Inspection on 15/03/06 for Matrixcare

This inspection was carried out on 15th March 2006.

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 12/09/05

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 Worcs WR14 1AR Lead Inspector Jean Littler Unannounced Inspection 15th March 2006 15:00 Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 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 Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 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. Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Matrixcare Address 369 Worcester Road Malvern Worcs WR14 1AR 01684 566983 01684 575837 matrixcare@aol.com 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) Matrixcare Mrs Julie May Savage Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home only accommodates service users with a primary diagnosis of Autistic Spectrum Disorder. Staffing levels are provided in accordance with the Residential Forum’s care staffing tool. 12th September 2005 Date of last inspection 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 and Autistic Spectrum Disorder. The fees for each persons agreed care package are negotiated prior to admission depending on their assessed needs. 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 DS0000059194.V286442.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection was carried out on a weekday between 2.45pm and 7pm. One of the two managers was on duty and assisted with the inspection prior to one of the providers arriving. The inspector met both residents and both allowed the inspector to see their bedrooms. They were observed interacting with staff during the evening. Two staff were interviewed in private. 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. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 6 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 Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 7 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): EVIDENCE: These standards were not assessed, however the same two men are resident in the Home as at the time of the last inspection and there are still three vacancies. The manager reported that two young men were being considered for placement and one was due to come for a visit soon. Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 8 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): 10 Residents’ personal information is being kept securely and staff are aware of the need to keep this confidential. EVIDENCE: Both residents have care plans in place and have recently had review meetings held with their representatives. The managers are aware that these need to be held at least six monthly. The staff spoken with reported that the information in the care plans helps them work consistently with both residents and they write monitoring notes for each shift they work. The worker whose role is to support one resident to attend college four days a week maintains a record in the Home so other staff are aware of any progress or issues. The plans were not seen on this occasion due to the inspector having unplanned and in-depth discussions with one of the providers. The plans are sampled regularly by the providers’ representative who carries out monthly monitoring visits and copies his reports to the Commission. The areas he has identified for improvement, such as making the daily notes refer to each resident’s personal goals, have been acknowledged by the managers. Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 9 A format Person Centred Planning is in place and training has been provided. Contact has been made with the local council (PCP) coordinators who provided an information DVD. Residents’ personal files are held in the office in locked filing cabinets. Current daily recording notes for the last month are held in the lounge. This practice had recently been picked up during a monthly monitoring visit and arrangements were due to be changed. Both staff spoken with had been made aware of their duty to keep personal details confidential and had seen the policies relating to this. Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 10 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, 13, 16. Appropriate arrangements are in place to provide residents with a mix of suitable in-house and community based activities. Staff respect the residents’ rights and responsibilities in their daily lives as far as practicable given their need for support. EVIDENCE: The two residents have very different interests, strengths and needs and therefore have separate daily routines. One attends college four days a week in term time with a support worker from the Home. This worker finds options for day activities during college holidays e.g. a four week summer placement was enjoyed last year and so has been rebooked for this year. The other resident has a more flexible activity routine depending on his health. Staff reported that efforts are continuing to find activities he can enjoy e.g. an evening disco was tried but was not successful. He enjoys horse riding so this has been increased to twice a week. He had also enjoyed going to the pub recently so this was going to be arranged again. In-house the garden is used a lot, one resident seems to enjoy watching staff carrying out tasks, but does not want to participate directly. One resident uses the second lounge as a games room, he also has specific hobbies he enjoys and he will spend time watching Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 11 his favourite videos. The new worker reported that the daily routines were flexible depending on day care arrangements or appointments. She had observed staff giving residents the opportunity to spend time alone while still being monitored. Staff reported that the residents’ independence is encouraged e.g. one resident is supported to take part in doing his own laundry. Development aims are included in the care plan e.g. learning personal care skills, and how to choose and buy clothes. The staff felt they were able to understand the residents immediate needs through the methods of communication they used. One resident knows Makaton signing system and communicated with the inspector using this. Staff have watched a video but because the resident has some language Makaton was not being promoted as it is felt this may stop his language skills developing. Currently a Total Communication Approach has not been adopted as it is felt there will be no benefit for the current residents. The Home has yet to put in place a ‘total communication’ approach. If all types of communication were used together the residents may be enabled to have a better understand their environment, lives, choices, and better express their needs and feelings. Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 12 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): EVIDENCE: These standards were not fully assessed, however from discussions it was clear that both residents were being supported to attend health appointments and their health and general wellbeing was being monitored on a daily basis. The manager reported that professional support has been requested in regards to a specific behaviour pattern. During the inspection one resident needed emergency support for a health condition. Staff were seen to stay calm and respond appropriately offering reassurance and ensuring his safety. Both staff described a daily personal care routine that allowed the needs of both residents to be met in a flexible and responsive way, for example they may have a lie in, have two baths a day. The providers are going to a briefing soon to gain a better understanding of the ‘Knowledge Set’ on medication training published recently by Skills For Care. Following this they plan to then make a decision as how best to provide more in-depth staff training for medication administration and management. In the mean time new staff are going to trial a Safe Handling of Medicines Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 13 distance learning pack. The brief Monitored Dosage System course will also continue to be accessed through the pharmacy who supply the medication. Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 14 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): EVIDENCE: These standards were not assessed, however no complaints or adult protection issues have arisen since the last inspection. Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 15 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, 25, 26, 27, 28, 29, 30 The house is well suited for use as a Care Home and it provides an attractive environment for the residents. Appropriate arrangements are in place to keep the Home clean and in good condition. The bedrooms have been personalised and specialist equipment provided where needed. EVIDENCE: The Home is situated close to the town’s amenities in an established residential area. The house has large well-proportioned communal rooms and bedrooms, two of which have en-suite bathrooms. There is a very large attractive enclosed garden. The property is being well maintained internally and externally and it is fitted with fire prevention equipment. The house has been attractively decorated and furnished with comfortable good quality items. Both residents have personalised bedrooms that reflect their interests and practical needs. Specialist equipment has been provided where this is needed. The Home was clean and tidy and arrangements for managing infection control have been improved e.g. laundry management. Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 16 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): 32, 33, 35, 36. Suitable staffing levels are being provided to meet the residents’ support needs. The providers are continuing to improve the arrangements to train staff so they are better equipped for their role. The residents are benefiting from a well supported staff team with good morale. EVIDENCE: At least two staff are on duty at all times when the residents are at home. One resident has a dedicated worker for support while at college. At night one worker is awake and one sleeps in. In all, fourteen staff posts exist but this number will be increased if new residents are admitted. There is currently one vacancy that has been filled but the worker has not yet taken up the post. The providers representative noted at a recent visit that occasionally staff have worked extended shifts, even covering a day and night shift consecutively, because of short notice sickness. A commitment has been made that this will not happen again, however, further consideration needs to be given to how cover will be provided in these circumstances. Currently permanent staff are asked to cover gaps were possible, agency staff are not used and there are only two bank workers. Rotas are produced on the computer and a copy of the current and last months rota were seen. These showed reasonable shift patterns were the norm, except as detailed above, under exceptional circumstances to cover sickness. The original rotas, that are often amended as arrangements change, are currently Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 17 removed from the Home at the end of each month for payroll purposes. The manager agreed to ensure rotas remain on site in line with the Care Home regulation. The providers had recently informed the Commission that a new worker had been dismissed. He had been employed prior to an enhanced Criminal Records Bureau check (CRB) being returned. As interim measures a check had been received against the Protection of Vulnerable Adults list, references gained, and the man was working under supervision. Subsequent information revealed information that raised serious concern about this mans suitability of the role. The providers did take appropriate action including dismissing the worker and making a report to the Commission and Worcestershire’s Adult Protection Coordinator. The providers have now referred the person to the PoVA list. It was positive that after these events the providers amended some procedures to reflect the lessons learnt. These circumstances were unusual, however they demonstrate the importance of robust recruitment procedures including gaining the full CRB check prior to employment commencing. The providers are intending to start this workers replacement before receiving his CRB check, as they feel the staff team is stretched. The providers and managers must ensure that new staff are only started prior to a satisfactorily CRB being returned in exceptional circumstances. Evidence of what these circumstances are must be maintained and available for inspection. The two staff were spoken with in private. One was new and the other had been in post for two years. Both reported that the service was positive and provided the residents