service user who has a learning disability and a mental disorder. Removal of registration for one service user who has a physical disability and a mental disorder. The maximum number of service users who can be accommodated is: 13 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: Learning disability (LD) 13 Date of last inspection Brief description of the care home Mariantonia House was first registered as a care home in 1996 for five people and there was a phased development to achieve its current registration. The home now provides accommodation and personal care for 13 adults who must require care primarily due to learning disabilities. Residents may have additional needs relating to their mental health, although the home will not accept anyone with violent or Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 13 Brief description of the care home aggressive behaviours. The services philosophy is to provide 24-hour supervision and a safe haven, which gives protection and support. The home is owned and managed by Antonio Magro and Emanuela Magro who are both personally involved with the dayto-day care provision. Mrs Magro is the registered manager. The home is located on a main road within a reasonable walking distance of Kidderminster town centre. There are also local shops and other facilities, which include a railway station. The property is Victorian (with a listed status) and is detached. It has a lawned garden area, parking spaces and two patios. The main house occupies a large corner site that has been extended to provide more bedrooms and facilities. There are eleven single bedrooms with en-suite toilet and shower facilities and one shared bedroom with a separate bathroom. Eight bedrooms are situated on the ground floor. There are also several toilets and bathrooms, two sitting rooms, two kitchens, a laundry and a dining room for everyone to share. Information about the service is provided in a statement of purpose and service users guide documents (the guide is also in a user-friendly format), which are available from the home. The weekly fee is dependent on individual residents assessed needs, as agreed between the home and their funding authority. This charge covers everything provided by the service except such as newspapers, hairdressing, chiropody, opticians, personal clothing and effects, dry cleaning and the cost of holiday accomodation. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is a key inspection of the service provided by Mariantonia House. This means all the standards that can be most important to people using care services are assessed. As part of this inspection we, the Commission, visited the home for over six and a half hours without telling the staff or people living there beforehand. It was agreed that the people who live there should be referred to as residents in this report. An expert by experience (called the expert in this report) helped with this inspection. This is someone with personal experience of learning disabilities services who is trained to be with inspectors on visits to care services. The expert observes what happens in homes and talks to residents to find out their views of their lifestyle and the service. They also make a report of their findings and the information is included in our reports. Care Homes for Adults (18-65 years) Page 6 of 31 The expert spent two and a half hours at the home and spoke with four residents. One care worker was interviewed and asked about their role, training and support and the lifestyle and care of residents. The way the home is run, any changes made since the last inspection and plans to develop the service were discussed with the manager. Surveys about the service were completed by 10 residents, five staff and two care professionals involved with the home. Their feedback is also referred to in this report. The manager completed an annual quality assurance assessment (AQAA), as now required, before our visit. The AQAA asks managers to say what their service does well and could do better and about their plans to improve the service. Some relevant records were also checked including residents care plans and staff files, and parts of the building were looked around. All other information received by the Commission about the home since the last inspection is considered. This includes a concern raised with the local authority and events affecting the welfare and safety of residents (these are called notifications). What the care home does well: What has improved since the last inspection? The last key inspection of the home was completed on the 8th of January 2008. Improvements made to the service since then are as follows:Progress is being made to make residents care more person centred. This means that there is more focus on what individuals want and their goals and how they can be supported to achieve them. People are also more involved in planning their own care. Residents have more individual support from their keyworkers. They are staff allocated to them who have some time to spend just with them. This helps to make their care more personal and gives them scope to do what they want to do on their own. Efforts are being made to find more opportunities for residents to work and learn out in the community. Some people have voluntary jobs and are doing college courses. Parts of the building have been redecorated and had new carpets fitted. This makes the Care Homes for Adults (18-65 years) Page 8 of 31 house look nicer for residents. Each resident now has their own health action plan. These plans are also easy for them to understand so they can be more involved in keeping fit and healthy. New staff now do not start work at the home until they have had a police check. This helps to make sure they are suitable to work caring for people using care services. Staff are having training about residents special needs and how to work with them. This is helping them to understand and be able to support people better. