Inspection on 07/06/07 for Martha House

This inspection was carried out on 7th June 2007.

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

The inspector 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

Martha House 08/06/06

Martha House 14/03/06

Martha House 16/12/05

Martha House 13/03/05

Martha House 06/10/04

Martha House 26/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Martha House Hampton Green Old Eign Hill Hereford Herefordshire HR1 1UB Lead Inspector Christina Lavelle DRAFT REPORT: Unannounced Inspection th th 11 &12 June 2007 11:00am-4.00pm & 2.30- Martha House DS0000027684.V333463.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 Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Martha House Address Hampton Green Old Eign Hill Hereford Herefordshire HR1 1UB 01432 279314 01432 271585 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.martha-trust-hereford.org.uk Martha Trust Hereford Limited Mr Peter Andrew Leach Care Home 14 Category(ies) of Learning disability (14) registration, with number of places Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home may accommodate younger adults aged 18-65 years with a learning disability and who also have a physical disability. This home may accommodate children who also have a physical disability. 8th & 9th June 2006 Date of last inspection Brief Description of the Service: Martha Trust Hereford Limited was established as a company in 1996 and is also a registered charity. Martha House was opened as a care home in 1997 to provide accommodation and nursing care for children and younger adults with profound physical and learning disabilities and who are non-ambulant. This mix of age groups is unusual and runs counter to mainstream philosophy and current practice for social care services. However the service was set up in response to a lack of suitable provision in the area at the time. Furthermore the continuity of service beyond childhood is central to the home’s philosophy. Martha House provides lifelong care for twelve service users and the other two places are allocated for respite care to support their families and carers. Martha House is situated in a quiet residential area, about a mile from the centre of Hereford city. The premises are purpose built and the facilities have been developed to address the needs of individual residents and the group as a whole. Service users all have their own bedrooms and there is plenty of communal space. Many specialist aids, adaptations, equipment are provided, including therapy rooms such as a physiotherapy room (with rebound therapy) snoozelen sensory facilities and a hydrotherapy pool. The grounds are large and the gardens were designed to provide a number of separate areas and include raised beds, lawns and patios. Pathways are all level and the gardens can be used for shared activities and as private space. Information about the service provided is available in a Statement of Purpose and Resident’s Guide document, which can be obtained from the home. The fee levels for the service are agreed between the Trust and service users’ funding authorities and are assessed depending on their individual care needs. There are no specific additional charges made by the home. Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a key inspection of Martha House. This means the inspector checked all the Standards that can be most important for people who live in care homes. The first visit to the home was made without telling staff and service users beforehand. Time was spent with service users observing their routines and activities and talking to staff. It is difficult to ask most service users what they feel about living at the home because of their disabilities. Therefore only one service user had completed a survey form about the home, with support from a senior carer. The second visit was spent with the manager discussing how the home is run and any changes made to the service since the last inspection. Thirteen relatives of service users and sixteen health/social care professionals involved with the home had sent in comment cards showing their views of the home. Their feedback is referred to in this report. There was useful information in a questionnaire the manager had completed before these visits and all other information received by the Commission about the home was considered. Various records kept by the home were also looked at and a tour made of the house. What the service does well: Martha House provides a caring and comfortable home within the community for people with high support needs. The home would only offer support to new service users if their needs could be met and they fit in with existing residents. Service users all have a care plan, which they, their family and relevant people make and review often. Plans help staff know their needs and what they like. Service users are supported to lead full and interesting lives. They take part in activities they enjoy and many therapies when at home. They go out into the community and some people attend life skills sessions at local colleges. Service users’ families are very happy with the care at the home. One person comments that “Vulnerable residents are looked after excellently in all aspects of their lives and there is good feedback between relatives and staff”. Staff make sure all service users’ personal and health needs are met and their medicines are managed safely. Health and social care professionals think the home offers good care and that staff work well with them. Two comment “We are impressed with the efforts made to improve care through the provision of therapy and staff training” and “Staff are welcoming and appear receptive”. Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 6 Martha House is very well kept. It has a lot of space and therapy facilities, lovely gardens and bedrooms are personal. The house is bright and staff keep it safe, fresh and clean. All this makes it a nice home for people living there. Staff receive a lot of training, which helps them understand and have the skills to meet service users special needs properly and know how to keep them safe. The home is well run by the Trust and the experienced and qualified manager. The staff team receive good support and all work well together. They are committed to offering service users individual and good quality care. