Inspection on 10/11/05 for Martinmass Close Care Home

This inspection was carried out on 10th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Martinmass Close Care Home 13/11/08

Martinmass Close Care Home 14/11/07

Martinmass Close Care Home 11/05/07

Martinmass Close Care Home 09/05/06

Martinmass Close Care Home 07/06/05

Martinmass Close Care Home 22/03/05

Martinmass Close Care Home 09/06/04

Martinmass Close Care Home 17/03/04

Similar services:

Hillside

Applegarth

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Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Martinmas Close Care Home 6-8 Martinmas Close Lenton Nottingham NG7 4HE Lead Inspector Joanna Carrington Unannounced Inspection 10th November 2005 10:00 Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 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 Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 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. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Martinmas Close Care Home Address 6-8 Martinmas Close Lenton Nottingham NG7 4HE 0115 846 1443 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) NCHA Ms Stephanie Hurd Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 07/06/05 Brief Description of the Service: Martinmas Close Care Home provides care and support for up to five adults with a learning disability. It is situated in a residential area of Lenton close to a range of public amenities and within easy reach of Nottingham City centre. All five bedrooms are on the first floor and are single rooms; none are en-suite. There are two shared bathrooms and downstairs a communal lounge and dining room. The physical layout of the home makes it unsuitable for people with mobility problems. Parking is available on two driveways and there is an enclosed garden to the rear of the property. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over four hours on 10th November 2005. This was the home’s second statutory unannounced inspection for this inspection / financial year. At the time of the inspection there were no residents present as they were all at their day services and only the manager was available throughout the entire inspection process. The methods of inspection were discussion with the manager, a partial tour of the premises and checking of residents and staff records. The requirements and recommendations set at the last inspection were followed up and the remaining key standards were also assessed. What the service does well: What has improved since the last inspection? Since the last inspection the manager has now applied for registration. Once all references have been returned then the next stage will be the fit person interview. The manager has now also commenced the NVQ Level 4 Care and Managers Award. The manager is accessing the Nottinghamshire Committee for the Protection of Vulnerable Adults Policy and Procedures appropriately and is now also notifying the Commission of any issues of Adult Protection. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 Page 6 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. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 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 Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 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): X None of these standards were assessed on this occasion. EVIDENCE: Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 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, 7 and 9 Residents’ needs and how to meet these needs are reflected in individuals’ care plans, however, more detail is required for meeting the challenging behaviour of one particular resident. Residents are supported to make choices and decisions in their lives. Risk assessments need further development to ensure that restriction on residents’ independence are rationalised. EVIDENCE: The support plans seen do provide necessary information about how to support residents in meeting their individual needs. Support plans are reviewed at least every ninety days. Relatives / representatives are consulted over residents’ support. This is essentially at review meetings but where there are any significant changes or difficulties then relatives are informed. A resident’s social worker has been involved in the development of support plans, which is good practice. Since the last inspection a support plan for managing one resident’s behaviour has been implemented. However, following some serious Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 Page 10 incidents involving other residents, this has highlighted the need to update this support plan by establishing more individualised and detailed procedures to ensure consistency and ultimately, to protect all residents. The manager has called upon other specialist professionals, including Speech and Language therapist, psychologist and social worker to help in this process. It was evident from the content of support plans that the choices and preferences of residents are always considered. There are support plans for communication, important for staff to be able to promote decision making of residents. Speech and Language therapists have been involved where appropriate and there is a Signs and Symbols board available for staff to refer to. Although there are some good risk assessments already in place, for example road safety and individuals’ preferred activities, it is also important that where a care plan identifies the need to impose a restriction on an individual then a risk assessment is undertaken in order to justify this restriction. For example, there was a support plan seen stating that a resident must only have two units of alcohol and another support plan highlighting the need for a strict healthy diet, different to other residents diet. Both of these support plans require relevant risk assessments. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 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): 12, 16 and 17 Residents have opportunities to take part in appropriate activities and attend day services. Care plans still require further information to demonstrate that the rights and responsibilities of residents are safeguarded and promoted. Residents are offered a healthy varied diet. EVIDENCE: On the day of the inspection none of the residents were around because they were all at their day placements. One resident attends Barncroft day centre, which is where he went before he moved to the home. At the last inspection staff explained how because the home does not have its own transport this means that accessing the community is restricted. The manager reports that there has been some discussion at a higher level about the possibility of a vehicle for the home. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 Page 12 At the last inspection it was noted that residents do not have keys to their bedrooms, which means that their bedrooms are left unlocked. Care plans for Privacy and Dignity need to refer to this, explaining why individual residents do not have keys. This is now outstanding from the previous inspection. It is also best practice that any household chores that residents do are recorded in their individual support plan. This is now also outstanding. The menu plans and the detailed records of what residents have eaten show that balanced nutritious and varied meals are offered to residents, with plenty of fresh vegetables. There are support plans for nutrition and eating and drinking, which identify the food likes and dislikes of residents and preferences regarding eating alone. Records also show that alternative meals are available to residents. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 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): 19 and 20 Residents’ health care needs are met. Improvements to the current medication system are required to ensure that it promotes and protects the safety of residents. EVIDENCE: Residents have regular health care and dental checks. Specialist professionals such as psychiatrists, psychologists and speech and language therapists are accessed in order to address the emotional health care needs of residents. Conditions such as epilepsy and weight of residents is monitored and recorded. In one resident’s support plan to support with weight loss it states that weight is monitored monthly but records suggest that this has not been done for a few months now. The manager reports this is because the resident refuses to go on the scales. This itself should therefore be recorded. At this inspection there were no errors with the administration of medication found. Nottingham Community Housing Association’s own Medication Administration Records (MAR) are used, which means that all instructions are handwritten. This is acceptable but current practice does not ensure that errors will not occur; the MARs are not as clearly written as they should be. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 Page 14 Instructions should not just state how many tablets are to be given at a dose, but the strength of the dose must be specified. There was also some illegible scribbling on the MARs and there is nowhere on the MAR to count in the quantity. Currently, the home uses a pharmacist, which is not contracted with the Primary Care Trust to provide advice and to visit the home. This is best practice as it is helpful in promoting the safe handling of medicines. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 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 and 23 There is an appropriate Complaints Procedure, which assures that residents and their relatives concerns are listened to and acted upon. Necessary action is taken in order to promote the safety and protection of all residents. EVIDENCE: The service user guide and Martinmas Close Handbook contain information on the Complaints Procedure including how to contact the Commission for Social Care Inspection (CSCI). There have been no complaints made in the last year. The residents at Martinmas Close, due to their profound disabilities, will not be able to access the Complaints Procedure themselves. Therefore, it is recommended that relatives and representatives are reminded of this procedure and that staff should also be encouraged to assist residents in accessing the complaints procedure, so that any issues concerning residents are acted on and taken seriously. There have been some recent abusive incidents involving one resident attacking other residents and staff. A notification to the Adult Protection Unit has been made and a multi-disciplinary approach is being taken in how to stop these incidents occurring and ultimately, to protect the other residents. At present, an additional member of staff is being brought on shift to supervise this resident and a Speech and Language has visited the home to observe behaviour. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 Page 16 The manager must continue to ensure that all incidents are monitored closely and also consider very seriously how appropriate the supervision arrangement is in relation to staffing and meeting the needs of all residents. (Bearing in mind this arrangement was in place at the time of the last inspection for two other residents, who are still living at the home). As required at the last inspection the manager is now notifying the Commission when a notification is made to the Adult Protection Unit, so that the Commission can oversee the protection of residents from abuse. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 Page 17 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 Residents live in a homely and comfortable environment but some work to the external décor of the building is required. EVIDENCE: The home is pleasantly decorated with domestic fittings and furnishings throughout. At the rear of the building the external window frames, particularly the kitchen’s, are badly rotting and so is the back door. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 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 and 36 Staff have good opportunities to training, which ensures that the needs of residents are met. Increasing supervision sessions for staff will be of benefit to both staff and to residents. Further information is required on staff files, for the protection of residents. EVIDENCE: Staff have access to both training with the Healthcare Trust and Nottingham Community Housing Association. The deputy manager of the home is responsible for ensuring that staff keep up to date with mandatory training courses and identifying training opportunities to enable staff to be equipped to meet the needs of residents. A training record looked at shows that some training courses attended and due are suicide awareness, autism, cultural awareness, communication, sexuality and abuse and mandatory refreshers. Staff files show that in the past year staff have had approximately two supervision sessions. It is recommended that staff have at least six supervision sessions per year and given the current challenges that residents’ present (See Standard 23) this level of supervision is more appropriate. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 Page 19 In accordance with the Care Home Regulations, the manager is obtaining copies of information that is held centrally, for staff files. However, not all staff have copies of their references on their file, which is required. This is now outstanding from the previous inspection. Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 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): X None of these standards were assessed on this occasion. EVIDENCE: Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X X X 2 3 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Martinmas Close Care Home Score X 3 1 x Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000002253.V261935.R01.S.doc Version 5.0 Page 22 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 YA6 Regulation 15 Requirement Timescale for action 30/11/05 2. YA16 12 3. YA20 13(2) 4. YA24 23 Develop a detailed care plan for the named resident that establishes individualised procedures for how to respond to challenging and aggressive behaviour. Ensure that there are risk 31/01/05 assessments / care plans in place outlining why service users do not have keys and measures in place for respecting privacy and for the security of service users belongings. (This is an outstanding requirement from the previous inspection. Original timescale 31/07/05 not met.) Ensure that there are adequate 30/11/05 arrangements for the recording, handling, safekeeping and safe administration and disposal of medicines received into the care home. (Requirements concerning medicines were set at the previous two inspections. Ensuring a safe system is now outstanding from last inspection, original timescale 30/06/05 not met.) Ensure that the premises of the 31/01/06 care home are of sound DS0000002253.V261935.R01.S.doc Version 5.0 Martinmas Close Care Home Page 23 5. YA34 17, 19 construction and kept in a good state of repair both externally and internally. This refers specific ally to the kitchen window and back door. Ensure that, if copies or original references and all other records listed in Schedule 2 of the Care Home Regulations 2001 are being retained on the premises, that this is for all staff. (This is an outstanding requirement from the previous inspection. Original timescale 31/07/05 not met.) 31/12/05 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 YA9 YA16 YA20 Good Practice Recommendations Undertake risk assessments, whenever a restriction of an individuals’ liberty is imposed. It is recommended that there is a specific care plan for domestic skills for each resident. To promote safe and best practice use the services of a pharmacy that are contracted with the PCT to provide advice to the home about the medication system and to visit twice per year. Remind relatives and representatives of the Complaints procedure and encourage staff to assist residents in accessing the complaints procedure, so that any issues concerning residents are acted on and taken seriously. Monitor and periodically review the ‘shadowing’ arrangement in place for one resident to ensure that this is the most effective way of managing this residents behaviour, without impacting on providing for and meeting the needs of all other residents. All staff to have at least six supervision sessions per year. 4. YA22 5. YA23 6. YA36 Martinmas Close Care Home DS0000002253.V261935.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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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