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident that the home could support them. This is because a full assessment would be made of their needs. The home would also know about their preferences and wishes from involving them and/or their representatives in their needs assessment and admission. Evidence: There have not been any new residents move into the home since the last key inspection. It is evident however from the previous inspection, and it was also reaffirmed with Mrs Magro, that prospective residents would not be admitted to the home until a thorough assessment of their needs has been undertaken. It is confirmed that the home always obtains copies of community care assessments, completed by the care manager who referred possible residents. Mrs Magro then visits them at their current residence to assess their needs, obtain more information about them from relevant others and to give them information about Mariantonia house. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Introductory visits to the home are then arranged, which can include overnight styays and/or for a weekend. A trial stay of three months follows and at the end of this trial period a review meeting is held when a decision is made about the suitability of the placement. One resident comments in their survey I was shown around the home and the bedroom I would have. I was also told my budgies could move in. Prospective residents, their family, social worker, home staff and other involved people are included in these assessment and admission processes. Staff are also consulted, and their views and those of residents are sought because the compatibility of possible new residents with the current resident group is always considered. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met and they each have a care plan. If progress made by the home to involve people more in planning their own care continues it would better ensure that their personal goals are identified and achieved. Residents can make choices in their daily lives and routines, but should also be encouraged and enabled to make more decisions about their lives and take risks to promote their independence. Evidence: Management and staff recognise that residents have the right to make choices and decisions. The expert comments that X says he can get up and go to bed when he wants. He can go to his bedroom when he wants to be alone and watch TV. However it is clear that there is scope for some people to have more responsibilty for such as their finances. The expert was told that residents are given their money by the manager and questions why they cant go to the bank to get their own. It is good that staff are now working with individuals to encourage and support them to take more control of their lives. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: Each resident has a plan of their care and a sample of their care records and plans were looked at during our visit. The expert also asked people about their plans. The home has introduced a new care planning format and is also developing life books with residents. The new plans appropriately include a needs and goals assessment and show what people say they want to do with their life, their likes and dislikes. They should be drawn up in a way that individuals can understand. Progress has been made by the home since the last inspection to implement a person centred approach to care planning. This means that the focus is more on helping individuals identify and achieve their personal goals and they should be fully involved in setting up and reviewing their own plans. However some aspects of the new plans had yet to be completed. Mrs Magro says that keyworkers will be doing this, and then reviewing plans monthly, with residents involved. Plans should reflect peoples goals and reviews any actions taken to achieve them with progress and outcomes recorded. The home is also developing a keyworker system, which involves care staff allocated to particular residents and having some specified time to provide them individual support. One staff member comments in their survey the keyworker system is working very well to ensure service users get a chance to do what they want and have their say. The expert reports that two residents say they know about their care plans but others were unsure and did not know what was in the plans or that they could have a copy of their own plan. The expert rightly feels that plans should be accessible to residents and they should be supported to go through and agree what is put in them. Risk assessments are completed but some are rather basic and focus on keeping people safe. There are also protocols in place to help staff manage some peoples challenging behaviours. However risks assessments should also link in with the person centred plans and reflect how residents are being enabled to be independant. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents take part in activities that meet their personal interests and go out in the community. Staff treat them as individuals and respect their privacy. Whilst residents are able to live their chosen lifestyle if development of their daily life skills was facilitated more their independence could be better promoted. Residents are supported to maintain links with their family, friends and representatives and the home provides healthy meals they enjoy. Evidence: Each resident has a weekly activities schedule and it is evident that most people have full, active social lives and use facilities and services out in the community. Some people are able to go out without staff support and as the expert says it is good that X goes out independently and uses public transport. The expert was also told about how some people regularly go to pubs and clubs and meet up with their friends outside Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: the home. It would be good if their plans also reflect how their social and developmental needs are being met, as well as activities they enjoy and participate in. The home has sought and found more educational and work opportunities for some residents, such as IT skills courses at college and voluntary work placements. Others attend day services, although Mrs Magro says such opportunities are now limited. The AQAA states that keyworkers also have dedicated quality time to support people with such as personal shopping, sorting