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Thorough assessment and admission procedures are in place to make sure that the home can meet the needs and wishes of prospective service users. EVIDENCE: The Trust provides a criteria and procedure for admissions to the home. They specify an initial assessment will be carried out of potential service users’ needs with information obtained from their family, carers and relevant other people. One service user said they were asked about moving in and received enough information about the service to help them and their family make a decision. The manager and senior nursing staff are responsible for the assessment of prospective service users. The assessment format used is based on a nursing tool, which has been modified to suit the home. Most service users also have a community care assessment carried out by their funding authority, identifying their core needs. It is good their compatibility with existing residents is also considered. The care records of a recently admitted service user were checked and their admission discussed with staff. A senior nurse and care staff had appropriately visited them at their previous residence when their needs etc Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 9 were discussed with their family and professionals involved. Following a trial stay at the home a review was held to confirm the suitability of the placement. Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Service users’ care plans show all their current needs and preferences and so help to make sure they receive the support they want and need. People who use the service are encouraged to make choices in their lives, to the extent they are able. Risk assessments are carried out to minimise possible risks and so keep them safe. EVIDENCE: A sample of service users’ care records was examined. Each person has a detailed care plan drawn up with them when possible, and their primary nurse, family and relevant health and social care professionals. Plans appropriately cover all their personal, psychological and social needs; also, their likes and dislikes, preferred daily routines and abilities. Specific areas of need such as nutrition, continence, communication, exercise and health related treatment plans are included. Plans are reviewed regularly, with relatives etc. involved and so reflect their changing needs. Staff also make daily reports on each Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 11 service users’ activities, health and welfare showing their plans are being followed and so needs met, and providing helpful information about their lives. It is clear that staff respect service users’ individuality and that their needs are put first and foremost. Each service user is allocated a primary nurse, a senior carer and about five other key carers. This ensures their needs are well known as one or other is usually on shift and supports them. This helps personalise service users’ care and staff can spend more time with them and get to know what they like and encourage them to make choices etc. Whilst no current service users have external advocates they all have close family links and their keyworkers advocate on their behalf. The manager is aware of the availability of local advocacy services and says the home would access them if a need arose and for service users without representatives. Risk assessments are carried out as part of care planning and relate primarily to reducing risk from injuries and poor health due to service users’ physical condition, immobility and behaviours. All service users have moving and handling assessments, including the use of hoists and other equipment for which staff receive training. Some are very detailed and photographs show the techniques and equipment involved. Other areas are such as eating and drinking, bathing, hot food, pressure area care and using the pool. Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including these visits to the service. Service users are enabled to take part in a wide range of activities, which they enjoy and benefit from as they help them to relax, develop their life skills and mix in the wider community. Their rights and individuality are also respected and they are supported to maintain links with their families. The home provides wholesome meals that service users like and that meet their needs. Mealtimes are relaxed and service users receive appropriate support. EVIDENCE: The Trust employs a designated activities co-ordinator whose responsibility is to organise on site and community based activities. This role is well developed and she helps to set up activity plans for service users, based on their needs assessment, with the involvement of the physiotherapists and senior carers. Staff understand the expectation that they support service users with activities Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 13 and staffing ratios reflect their high level of needs. The value of employing qualified staff for such as physiotherapy, music and massage and for other complementary therapies and sensory experts is also recognised. Service users’ plans and activity schedules show they participate in a variety of activities to meet their individual needs, both in house and in the community. When at home service users use the hydrotherapy pool and have one to one and rebound therapy sessions with the home’s physiotherapists to improve their mobility, as well as music, art and many other complementary therapies. The home is equipped to a high standard and there are specialist facilities, which are being regularly used. They include two sensory rooms fully equipped with an extensive range of equipment for tactile and sensory development. Sessions are also arranged for service users to experience life skills such as cooking in the service users’ own designated kitchen. The home facilitates community involvement and has three minibuses with lifts and another vehicle that can accommodate wheelchair users. Some service users go horse riding and to cookery, gardening and animal care courses at local colleges, which also provide the opportunity for them to develop outside friendships. Arrangements are made for religious services and some attend a local family service. They are also supported to go to coffee mornings, lunches out, bowling, shopping, cinema, theatre etc and have an annual holiday, based on their