with a good quality of life. They felt the staff team morale was good and the team was effective. They found their regular supervision sessions helpful and both managers were approachable. Both staff had or were due to attend training for their role including first aid, moving and handling, Learning Disability Award Framework foundation units etc. The longer standing worker had missed previous training sessions on adult protection and a fire safety lecture. He was not aware that these were being arranged again, but he did seem aware of essential information in both areas. The managers should ensure he and any other staff with training gaps attend the next courses available. The new worker had not been informed of the details of how all her training needs would be met e.g. when she would attend epilepsy training, but she had found the training so far helpful. As detailed elsewhere the additional in-depth medication training is being looked into. Autism workbooks have just been provided and all staff are going to work through these. Person Centred Planning and Positive Approaches to Challenging Behaviour courses have been held. Three staff are currently working towards NVQ awards and the Home is working towards having over 50 of the staff qualified. A clear training plan for 2006/7 has been provided. Consideration should be given to arranging Total Communication training so Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 18 the managers and staff are fully informed about this approach when considering the needs of the residents. Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 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 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): 39, 42, 43. The home is being effectively managed and the senior team continues to work to improve standards. Suitable arrangements are in place to manage Health and Safety hazards. The quality monitoring systems in place are proving effective, but these need to be further developed. EVIDENCE: A senior support worker has recently been appointed as a second and joint manager. She plans to start the NVQ Registered Managers Awards. Both managers have split the areas of responsibility e.g. health and safety, but both have responsibility to manage day-to-day decisions and provide cover for each other. The new manager will need to apply for Registration with the Commission unless her job description is amended to clearly show that she is accountable to the current registered manager. The main quality assurance system is through the monthly unannounced monitoring visits carried out by a suitably experienced external person. The providers should be commended for this investment which provides an objective checking process. This process is proving to be effective and the Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 20 managers are developing an action plan when any areas for improvement are identified. The organisation is one that is striving to operate openly and continually raise standards. The quality assurance systems need to be further expanded to fully meet the requirements of Regulation 24, which states residents and their representatives need to be consulted as part of any periodic audit. Any review must result in a report being produced showing a cycle of continual improvements. This must be shared with stakeholders and the Commission. It is positive that after full review of recent personnel difficulties with one worker the providers acknowledged that there was a need to further develop the Home’s procedures. Consideration should also be given to both managers attending training relating to personnel management. The events that fell under regulation 37 were reported to the Commission but not when concerns about the worker were first identified. The contact with the Commission is usually through the providers. The managers should increase the level of contact with the Commission as this will assist in developing a constructive relationship, will help evidence the managers’ fitness for their role, and will support the new methods of inspecting which may lead to less frequent inspections. The person carrying out the monthly visits also provides both managers with support sessions. One of the providers also gives formal supervision sessions bi-monthly. Regular checks to monitor Health and Safety areas continue to be carried out e.g. fire alarm tests. These are monitored during the monthly visits by the providers’ representative. Improvements have been made in infection control arrangements e.g. in handwashing and laundry systems. Regular checks are in place to reduce the risk of Legionella. A discussion was held with the provider regarding the risks posed to residents from radiators and hot pipes. The provider agreed to carry out a written risk assessment and ensure reasonable safety measures are in place. Since the inspection confirmation has been received that the assessment has been completed and action was taken to reduce the risk. Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 x ENVIRONMENT Standard No Score 24 4 25 4 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X x x X 2 X X 3 3 Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? N/A 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. 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 YA32Y Good Practice Recommendations Provide training in total communication methods. Continue to promote NVQ awards for staff with the aim of having at least 50 of the staff team qualified. Further develop communication methods within the service e.g. using objects of reference and pictorial communication aids. (Brought forward). Develop the complaints procedure into a format more suitable for people with a learning disbaility. (Brought forward). Develop information about the Home e.g. the Service User’s Guide, in a format suitable for people with a learning disability. Keep accurate staff rotas in the premises and ensure these are available for inspection. Further develop quality assurance systems in line with regulation 24. 2 3 YA11YA8 YA1YA22 4 5 YA41YA33 YA39 Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN 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. Extracts may not be used or reproduced without the express permission of CSCI Matrixcare DS0000059194.V286442.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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