out their clothes and keeping their rooms clean. Mrs Magro says the home has considered if residents could move towards a more independent lifestyle, which is accepted as good practice for younger adults. This should include recognising their responsibilties for the homes domestic routines and for such as their own rooms, menu planning and cooking. A checklist of household tasks has been devised for residents to indicate if they wish to be involved on a voluntary basis. Some people help with such as laying tables, preparing vegetables and the homes shopping. Whilst clearly staff cannot force residents to take a more active role, efforts should continue to encourage, support and facilitate them to be more involved and so develop their daily living skills. Some people told the expert they would like to cook more, make their own packed lunches and plan menus but are not given an opportunity to do so. Staff appear to respect individuals rights and privacy. The expert comments it is good people respect Xs religious beliefs and X has his own key to his bedroom door and said staff knock on my door when they want to come in. One care professionals survey indicates that staff always respect service users privacy and dignity. Some residents belong to an external advocacy group and one is a committee member. Residents are supported to maintain links with their families and friends. The expert was told about peoples friendships and how they and their families visit the home. Social events are also arranged regularly to which family and friends are invited. Some relatives previously confirmed they were kept informed and up to date about important matters. The expert and two care professionals concur with our impression that the home has a warm and friendly atmosphere. Regarding food provided by the home feedback to the expert was that residents like the meals very much. Staff say they aim to promote healthy eating and most meals are home made with fresh meat and vegetables and fresh fruit is always available. One resident told the expert that they make their own breakfast when they wish and the expert comments it is good that mealtimes are flexible and people can eat their meals when they want to. Snack meals are also chosen flexibly although residents do not make their own packed lunches, which some could and should be supported to do. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: Staff know what people like but there is not a choice of main meal and/or residents are not involved in menu planning, which could help them develop their life skills. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal care from staff in ways they need and want. Their health needs are met and where necessary the home has procedures in place for staff to follow. Residents medicines are managed safely by staff if they cannot manage their own. Evidence: Residents personal and health care needs are specified in their care plans and a separate health action plan (HAP), which have been introduced since the last inspection. One resident showed the expert their plan who comments X understood everything that was in their plan and it was easy to read. This is good. HAPs have been set up by keyworkers with residents and (if agreed) with input from their family. They include action planning and reviews and Mrs Magro says it is planned keyworkers will be reviewing and updating the HAPs with residents at least six monthly. HAPs include details of peoples ability to self-care, their preferences and any support they need with bathing, washing their hair, eating and drinking etc. Keyworkers role includes helping residents to buy and look after their clothes and maintain good Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: personal hygiene. Lifestyle issues, such as exercise and diet, are appropriately included in the HAPs. The AQAA confirms that some residents arrange their own health care appointments and they can all see doctors and other practitioners of their choice in the community. When support is needed staff provide it and also make sure that residents have routine and regular health care checks. Specialist health care input is accessed from the community learning disabilities team and a psychologist. Staff at the home have been receiving training from this team on mental health and managing behaviours, and one health care professional reports a positive response to training and that progress has been made. When people have particular behavioural difficulties protocols are in place for staff to help them manage them better and more consistently. Records are kept of all health care input residents receive, appointments attended and where necessary of physical checks such as weight. Daily reports are kept for each person to show any changes and the AQAA states staff know people very well and are always alert to changes in appetite, mood, behaviours and general well being. Regarding medications kept for residents the home has policies and procedures in place for staff to follow. They include for homely remedies and guidance for care homes from the Royal Pharmaceutical Society. Necessary medication records that are kept by the home were checked and found to be maintained and completed appropriately. There are secure storage facilities in the home for residents prescribed medications. A community pharmacist also regularly visits the home to check out their medication system. Staff designated to administer medicines on behalf of residents have undertaken a formal training process and completed training called the use and awareness of medicines in a care home setting. Each resident has a list of the medicines they are prescribed and a consent form to agree that staff can manage them on their behalf. Their ability to self -administer should be assessed and encouraged and some people manage their own topical creams or ointments. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to express their views and if people have concerns about the service they know how to complain. Concerns are listened to and action taken to deal with them. There are systems in place to safeguard residents and follow up allegations. Evidence: The home has a written complaints procedure that is also available in a way that should help people with learning disabilities to understand it more easily. Residents had been given a copy and their relatives previously confirmed they know how to make a complaint. Residents surveys confirm they all know who to speak to if they are not happy about anything; Mrs Magro, staff or their keyworker. Most indicate they know how to make a complaint and all that staff always listen and act on what they tell them. They say they like the staff and managers, who we saw interacted warmly and openly with them. The expert also comments staff seem caring and friendly. Whilst formal residents meetings are not held in the home the AQAA states that residents views are being sought more through keyworkers. They also plan to hold more events at the home with families, advocates etc. invited. Some residents are in external advocacy groups. One care professionals survey says the home responds appropriately to any concerns. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: Staff surveys also confirm they would know what to do if any concerns are raised with them. The commission and home have not received any complaints about the service in the last 12 months. Although a concern was raised with the local authority relating to the homes management of and approach to a residents behaviour. Mrs Magro subsequenly agreed their behaviour had not been managed appropriately. It was agreed that the staff team would take up training in respect of mental health and behaviour management strategies and use community team resources more. Policies and procedures are provided by the home for staff in relation to abuse, adult protection and whistle blowing. All staff received relevant instruction through Learning Disabilites Accredited Framework (LDAF) induction training and NVQ (National Vocational Qualifification) and also recently had training on protection of vulnerable adults. Mrs Magro confirms she is aware of local safeguarding procedures, and how to make a referral, and that staff have been informed so they would know how to report any suspicion or incidens of abuse or neglect of residents. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents at Mariantonia House have a safe, well maintained home that is pleasant and comfortable. The home is kept clean and good infection control is promoted. Evidence: Mariantionia House is a large, detached Victorian house with a corner site on a main road in a residential area of Kidderminster. The home is in reasonable walking distance of the town centre and has local shops and facilities, including a railway station. The original building has a listed status and still retains some character features. The property has been gradually extended so that it now has a dining room and extra bedrooms, so providing more accommodation for residents. The home has lawned areas, two patios, two sitting rooms, two kitchens, a dining area, a laundry room, three bathrooms and a separate toilet for everyone to use. All but one of the bedrooms are single and they have en-suite toilets and shower facilities. The two residents who share a bedroom have made a positive choice to share with each other, having shared for over 30 years. They have a separate bathroom that is available just for their use. Eight bedrooms are on the ground floor. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: The homes environment is pleasant and comfortable and the decor and furnishings are of good quality. The expert comments that my first impression was that the home is very big and there are lots of rooms, adding that although big it has a homely feel and was clean. The expert also says that it is good that residents bedrooms are well personalised and they have their own bathrooms. However he noticed that all the photographs in the communal areas were of the managers family and not residents and says it felt like the people who live there were living in the managers home and if there are going to be personal photographs around the home they should include photographs of the people who live there as it is their home. The AQAA states the home has a stable maintenance programme for its repairs and redecoration and contracts are in place for regular servicing of installations and equipment. Since the last inspection Mrs Magro said they have finished the car parking area, recarpeted some parts of the home and that ongoing repairs and decoration have been carried out. Those parts of the building visited were found to be warm, clean, tidy and fresh. It is apparent that a good standard of hygiene and safety is maintained. The home has infection control policies and procedures in place and staff receive instruction to inform their working practices. They have also undertaken food hygiene training and are provided with any necessary equipment, such as disposable gloves. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have good, safe support as there are enough qualified staff on duty at all times. Their needs are met because staff receive appropriate training, supervision and support from their manager. More thorough recruitment procedures should be followed to ensure residents are protected from possibly unsuitable staff working at the home. Evidence: Staffing levels include four care staff on duty during the day on weekdays and three at weekends. Mr and Mrs Magro live at Mariantionia House and provide a substantial amount of cover in addition to care hours, including being on call every night as there are no waking staff deployed at the home. Since the last inspection an extra care worker has been employed and the AQAA states that staff are now deployed so the keyworker system can be implemented more effectively and so rotas allow a degree of flexibility as service users needs can vary greatly from day-to-day and rotas allow much more one-to-one support. Most staff confirm in their surveys there are always enough staff for them to meet residents personal and social needs. All staff have achieved an NVQ (National Vocational Qualfication) in social care, which is a positive indicator of their competence. Most staff have completed an accredited induction