Inspection on 12/09/05 for Matrixcare

This inspection was carried out on 12th September 2005.

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

Matrixcare 22/08/06

Matrixcare 15/03/06

Matrixcare 26/07/04

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 Matrixcare 369 Worcester Road Malvern Worcester WR14 1AR Lead Inspector Jean Littler Announced Inspection. 12th September 2005 at 11:00am. 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 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 Stationary 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. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Matrixcare Address 369 Worcester Road Malvern Worcester WR14 1AR 01684 566983 01684 575837 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Matrixcare Care Home 5 Category(ies) of Learning Disability (5) registration, with number of places Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: In addition to the details on the previous page two other conditions have been placed on the Homes registration. 1) The home only accomodates service users with a primary diagnosis of Autistic Spectrum Disorder. 2) Staffing levels are provided in accordance with the Residential Forums care staffing tool. Date of last inspection 26 July 2004 Brief Description of the Service: 369 Worcester Road is the sole concern of Matrixcare, and was granted registration as a care home in April 2004. The building is a converted domestic residence, and provides personal care, social care and accommodation for up to five adults aged between 18 and 65 years who have a learning disability with autistic spectrum disorder. The building is situated in a residential area on the outskirts of Malvern Link, in close proximity to local leisure and shopping facilities. Accommodation is provided on the ground and first floor areas within the home. There are very large secure gardens. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine announced inspection was carried out on a weekday between 11am and 5.30pm. The provider completed a pre-inspection questionnaire to provide additional information. One resident completed a questionnaire with staff support and was able to express some positive views. He did say he would like more chips on the menu. His relatives returned a feedback questionnaire which was generally positive, however concerns were raised about staffing levels and the lack of social stimulation in the Home because occupancy levels remain low. The providers monthly visit reports to the Commission, and other communication with the Home since the last inspection, were all considered as part of the assessment process. The inspector met the residents and saw them interacting with staff. The manager assisted with the inspection process and two staff were interviewed. What the service does well: What has improved since the last inspection? What they could do better: The information about the service should be further developed and should include more detail about what things residents are expected to pay for over and above their basic fees. Systems to assist residents to communicate effectively could be further developed. Arrangements for infection control need to be reviewed and improved. Staff training and development opportunities should be expanded to fully equip staff for their specialised roles. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 6 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. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 4, 5. Suitable information is in place to inform interested parties about the service. This has not yet been produced in a format suitable for the client group. One document need a minor amendment as detailed below. Suitable arrangements are in place to assess the needs of any person referred to the service and transition visits will be designed to suit each individuals needs. EVIDENCE: Both the Statement of Purpose and the Service User’s Guide had been reviewed in August 05. A minor amendment is needed to make it clear when extra charges will be made to residents over and above the normal fees e.g. for holidays and vehicle costs. These charges also need to be explicit in the Terms and Conditions document. The Service User’s Guide needs to be developed into a format more suitable for the needs of the client group. Both residents’ assessments were seen at the last inspection and this standard was assessed as being met. One resident had to leave the service when it became apparent that his complex behavioural needs could not be appropriately met by the service without it impacting negatively on the other residents. The manager is aware of the need to carry out very thorough needs assessments of potential residents. There has been some enquires from interested parties but no other applications have been received for new residents. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 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 standard(s) 6, 7, 8, 9. Good arrangements are in place for planning and reviewing residents’ care and development needs, and for managing any known risks. The residents may benefit from further development in methods of augmented communication. EVIDENCE: Comprehensive care plans and risk assessments are in place. These show that residents’ needs are being fully assessed and carefully planned for. The risk assessments showed due care is being taken to safeguard residents whilst still allowing them to take part in normal activities that benefit them. Both residents have aims and goals identified to help them reach their potential for independence. Reviews are being held at least six monthly with the involvement of representatives. It is positive that there are plans to introduce a person centred planning approach. Staff were seen to make good efforts to communicate effectively with the residents and some systems are in place to support residents to communicate their needs e.g. PECS and Mackaton. This area should be given greater emphasis. The total communication principle should be explored as all forms of communication can work simultaneously if used consistently over an Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 10 extended period. Improved communication methods will allow residents to be more easily consulted about their lives and the way the home is run. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 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 standard(s) 11, 14, 15, 17. Residents are being appropriately supported to develop their potential for independence and take part in enjoyable activities. These areas could be further developed through personal centred planning. Suitable arrangements are in place for residents to keep in contact with their relatives. A healthy and varied diet is being provided. EVIDENCE: One resident had been to college on the day of the inspection. He attends four days a week as part of his individualised activity plan. The other resident has a more flexible plan as he has a serious health condition that impacts on when he can go out. He did go to the shops during the inspection and the manager is keeping his activity arrangements under review. There is potential to further develop activity opportunities through person centred planning. The large garden provides an opportunity for residents to relax and enjoy activities e.g. play football. Vegetables and flowers have been grown this year and one resident enjoys watering them. Staff hope to further develop the gardens to provide a wide range of activities e.g. a sensory garden. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 12 Hobbies and interests are being supported e.g. one resident likes wrestling videos. Staff eat with the residents and are currently trying to encourage residents to remain at the table while others finish their meals. It is hoped this skill will enable them to enjoy eating out. The residents are being supported to assist in the home e.g. setting the table for meals and recycling. Residents are being supported to stay in contact with their families e.g. one resident listens to his grandmother on the phone. The menus showed a good variety of freshly prepared meals are being provided. Both residents have some specific dietary needs and these are being catered for. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 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 standard(s) 18, 19, 20. Personal care is being provided in a personalised manner and residents’ dignity is being safeguarded. Residents’ health needs were being addressed appropriately through links with health specialists. The medication is being managed in a safe manner. EVIDENCE: Both residents interacted with the manager and staff in a relaxed and confident manner. Residents are being supported appropriately with their personal care needs. One resident has been supported to get over a fear of water going on his head and he is now using the shower facility. Residents have personalised towels and bedding, and both were clean and well dressed. Daily routines are flexible depending on residents’ wishes, health and activities. Regular appointments are taking place for dental and other health checks. One resident had a full health check shortly after his admission to the Home. Annual health prevention checks should be included in the health care plans e.g. Wellmans checks. Monthly weight checks are being carried out if the residents agree. Arrangements are in place to closely monitor one resident’s epilepsy to help ensure his safety. He is checked frequently throughout the night and the night staff can quickly alert the member of staff sleeping in if they need urgent assistance. His parents check to see if any suitable products become available for monitoring night time epilepsy. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 14 The medication management and record keeping has been improved. Staff have attended training in the Monitored Dose System but should also attend an accredited course on the management of medication. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 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 standard(s) 22, 23 Arrangements for complaints could be further improved through better recording and the development of a complaints procedure for the residents. A framework is in place to help protect residents form the risk of abuse. EVIDENCE: One complaint had been received since the last inspection. This was from a neighbour about the time fires were lit to burn garden rubbish. This had been resolved quickly. Action taken in response to any complaints should be recorded in the complaints record. The complaints procedure should be developed into a format more suitable for the client group e.g. using symbols. Two of the staff that have left since the last inspection left as a result of their poor conduct being appropriately challenged. It is positive that staff felt able to raise their concerns about their colleagues. Due consideration was given to whether referrals to the POVA register were needed, this was decided not to be appropriate. No issues or incidents have been dealt with under the local multi-agency Adult Protection procedures since the last inspection. The manager was clear about the need to report any allegations of abuse. A clear and suitable Adult Protection procedure was seen, and all staff were signing to show they had read the Whistle Blowing policy. The staff handbook also contained these policies and all staff had a copy of the General Social Care Council code of conduct. Ten staff had attended a half day course on Adult Protection in January 05 and the manager had attended a more in depth course. This training should be provided for any staff who have not attended a course. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 25, 30. The residents’ bedrooms are suitable for their needs and have been well furnished and personalised. Infection control arrangements need to be reviewed in some areas to be brought into line with good practice standards. EVIDENCE: The rooms are large and have been nicely decorated. Furnishings are good quality and comfortable e.g. double beds, large sofas. Both bedrooms in use have been well personalised to reflect the resident’s personal tastes and needs. One has been fitted with sensory equipment that helps the resident relax during the day and settle at night. Infection control is being well managed in several areas e.g. storage of food. Arrangements could be further improved by providing paper towels in areas where staff wash their hands, and by replacing the practice of hand sluicing laundry by the use of red bags specifically designed for this purpose. The manager should consider contacting the Health Protection Unit to enquire about Infection Control Key Worker training. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 36. Suitable staffing arrangements are in place, however staffing for outings needs to be kept under review. Recruitment arrangements are robust. Appropriate staff support structures are in place. EVIDENCE: There is a team of eleven staff and five bank staff. Six staff have left since the last inspection in July 04 and replacements have been recruited. Recruitment records showed that robust checks have been carried out including CRB checks. Staff now have job descriptions and contracts. The rotas showed that a suitable level of staffing was being maintained in the Home. The residents require a high level of staff support particularly when going out in the community. One resident requires two to one staffing so at times outings are limited due to staffing levels e.g. on some weekends. Some of the staff have been approved to work with one resident alone in the Home to help facilitate the other staff going on outings. Staffing levels should be kept under close review whilst the Home is in this transitional stage to ensure the low occupancy and reduced staff team does not impact on the quality of residents’ lives. Training was not fully assessed, however training is being provided in core Health and Safety areas and some specialist areas such as epilepsy. Consideration should be given to a senior worker attending an Intermediate Food Hygiene course so they can provide refreshers and monitor standards in Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 18 the Home. Staff have been working through the LDAF induction and foundation work books and will continue onto NVQ awards. Many of the staff team have not worked with people with learning disabilities before and the staff spoken with felt the team would benefit from more specialist training. It was confirmed following the inspection that there are plans to provide this including autism awareness, positive approaches to challenging behaviours. The manager needs to become fully informed about training plans in the absence of one of the providers who has previously been taking the lead on this. She agreed to explore opportunities to access Total Communication training. The two staff spoken with felt supported in their roles and reported that the team is very committed and morale is good. They felt that the manager and providers are approachable and helpful. A framework is in place to provide staff with support. This includes staff meetings, handovers and supervision. Staff questionnaires are being used to provide feedback to the manager to help with planning as the service develops and the number of staff increases. The team seems keen for more residents to be admitted as prolonged low occupancy has caused some anxieties about the viability of the service and staffs’ long-term employment prospects. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 40, 41, 42. The Home is being effectively managed by the new manager and appropriate records are being maintained. Suitable policies to guide staff have been developed and further work is continuing. Arrangements to manage health and safety are still being developed in line with the standards and some areas for consideration have been highlighted. EVIDENCE: The previous manager left in August 2004. The deputy Mrs Julie Savage has been appointed manager and has applied to be registered with the Commission. She has a diploma in care and is working towards gaining her registered managers award. Once the manager’s registration is completed there are positive plans to recruit a deputy manager. The two providers are closely involved with the service and they provide support for the manager. The providers have arranged for the regulation 26 monthly visits to be carried out by an external professional to help ensure the Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 20 service is reviewed objectively. This person also provides the manager with professional supervision each month. The manager has recently reviewed many of the policies and procedures. Those seen including Adult Protection, are clear and comprehensive. Some are still being developed or are under review e.g. quality assurance, record keeping. A helpful staff handbook has been developed that reinforces some essential policies such as ‘Whistle Blowing’. All appropriate records are being maintained and the good standard of recording made the records informative and useful. Both residents are having their finances managed by their families and appropriate records were being kept of how personal monies were being spent. A check on one resident’s money showed the cash and records balanced. Effective health and safety related checks and maintenance systems are in place e.g. the fire alarm had been serviced in 2/05, gas safety check 2/05. Hot water outlets are restricted and the effectiveness of the valves is being checked regularly to reduce the risk of scalding. A comprehensive health and safety policy is in place and an overall H&S risk assessment is being developed. The provider confirmed following the inspection that the water system has been checked as part of an assessment of the risk of Legionella. The need for covers to be fitted to radiator and hot pipe work should be risk assessed as the residents are potentially vulnerable to scalds from these particularly if they have epilepsy. As detailed above some infection control arrangements need addressing. Matrixcare E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 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 2 3 3 3 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 2 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x 4 x x x x 2 Standard No 11 12 13 14 15 16 17 3 x x 3 3 x 3 Standard No 31 32 33 34 35 36 Score x x 3 3 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Matrixcare Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x 3 3 2 x E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 22 NO 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. 2. Standard Regulation Requirement Timescale for action 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 YA1, 5. Good Practice Recommendations Amend the Terms and Conditions of Residence document to make additional charges explicit e.g. contributions to holidays and vehicle costs. This document must form part of the Service Users Guide. To improve infection control arrangements provide paper towels in staff handwashing areas. (confirmation was received following the inspection that this had been actioned). Stop the practice of hand sluicing laundry. Carry out a risk assessment of the hazards posed to residents by radiators and hot pipe work. Further develop communication methods within the service e.g. using objects of reference and pictorial communication aids. Record any action taken to address complaints in the complaints record book. E52 E02 S59194 Matrixcare V242802 120905 Stage 4.doc Version 1.40 Page 23 2. YA30, 42 3. 4. YA8 YA22 Matrixcare 5. YA 35, 20. Develop the complaints procedure into a format more suitable for people with a learning disbaility. Provide more specialist training, e.g. total communication methods. Continue to promote NVQ awards for staff with the aim of having at least 50 of the staff team qualified. Provide accedited medication training on the administration and management of medication to those staff who take on these responsibilties. 6. 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