Inspection on 12/08/08 for Mary`s Home

This inspection was carried out on 12th August 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

Mary`s Home 12/06/07

Mary`s Home 03/05/06

Mary`s Home 09/12/05

Mary`s Home 28/04/05

Mary`s Home 29/10/04

Mary`s Home 27/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Mary`s Home 88 Warham Road South Croydon Surrey CR2 6LB Lead Inspector Lee Willis Key Unannounced Inspection 12th August 2008 10:30 X10015.doc Version 1.40 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 Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mary`s Home Address 88 Warham Road South Croydon Surrey CR2 6LB 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) 020 8688 2072 020 8667 9242 hellenappah@hotmail.com Dr Edward N Osei Appah Mrs Helen Appah Position vacant Care Home 29 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (29) of places Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD 2. of the following age range: 50 years and older The maximum number of service users who can be accommodated is: 29 12th June 2007 Date of last inspection Brief Description of the Service: Mary’s Home is a privately owned residential care home that provides accommodation and personal support for up to twenty-nine generally older adults with a past or present experience of mental ill health. Jocelyn Owusu-Asabere was appointed as the homes new acting manager in February 2008 following the resignation of the former registered manager Regina North. Set back from a busy road in South Croydon the home is within fifteen minutes walk of the centre of town and is relatively near a wide variety of local shops, cafes, pubs, and banks. The home does not have its own transport, but hires vehicles as and when required. Furthermore, a bus stop is located just outside the home with excellent links to central Croydon. Built over three storeys this extended detached property comprises of twentythree single occupancy bedrooms, of which sixteen have en-suite facilities; three doubles; a separate dinning room; large main lounge with a designated smoking room attached; kitchen; laundry and sluice room; an office; and staff room. The large garden at the rear of the property, which is mainly lawn, is very well maintained. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 5 The provider ensures information about the facilities and services on offer are made available to prospective service users and their representatives through the homes Statement of purpose and Service users guide. The homes scale of charges currently ranges from £1,697.44 to £2,750 a month. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 2 stars. This means the people who use this service experience good quality outcomes. From all the available evidence we gathered during the inspection process it was clear the service now has significantly more strengths than areas of weakness. All the shortfalls identified at the homes previous inspection were recognised by the provider and appropriate action taken to address them. We spent seven and a half hours at the home. During the visit we spoke at length to four people who use the service, and met six others briefly. We also spoke to the new acting manager, three support workers, and the homes cook. We received thirty nine ‘have your say’ comment cards about the home, of which 26 had been completed by the people who use the service, 1 by a relative, and the rest by members of staff. Various records and documents, including the care plans for three people whose care we had chosen to case track were all examined in depth. The remainder of this site visit was spent touring the premises. Finally, the acting manager completed an Annual Quality Assurance Assessment for the home, which tells us what the service thinks they do well and what they could do better. What the service does well: What has improved since the last inspection? Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 7 The relatively new acting manager has a clear vision about the direction she wants to take the home in and has made a number of significant improvements to the home in the past six months. Care plans have been improved to make them more person centred. Plans now set out in greater detail what support each residents needs to ensure their needs and wishes are met. Furthermore, residents designated keyworkers are now reviewing care plans on a monthly basis and up dating accordingly to reflect any changes in need. Residents meetings have been reintroduced ensuring they have far more opportunity to influence the running of their home. E.g. several day trips to the coast have been organised in response to suggestions made at a recent meetings. The new acting manager is very approachable and this inclusive style seems to be very popular with the residents, their relatives, and staff. Since the homes last inspection new carpet has been fitted in the hallway and a gazebo erected in the garden. All the requirements identified in the homes previous inspection report have been met in full: Call bell alarm cords have been extended to enable them to be accessed from the floor and the proprietor is now visiting the home on a monthly basis to carry out regular quality assurance reviews. What they could do better: All the positive comments made above notwithstanding their remains a number of areas of practice where further improvement is required in order to enhance the lives of the residents as well as keep them safe: The residents must be provided with more up to date contracts that make it more explicit what facilities and services they will be charged ‘extra’ for (i.e. not covered by the basic cost of each placement). This will enable the residents and/or their representatives to determine whether or not they are getting value for money. All the residents must have up to date care plans that include risk assessments regarding challenging behaviour. This will ensure staff have all the information they require minimising the risk (so far as reasonably practicable) of residents being harmed. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 8 When medication is administered it must be clearly recorded and at the time it is given to residents. The way in which the service quality controls and monitors its medication handling practices must also be reviewed as a matter of urgency. Finally, the home must ensure all support workers who are currently authorised to handle medication on behalf of the residents receive refresher training/instruction in the safe handling of medication in a residential care setting. All these measures will (so far as reasonably practicable) enable staff to minimise and recognise poor medication handling practices. The provider has been served with a warning letter reminding them of their medication handling responsibilities and the consequences of failing to keep the residents safe. The Commission must be notified without delay or as soon a reasonably practicable about the occurrence of any significant incident or event involving the residents. This will ensure the residents are kept safe, as it will enable us to monitor more closely how the home manages such incidents. 50 of all the staff who completed our feedback forms told us training was an area where the home could do much better. The home must identify any gaps in its staff teams basic knowledge and skills and develop a training programme to address any identified shortfalls. This will ensure all persons working at the home are suitably competent and qualified to meet the needs and wishes of the residents. The manager must receive training in the local authorities safeguarding vulnerable adults protocols and achieve an National Vocational Qualification in management and care (Level 4). The temperature of hot water emanating from all the homes baths and shower units must be tested at regular intervals (i.e. at least weekly) and appropriate records kept of the outcomes. This will ensure the risk of residents being scalded is minimised. 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. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3, & 5. People using the service experience good quality outcomes in this area. We have made this judgment using arrange of evidence, including a visit to the service. In the main residents and their representatives have access to the vast majority of information they need to decide whether or not the home is the right place for them or their loved one to live, although a lack of transparency regarding the range of fees residents and their representatives can expect to be charged for facilities and services provided makes it difficult for people to decide whether or not they are getting value for money. The providers ensure the needs and wishes of prospective residents are fully assessed prior to their admission, which includes an opportunity for them to visit the home, so the individual, their representatives, and the providers can all make an informed decision about the suitability of the home. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 11 EVIDENCE: “I’ve lived at Mary’s Home for a long time and I love it here”, and “It’s the best place I’ve lived and I’m feeling much better because of it” were comments made by two people who reside at Mary’s home. These residents told us they had been given a copy of the homes Guide, which they kept in their bedrooms. The homes Statement of purpose and Guide have not been up dated to include any information about the fees residents and/or their representatives will be charged for services and facilities provided. However, we accept the new acting managers explanation that because she has only been in post for a relatively short period of time she has not fully addressed this outstanding requirement, although she is in the process of up dating the homes Statement of Purpose and Guide to ensure they include all the correct information. The current Guide is also not available in a particularly ‘easy to read’ version and we recommend the revised document should be written in plainer language and possibly illustrated with some photographs and/or pictures. The acting manager produced a written contract for the homes most recent admission, which set out in detail the individuals terms and conditions of occupancy. The contract had been signed and dated by all the relevant parties and information about the overall care and services to be provided, including accommodation and food, the rights and obligations of both the resident and the provider, and under what circumstances a placement could be terminated. The acting manager demonstrated a good understanding of what constituted ‘best’ practice regarding new admissions. She told us the home had received four new referrals in the past six months of which three were accepted. As part of the admissions process the acting manager was able to produce a copies of the needs assessments she had carried out with the prospective residents before a decision about moving in had been taken. The needs assessment carried out with the homes most recent admission was very thorough and covered every aspect of their person; social and heath care needs and wishes, including religious and cultural ones. It was clear that in declining one referral the acting manager was very aware what the homes aims and objective were and what needs her staff team were capable of meeting. A relatively new resident told us they had been invited to visit the home, meet the other residents, and staff before moving in. The manager told us it was custom and practice for all prospective residents and their representatives to be given the opportunity to visit the home as often as they wished prior to admission. It was positively noted that the manager had allowed the friend of one prospective resident to visit the home on their behalf, as they were unable to do it themselves. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Care plans reflect what is important to the individual resident, their capabilities, and what support they require to ensure their personal, social, and health cares needs and preferences are met. Arrangements for assessing, managing, and reviewing risks are also sufficiently robust to ensure the residents are (so far as reasonably practicable) kept safe, although the way home develops strategies to manage behaviours that challenge must be improved. This will ensure all the residents receive the person centred support that meets their needs. The homes arrangements for handling and monitoring all medicines received, administered and disposed of on behalf of the residents are woefully inadequate. This will need to be improved as a matter of urgency to ensure the residents always receive the correct levels of medication. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 13 EVIDENCE: We looked at the care plans for the four people we had selected to case track. The acting manager has improved the care plan format to make it far more person centred and easier for staff to identify what support residents needed to achieve their goals. Each plan viewed set out in detail the personal, social, and health care needs of the individual; what their strengths, wishes, and aspirations were; and included the care programme approach where a resident was subject to the Mental Health Act. It was also positively noted that care plans are now being reviewed by residents designated keyworkers on a monthly basis and up dated accordingly to reflect any changes in provision. Two residents met told us they knew who their keyworkers were and felt able to talk to them or the new manager if they had a problem. One member of staff spoken with at length was very clear about their keyworker responsibilities, which included reviewing care plans each month. Care plans looked at in detail contained various assessments and management strategies to minimise any risks and hazards that had been identified, including how to minimise residents falling. The manager and a number of the residents told us the behaviour of one resident could challenge the service at times. It was therefore surprising to note this individuals care plan contained no reference to this or management strategies to enable staff to manage the identified risks associated with their behaviour. The homes accidents book showed that the vast majority of the incidents involving the residents in the past year had pertained to falls. Other records, including the homes appointments diary, residents individual daily diary notes and a notice board in the staff room, indicated that staff actively encourage and support the residents to access various health care professionals. Three residents told us GP’s, community psychiatric nurses, and dentists regularly visit the home. During the visit the manager was observed making an appointment on behalf of a resident for them to see their GP after making a request that morning. The entire resident met told us they looked forward to the weekly exercise and movement classes held at the home by an external activities coordinator. Five recording errors where staff had failed to sign for medication given to two residents were noted on medication administration (MAR) sheets sampled at random. It was also noted that none of the medication administered at lunch time (12 noon) had been signed for by 14.30. The member of staff who had been responsible for administering medication at this time was later observed in the main lounge signing all the relevant MAR sheets at 15.00. Furthermore, an audit of one drug, which staff had failed to sign for each time it was meant to been given, revealed a dosage had at been missed. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 14 A senior member of staff told us the homes medication is audited on a monthly basis. It is clear from the poor medication handling practices outlined above that these quality assurance arrangements are woefully inadequate and need to be reviewed as a matter of urgency. Finally, all staff who handle medicines on behalf of the residents need to be more vigilant and improve their basic knowledge and understanding of best medication handling practices. The aforementioned negative comments notwithstanding the acting manager is commended for taking appropriate disciplinary action against a member of staff who recently failed to administer medication at times prescribed by the GP. Furthermore, all Controlled Drugs (CD) held in the home on behalf of the residents were accounted for and the CD register, which two staff had signed each time a CD had been handled on behalf of a resident (i.e. received, administered or disposed of), matched current stocks held. Three residents spoken with at length told us they could have a key to their bedroom if they want and that staff never locked their rooms. Staff were observed knocking on residents doors before entering. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Improvements made to the number of social activities on offer at the home means the residents have far more opportunities to engage in events that satisfy their social, religious and recreational interests. This ensures the lifestyle they experience at the home matches their expectations and preferences. There is always a choice of varied, nutritionally balanced, and appetizing meals available ensuring residents varying cultural and dietary needs are well catered for. EVIDENCE: On arrival two residents were relaxing in various parts of the home in their nightclothes. Both told us they could get up, have breakfast, and get dressed when they liked. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 16 All the residents spoken with told us they were not aware of any restrictions placed on them regarding what time they went to bed or when their loved ones or friends could visit them. One resident told us their ex-boyfriend use to come and visit her at Mary’s home on a regular basis and sometimes stayed for tea. The relative of one resident wrote on a comment card “I can visit the home when I like and staff always make me feel welcome”. Since the homes last inspection the acting manager has reintroduced residents meetings. Records showed these are held on a monthly basis and are well attended. It was positively noted that the acting manager had arranged twoday trips to the coast for everyone after a resident at a recent meeting suggested it. Various records examined showed an improvement in the number and variety of social activities the residents could now choose to participate in, both at home and in the wider community. Typical comments made by residents about activities included, “there is always ample things to do in the home”, “I like joining in the weekly exercise classes”, “the bingo is good”, and “staff let me be – I can smoke in the conservatory or watch television in the main lounge if I want”. During the course of this visit staff were observed holding a quiz in the lounge for anyone who was interested to join in. All the written and verbal feedback received from the residents about the meals provided was extremely positive. Typical comments included “the food is nice and there is plenty of it”, “you always have a choice”, “you can always have a sugar free pudding if you want”, “you can help yourself to drinks”, and “the cooks brilliant”. The two choices of main meal on offer at lunch time of fish in parsley sauce and lamb stew both looked and smelt very appetising and nutritionally well balanced. The fish was served with mixed vegetables and potatoes and was very tasty. The meals served matched those advertised on a board in the dinning room. One resident told us you could ask the cook to make you something else if you didn’t like any of the meals on offer at a particular mealtime. It was positively noted that records of food actually consumed by the residents showed that in addition to the more traditionally English style meals that were served on a regular basis the cook also specialised in preparing Caribbean dishes for those residents who preferred that style of cuisine. It was positively noted that staff actively encourage one resident to make their own Caribbean style food on a regular basis. . Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. The homes arrangements for dealing with concerns and complaints ensure the residents and their representative’s feel their views are listened too and acted upon. Residents are protected from abuse, but the acting managers understanding of local safeguarding protocols and when to report significant incidents to external agencies must be improved to ensure the service is more open and transparent. EVIDENCE: The homes complaints log revealed the four formal complaints made about Mary’s home in the past six months had all be investigated an appropriate action taken in a timely fashion to resolve the concerns raised. Throughout the course of this inspection four residents were observed coming to the office to talk to the manager about their concerns. The office door remained open throughout the day and the manager dealt with all the issues raised in a very professional and prompt manner. Three residents spoken with about the new manager all told us she was very approachable and felt more confident their concerns would be dealt with. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 18 The new acting manager demonstrated a good understanding of what constituted abuse, but was unclear when and to whom to report it if abused was witnessed or suspected in the home. The manager told us no allegations of abuse had been disclosed in the home in the past twelve months. Records revealed that a number of accidents and incidents, which had adversely affected the welfare of the residents, had occurred in the home since she had been in post, which we should have been notified about. The manager was adamant that she would report any incident that adversely affects the welfare of the residents from now on and will remind her staff about their duty of care to keep the Commission informed about such occurrences. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. The overall the interior layout and decoration of the home, including its soft furnishings, ensures the residents live in a relatively comfortable and noninstitutional environment. The homes arrangements for controlling infection are also sufficiently robust to ensure the residents live in a hygienically clean and offensive odour free environment. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 20 EVIDENCE: The main communal areas, including the well-maintained garden at the rear of the property, are very spacious and comfortable places for the residents to sit and relax. Since the homes previous inspection all the environmental requirements made in the subsequent report have been met. Also, new carpets have been fitted in the hallway and a wooden gazebo erected in the garden. A lot of residents were observed having cigarettes in the smoking room and the new gazebo throughout the course of this one day inspection. Several residents told us they enjoyed relaxing in the smoking room, which has recently been fitted with an extractor fan. Two bedrooms were viewed with the current occupants permission. Both residents told us they had enough space to keep all their belongings in their bedrooms. However, while a relatively new single occupancy room in the new part of the building looked very personalised with lots of pieces of furniture, pictures, ornaments and photographs noted, the shared bedroom viewed in the old part looked rather ‘shabby’ in comparison. The curtains, linoleum flooring, the wardrobe, and general décor in this bedroom had all seen better days. Two residents spoken with at length both told us they felt the home had improved its response times when it came to dealing with outstanding maintenance issues, which had been brought to the attention of the manager. The new acting amanger produced the homes new maintenance book, which referred to a maintenance issue one resident, told us about. The temperature of hot water emanating from an ensuite shower unit was found to be a safe 40 degrees Celsius when tested at 15.00. As required in the homes previous inspection report all call bell cords had been extended to enable the residents to access them in the event of a fall. Staff responded within ten minutes to a call bell being activated in a first floor bathroom. During a tour of the premises it was noted the home remains spotless clean and no offensive odours noted. 100 of the written comment cards returned by residents ticked the always box in response to the answer about whether their home was kept clean and tidy. The homes laundry room is suitably positioned so staff do not have to take foul or soiled laundry through any areas where food is prepared stored or eaten. The washing machine has a sluicing facility and a wash hand basin is predominately sited in an adjacent room. Staff were observed wearing latex gloves and aprons at various times throughout the inspection when preparing to give a resident personal care. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Residents can be sure that they are safe because there are enough staff on duty at all times. However, the service needs to improve its arrangements for identifying when there are gaps in staff knowledge and skills to enable the manager to develop training programmes to rectify any shortfalls. This will benefit the residents because suitably competent and qualified staff will meet their needs. Residents have confidence in the staff because the right checks have been done to ensure the suitability of all new recruits to work with vulnerable adults. EVIDENCE: All the support workers who were on duty during this site visit were observed interacting with the residents in a very caring and respectful manner. Typical comments made by the residents included, “the staff are lovely”, “the staff here have helped me recover”, and “the staff are the best thing about the place”. The manager told us that at least three support workers are on duty throughout the day with an additional fourth often employed to cover busy Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 22 periods. 100 of people who returned comment cards wrote there are ‘always’ enough staff on duty. The manager told us her role is supernumerary and that current staffing levels were sufficient to meet the needs and wishes of the residents. It was positively noted that extra staff had been drafted into cover the home while half the residents went on a day trip. The manager’s flexible approach to arranging staffing levels is clearly led by the needs and wishes of the residents and not her staff team. The manager told us she had employed six new members of staff since being appointed. Documents obtained by the home in respect of these individuals, which were all made available on request included: completed job applications; minutes of their job interviews; two written references, including at least one from the individuals previous employer; up to date criminal records bureau and Protection of vulnerable adults checks; proof of identities; and where applicable Home Office approved work permits and or visas. All staff that returned comment cards confirmed their employer had carried out thorough recruitment checks on them before they had been permitted to commence working at Mary’s home. One new member of staff told us their induction had also been very thorough and had covered safe working practices, their role and responsibilities, and the needs of the residents. The staff team consists almost entirely of Black British and Afro-Caribbean female support workers, which does not reflect the ethnic mix of the mainly white British resident group. The manager told us she has very few staff vacancies at the moment, but has agreed to be mindful of this cultural and gender imbalance when she next recruits. 50 of all the written comment cards returned by staff and a lot of the verbal feedback they gave us during the inspection indicated that their training was an area of practice where the home could do much better. The manager told us she believed her current staff team were suitably trained to meet the needs of the residents, but was unclear exactly what strengths and skills her team had acquired and how up to date their training was. The manager needs to carry out a thorough training needs and development assessment of her current staff team as a matter of urgency, and take action to address any gaps in her teams basic knowledge and skills. The minutes of the homes two most recent staff meetings showed they were being held on a monthly basis and were well attended. Both meetings had covered a variety of topics, including the changing needs of some of the residents, keyworker roles and responsibilities, and care plan reviews. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 35, 36 & 38 People who use the service experience good quality outcomes in this area. We have made this judgement using arrange of evidence, including a visit to this service. Resident’s benefit from living in a home that is now run by a competent manager, although she needs to up date some of her existing knowledge and skills to become more effective. Overall, the homes quality assurance and self-monitoring systems are good ensuring all the people who have a major stake in how the service is run can influences its operation. However, residents are being placed at unnecessary risk of harm because not all the homes fire safety and water testing arrangements are sufficiently robust to promote and protect their health and welfare. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 24 EVIDENCE: The relatively new acting manager has worked at Mary’s home for nearly a year. She was first employed as a deputy manager before replacing the former registered manager in February 2008. Jocelyn told us she has well over two years experience working as a senior carer for a domiciliary care agency. She has also recently submitted her application for the Commission to register her as the homes new manager, subject to a ‘fit’ person interview with us. It was evident from all the feedback received from residents and staff that they like the leadership approach of the new manager who is clearly very approachable and keen to operate an open door office policy. However, although the acting manager was able to demonstrate she had a clear vision for the service she will need to achieve her NVQ level 4 (Registered Manages Award) in management and up date some of her existing knowledge and skills in order to perform all her duties as a residential home manager (See requirements No’s 6, 7 & 8). As required in the previous inspection report the proprietor is now visiting the home at regular intervals (i.e. at least once a month) and is producing far more detailed reports regarding his findings. The acting manager told us she found these visits useful and feels supported by the homes owner who is always on hand to offer her advice. Several residents told us they are often given satisfaction surveys to complete. The manager was reminded that the results of any surveys distributed by the home should be assessed and made available to any interested parties, including residents, their relatives, care managers and the Commission. The balances recorded on financial sheets kept in respect of two residents whose care was being case tracked matched the amounts being held by the home on their behalves. There are also receipts for all purchases made by staff on behalf of these residents, and their money is individually stored in lockable tins kept in the safe. We examined the personal files of three members of staff, including a relatively new recruit. Each file contained records of the formal supervision sessions that had each had with the acting manager since February 2008. These supervisions were being carried out on a monthly basis well in excess of the six a year identified in the National Minimum Standards and covered every aspect of care and individual career development needs. However, the acting manager conceded that she is finding it difficult to supervise all her staff on a monthly basis and we recommend she considers delegating some of the responsibility to a suitably experienced senior member of staff. We also suggest that at least one supervision is an appraisal of that member of staffs overall performance in the previous twelve months. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 25 The acting manager was unable to produce a fire risk assessment for the building on request. This will need to be carried out as a matter of urgency. Fire records revealed that the homes fire alarm system continues to be tested on a weekly basis and that fire drills are now being carried out at regular intervals. Two fire resistant doors tested at random both closed flush into their frames when released in line with good fire safety practice. Contrary to health and safety regulations staff are not testing the temperature of hot water emanating from all its baths and shower units at regular intervals (i.e. at least once a week) and appropriately maintaining a record of the results. Up to date Certificate of worthiness were made available on request to show that suitably qualified engineers had checked the homes gas installations, fire extinguishers and alarms, and portable electrical appliances in the past twelve months. The acting manager told us one resident insists on smoking in their bedroom contrary to the homes rules. The manager needs to risk assess the situation taking into account the health and safety implications of allowing to continue while respecting peoples rights to make informed choices. Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 2 Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 27 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 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 OP1 Regulation 5(1)(bb) & (bc) Requirement All the residents and/or their representatives must have access to an up to date Guide that includes details of the total fees payable for facilities and services provided, arrangements for the payment of such fees, and the arrangements for charging and paying for any services additional to those covered by the basic cost of each placement. This will ensure the providers charging arrangements are made far more open and transparent which will enable residents and their representatives to determine whether or not they are getting value for money. All the residents must have up to date care plans that include risk assessments regarding challenging behaviour. This will ensure staff have all the information they require to minimise the risk (so far as reasonably practicable) of residents being harmed. Timescale for action 12/09/08 2. OP7 13(4) 01/09/08 Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 28 3. OP9 13(2) & 17(1)(a), Sch 3.3(i) When medication is administered to residents it must be clearly recorded at the time it is given. This record must include the date on which the medication is administered. This will ensure the residents receive the correct levels of medication and are kept safe. Provider served with a warning letter reminding them of their medication handling responsibilities. 12/08/08 4. OP9 13(2) 5. OP9 18(1)(c) 6. OP18 37(1) & (2) The way in which the service 01/09/08 quality controls and monitors its medication handling practices must be reviewed as a matter of urgency. This will ensure poor medication handling practices are recognised and errors kept to a minimum. This will ensure the residents receive the correct levels of medication and are kept safe. A warning letter issued Re this matter (See Requirement No 3 above). 01/09/08 The home must ensure all support workers who are currently authorised to handle medication on behalf of the residents receive refreshing training/instruction in the safe handling of medication in a residential care setting. This will ensure the residents are kept safe. A warning letter issued Re this matter (See Requirement No 3 above). The Commission must be notified 12/08/08 without delay or as soon a reasonably practicable about the occurrence of any significant incident or event involving the residents. This will ensure the residents are kept safe, as it will enable us to monitor more closely how the home manages such incidents. DS0000025811.V366142.R01.S.doc Version 5.2 Page 29 Mary`s Home 7. OP18 9(2)(b)(i) The manager must receive training in the local authorities safeguarding vulnerable adults protocols. This will ensure the safety of the residents. 12/09/08 8. OP30 18(1) The home must identify any 01/10/08 gaps in its staff teams basic knowledge and skills and develop a training programme to address any identified shortfalls. This will ensure all persons working at the home are suitably competent and qualified to meet the needs and wishes of the residents. The manager must complete her NVQ Level 4 training in management and care (i.e. registered managers award). This will ensure she is suitably qualified to run a residential care home for adults with mental ill health. The building must be assessed for the fire risk it presents to the people that use and work at the service and action taken to minimise any identified hazards or risks. This will ensure the safety of the people who use the service. The temperature of hot water emanating from all the homes baths and shower units must be tested at regular intervals, and outcomes recorded, including any action taken to remedy faults identified. This will minimise the risk if residents being scalded. 01/01/09 9. OP31 9(2)(b)(i) 10. OP38 23(4)(a) 01/09/08 11. OP38 13(4) 12/08/08 Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 30 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. Refer to Standard OP1 Good Practice Recommendations The residents and their representatives should have access to easy to read versions of the homes Guide that includes their views about the standard of care provided at Mary’s Home. This will ensure everyone who has a stake in the service will have access to all the information they need to know about the facilities and services provided, and how much they will be charged for them. The service should develop a time specific redecoration programme to ensure all bedrooms remain comfortable places to reside. The way in which the service recruits new members of staff should be reviewed to ensure the ethnic and gender mix of the staff team is far more representative of the resident group. How stakeholder satisfaction questionnaires are used in the home should be reviewed, as current arrangements means the results of these surveys cannot be made available to any interested parties such as residents, their relatives and other representatives. The way in which the manager supervisors her staff team should be reviewed and this responsibility shared with suitably experienced and qualified senior member/s of staff. Any staff delegated this task should be suitably trained and at least. Furthermore, all staff should have their overall performance and training development needs appraised at least once a year. This will ensure an appropriately trained and supervised staff team supports the residents. The practice of restricting when residents can smoke in their bedrooms should be reviewed and placed with an appropriate risk framework, which takes into account both fire safety, and freedom of choice issues. This will ensure residents are kept safe while their rights to make informed choices are not restricted unnecessarily. DS0000025811.V366142.R01.S.doc Version 5.2 Page 31 2. OP24 3. OP29 4. OP33 5. OP36 6. OP38 Mary`s Home Mary`s Home DS0000025811.V366142.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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