programme, person centred planning instruction and most recently training Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: on mental health and behaviours. Further training is continuing and other courses have been arranged at a local college, including dementia and terminal illness. Staff surveys confirm their induction training covered everything they need to know and they receive training relevant to their role. Their comments include our training is always kept up to date and management are always discussing ideas on how to further our knowledge and understanding of all aspects of our job. Feedback in surveys and from the staff member interviewed is positive about their training and support. Regarding recruitment and selection of new staff the AQAA, Mrs Magro and staff confirm that necessary checks were taken up being they started work at the home. This included an enhanced criminal records bureau (CRB) and protection of vulnerable adults (POVA) check. Although Mrs Magro is aware that two written references are required, one staff record looked at contained written requests sent to the persons referees but only confirmation received verbally by the home that they were satisfactory. It was explained that the applicant is young and only had two previous employers and that references from their last (and only care employer) and a college tutor were not returned. Mrs Magro had spoken to these people about the applicant and obtained verbal references but there should be evidence that written references have been followed up or alternatives sought whenever feasible. Staff now receive regular individual supervision and have an annual work appraisal. One person comments I have been offered appropriate support (professional and emotional) in order to do my job. Staff also all confirm they meet managers regularly, they are approachable and ways of passing information work well. One says in their survey all staff get on well and communicate relevant information throughout the day. We all consider ourselves as part of the team. Staff team meetings are held and although they do not have formal shift handovers they are expected to read the diary and daily reports and are given personal updates from the manager or senior staff. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident in the service at Mariantonia House because it is run appropriately. Practice in the home has been reviewed and is being developed so that residents support is individualised and continues to improve. The environment is safe for residents and staff because good health and safety practices are carried out. Evidence: Mrs Magro has many years care experience and attended many relevant training courses. She has achieved the Registered Managers Award in management and is working towards NVQ level 4 in care. Mrs Magro is clearly very committed to the home and residents and to providing a nice, comfortable environment and a good service. It is positive that more focus on a person centred approach is being developed and efforts made to offer more individualised support to residents. This needs to continue, alongside encouraging, facilitating and promoting their independence. The evidence obtained in this inspection through observation, surveys and the experts reports confirms there is a caring and friendly atmosphere in the home and that residents Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: seem to be happy living there and say that they like the managers and staff. The AQAA contains detailed information about the service and what it does well. It also recognises where they still need to make improvements to develop the service and changes they are making to achieve this. This includes such as continuing to offer staff training relating to residents special needs and finding opportunities for residents within the community to help them develop life skills. These aims should be part of the homes quality assurance and monitoring system, incorporating the views of residents and feedback from other people (such as families and professionals) that the home has obtained through annual evaluation questionnaires. Regarding health and safety within the home staff receive training they need in all the mandatory areas including fire safety, first aid, food hygiene and adult protection. It is good that some residents have also had fire and food hygiene training. The home has policies and procedures in place to promote good working practices. The AQAA confirms that appropriate risk assessments are in place (such as for fire and hazardous substances); checks on fire safety and electrical systems and equipment are carried out and gas installations and central heating are serviced regularly. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Progress to implement a more person centred approach to care planning should continue. This would help to ensure residents are fully involved in planning and reviewing their own care. In this way their personal goals would be identified with actions taken and support given to achieve them. Residents person centred plans should include how they can be supported to take risks. This should show, and help to ensure, that they are being enabled to maintain and/or develop independence. Residents responsibilities in their daily lives should be recognised and efforts by staff to encourage and facilitate their participation in household tasks, cooking and menu planning etc. should continue. This would help to promote the development of their daily living skills and independence. A system should be put in place by the home to ensure that recruitment procedures are as thorough as possible. Specifically that when requests for written references for new staff are not returned by the referees that there is evidence recorded that this has been followed up by the home and/or verbal refrences obtained and that whenever possibe alternative references are sought. This is to help to ensure that residents are protected from unsuitable staff Page 29 of 31 2 9 3 15 4 34 Care Homes for Adults (18-65 years) providing their care. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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