individual interests. Care reviews include a review of each person’s activities and it is good new ones are being sought, such as a farm project. Service users’ relatives keep in contact and most take an active interest in the quality of care. Some service users go home on visits and for weekends and their families visit regularly. The home has a designated family room so that visitors can be received in private without disturbing other service users. The manager and staff know relatives personally and invite them to social events at the home. They are all very positive about the care and confirm they are made welcome in the home, are kept informed and can visit in private. They are consulted and involved in making decisions when service users are not able to. The importance of a healthy diet and enabling service users to eat meals they enjoy, whilst receiving appropriate support, is clearly recognised. The home employs qualified cooks and other catering staff. Meals are all prepared from fresh ingredients and seasonal vegetables and fruits are incorporated in the menu planning. The current menus reflect a good range of wholesome dishes that include meat, fish and vegetarian dishes with yoghurts, fresh desserts etc. Service user’s likes and dislikes are also recorded and considered as part of menu planning. To ensure any specialist needs are met input from a Dietician is arranged and records of weight monitoring are kept. Meal times require high levels of support from staff and during this visit there was enough staff available to provide this support and the mealtime was seen to be a very relaxed and pleasant experience. The home provides guidelines and staff Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 14 receive training in special techniques to help them support service users properly and various aids are used to encourage them to eat unassisted. Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Service users are being appropriately supported with their personal care, with attention paid to their dignity and to meeting their complex physical needs. Whilst their health is monitored, with routine and specialist health care input, it would help to confirm that necessary and preventative health checks are being arranged, and that good health is being promoted, if each service user has a Health Action Plan. Service users’ medicines are managed safely by the home on their behalf. EVIDENCE: The Trust provides policies and procedures relating to service users’ health care and how personal care is to be organised and carried out. Staff are made aware of and understand the importance of maintaining service users’ privacy and dignity. Care plans show the personal care they each need and any special needs relating to skin and pressure care, their morning and night time routines and relevant risk assessments. Service users were seen to be well presented and their clothing and appearance reflected their individuality and was age and activity appropriate. The home has an extensive range of moving and handling Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 16 equipment and care staff are required to attend training organised by the physiotherapist relating to maintaining safe practices for moving and handling. Plans outline service users’ medical history with records kept of physical checks for such as their weight, continence and mobility. There are also guidelines for staff relating to special needs and conditions such as epilepsy. Body charts are used to show any rashes, marks and injuries and there are seizure charts. Records are also kept of routine and specialist health care appointments e.g. Dentist and Optician. All appointments that service users attend require staff support and they record the outcomes of visits and treatment prescribed. Health care professionals indicate that the home communicates well with them, there is always a senior to confer with and that staff incorporate their advice into care plans and understand service users needs. They also make positive comments about the home and especially the physiotherapy provided. One GP saying “Excellent care provided…the continuity of carers is very good and helps with communication”. Nursing staff carry out routine health checks such as blood pressure and pulse rate monthly and other checks are arranged through GPs and specialists. It is now recommended by the Department of Health however that service users with learning disabilities should have an individual health Action Plan (HAP), which addresses all elements of their health. In particular HAPs should help to make sure and confirm that all service users’ health related issues have been identified and their good health is being promoted. This includes showing that any special health needs have been recognised and are understood. Also that they are being supported to stay healthy through preventative (e.g. annual well person checks) as well as routine and specialist health care input. Medicines are stored in a designated medication room and suitably secure medical storage cabinets and a fridge are available. There is a clear system in place and facilities for controlled drugs, should they be needed. Each service user’s medication records appropriately include their photograph, details of their prescribed medications and allergies and necessary guidance and protocols for special techniques and bedside rails. All prescribed medications are prepared and administered by nursing staff and service users’ relatives have signed consent forms, as no one is able to self-administer. New staff undertake induction training, working alongside trained staff for a month (one nurse specialises in this training) and then have annual medication management refreshers. They attend external training for specialist treatments and techniques. The home retains Patient Information Leaflets and has an up to date reference book for staff. Records are kept of all medications ordered, which are checked in on arrival and cross-checked again. Respite service users’ carers are contacted before every admission to check medication and any changes. Administration records are maintained appropriately and there are suitable arrangements for disposal of clinical waste and sharps. Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. There are appropriate frameworks in place to enable service users and/or their representatives to express their views and concerns and to safeguard them. EVIDENCE: The Trust provides a complaints procedure and a log to record concerns raised with the home, which would also include details of any investigations with the outcomes. One service user confirmed that they knew who to speak to and how to complain if they wanted to. Whilst their relatives felt able to raise issues with the manager (and most said they have never needed to) some were not aware of the home’s written procedure and should be reminded. There have been no complaints made to the Commission about the home since the last inspection. The staff induction programme appropriately includes instruction relating to abuse, child and adult protection and whistle blowing. The home’s training and development officer has also attended the local Adult Protection co-ordinator’s training session on protection of vulnerable adults (POVA) and the home has a copy of the POVA procedures. They detail the referral process for reporting any incidence or suspicion of abuse/neglect of service users and it is ensured that each staff member is familiar with them. It was previously confirmed that there are clear structures in place to manage service users’ money, with records kept of transactions made on their behalf. Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Martha House provides accommodation that suitably meets all service users’ needs and offers them a safe, clean and comfortable home. EVIDENCE: The home is a purpose built building located in a quiet residential area about a mile from the centre of Hereford city. The house is furnished and resourced to a high standard and over time the Trust has invested in extensive equipment to provide an environment that is stimulating for people with physical, learning and/or sensory impairments. The gardens are lovely and have many different areas and facilities for service users to use and/or sit in, with lawns, benches, shaded and patio areas, vegetables and flowers (some in raised beds). The accommodation is well maintained and the décor, facilities and equipment are of good quality. Designated cleaners and maintenance staff are employed and good attention is also paid to the external grounds. Work to improve the environment is ongoing e.g. the pool area was redecorated recently. Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 19 The bedrooms of lifelong service users are well personalised and decorated to individual taste and there is variety within this. Relatives, when appropriate, were involved in the choice of decoration of their bedrooms. Although not ensuite (and some are smaller than the Standards specify for wheelchair users) the bedrooms have sufficient space for the special beds, chairs, hoist tracking etc necessary to meet service users’ individual needs. The spacious communal areas and designated family room also compensate for the size of bedrooms. All areas of the home were found to be clean, tidy, fresh and bright. The Trust has available an infection control policy and this is a comprehensive document. The arrangements and facilities for laundry and sluicing are suitable. Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Service users continue to be supported by an effective, competent staff team, who know their needs well. Staff receive appropriate training and supervision. The Trust operates thorough recruitment procedures, which should help to ensure that only suitable staff work at the home, for service users’ protection. EVIDENCE: An emphasis is placed on maintaining high staffing levels so that service users receive the personal and social care they need and can have some 1 to 1 input during the day to facilitate their activities. There was observed to be plenty of staff on duty to supervise and support service users with therapies, escort them out and assist at mealtimes. The team comprises qualified nurses, care, catering, domestic and maintenance staff. Administrative staff, therapists, an activities coordinator and a Training and Development officer are also employed. Although staff turnover was quite high last year (and agency staff are deployed regularly) the manager says the home always uses the same agency personnel who work alongside contracted staff. Also, given the size of the team and the Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 21 stable core staff group, the agency staff and turnover does not affect continuity of care. It is good there is a wide age range and ethnic mix in the team, including men to provide same gender care for three lifelong male residents. Regarding staff recruitment one fairly new staff member had appropriately completed an application form, including details of all previous jobs, before attending for interview. The home had then taken up two suitable written references, a police check and verified their work permit. The home’s training officer is involved in staff selection and checks application forms to ensure they have no employment gaps. Declarations of health and convictions are obtained and copies taken of relevant personal documents. Potential staff are introduced to staff and service users and Trustees can also be involved in staff selection. All new staff undertake a full induction and are allocated a mentor from the staff team to support them. They receive copies of the home’s health and safety policy, terms and conditions of employment, a principles of care document and the General Social Care Council code of conduct booklet. Relevant policies and procedures and care related areas such as medication, pressure care and care planning are gone through with them and they sign a checklist to confirm this. Their performance is reviewed after three months and they have to complete a six-month probationary period before the appointment is confirmed. The home’s induction programme is being revised in line with common Standards for Skills for Care, as it is considered good practice for all staff working in learning disabilities care services to have this underpinning knowledge. Regarding staff training much of the home’s training programme is provided in-house by suitably qualified staff. Nursing staff attend “train the trainer” as well as relevant external courses. There is an annual training plan that covers the core health and safety topics, plus care and health related areas e.g. sensory workshops, care planning, continence management, facial and oral tract therapy, cerebral Palsy and Retts Syndrome. Staff indicate this training provides them with a good framework of knowledge and skills which are relevant to their practice. Although less than half the staff team have an NVQ in care (as the Standards specify) there is an ongoing programme in place to ensure this is achieved and staff currently doing NVQ are being regularly supervised by NVQ assessors on the staff team, including the training and development officer. It is confirmed staff receive appropriate support and supervision. Qualified and senior staff have an allocated team of care staff to oversee and the training officer supervises new care staff, catering and domestic staff. Staff meetings are held regularly and communication within the team is good. All staff groups say they feel well supported and can contribute and express their views. In addition report books are completed by managers, nursing and care staff and Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 22 informative shift handovers take place. Morale appears high within the team and staff were found to be open and approachable and to have a caring and patient attitude towards service users. . Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including these visits to the service. Service users benefit from a home that is being well run by an experienced and qualified manager. The Trust’s ethos and the management and staff team approach and practices promote service users individuality, safety and welfare. Systems are in place to monitor and review relevant aspects of the service. This should be developed and result in a plan for continual improvement of the home, based on what service users want and is felt to be in their best interest. EVIDENCE: The Trust has five trustees who participate fully in the business of the charity and the home. There is a Trust Director who is responsible for all aspects of running the company such as finance, administration and maintenance of the premises and a Nursing Director responsible for all aspects of care and staffing. Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 24 They both report to a Board of Trustees and so there is clear leadership and accountability in the home. The Nursing Director and registered manager (Mr Peter Leach) is a qualified nurse who has more than twenty years experience working at management level in the National Health Service. Mr Leach also achieved an NVQ level 4 qualification in social care in 2003 and has undertaken periodic training since then, including IT, a disciplinary investigation course and a NVQ new standards course. He also attends in-house training sessions. The home has a deputy nurse manager who has one working day allocated just for administration etc. Also twelve qualified nurses and fourteen senior carers. In respect of quality assurance and monitoring there is now an onus on registered providers to self assess their care service to ensure good standards are maintained. Also so there is a continual cycle of development, based on the views and wishes of service users and stakeholders. Progress has been made by the home since the last inspection to put systems in place to show the home is being monitored and to assess standards in all relevant aspects. The manager is co-ordinating a quality management review group to meet two monthly, which will review the service and set up quality initiatives. A report of these meetings will be produced and made available to interested parties. Regular audits are already undertaken in areas such as finances, medication, health and safety, accidents and incidents, complaints, maintenance, equipment and care plans. These audits need to be consolidated as part of the formal system of quality monitoring and assurance. The monthly required visits by the provider should also be included and so the resulting reports need to be more detailed and identify any areas to be addressed with action specified and followed up. Reports must also include feedback received from service users, staff and relatives about the service. It is recommended that an annual development plan for the service is produced and copied to the Commission. This plan also showing how feedback from relatives and other stakeholders, through such as questionnaires and care reviews, has been taken into account in the ways the service will improve for the benefit of service users. Regarding the promotion of good health and safety in the home it is confirmed that fire safety is ensured through such as arranging fire drills, training and weekly fire alarm tests. The home’s services, aids and equipment are serviced and maintained regularly and water temperature checks carried out. COSHH risk assessments and suitable arrangements for the disposal of clinical waste and sharps are also in place. The Trust provides health and safety policies and procedures and a handbook for all staff. Staff induction and training includes all the core areas such as fire, food hygiene, moving and handling and infection control. There were no safety hazards identified during this inspection and it was clear staff understand their responsibility and that due attention is paid to maintaining and promoting safety standards and good practice for the health and welfare of service users and staff. . Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 4 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 4 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered persons meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. No. 1 Refer to Standard YA19 Good Practice Recommendations The home should set up a Health Action Plan for each service user to demonstrate more clearly how their health is being monitored and their good health promoted through preventative as well as routine and specialist health care input. Progress should continue to develop a formal quality assurance and monitoring system for the service. This should result in a plan for continual improvement of the home, based on what service users want and/or is agreed by relevant people as being in their best interests. 2 YA39 Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 27 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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Martha House DS0000027684.V333463.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!