Inspection on 22/08/06 for Matrixcare

This inspection was carried out on 22nd August 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Matrixcare 15/03/06

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 22 August 2006 12:00 nd Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Matrixcare Address 369 Worcester Road Malvern Worcs WR14 1AR 01684 566983 01684 575837 matrixcare@aol.com www.matrixcare.co.uk Matrixcare 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) Mrs Julie May Savage Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 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. 15th March 2006 Date of last inspection Brief Description of the Service: 369 Worcester Road is the sole concern of Matrixcare. It was registered as a Care Home in April 2004. The building is a converted domestic residence 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. Each resident has a single bedroom and there is ample communal space including large secure gardens. The service 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 fees currently range between £1388 and £1965 per week. The residents have to pay for their own personal items such as clothes, toiletries and hobby items. Additional charges are made for transport costs, holidays, meals out and entrance fees for all community activities. Information about the service is available from the Home on request or from the provider’s website. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out on a weekday between 12pm and 6.40pm. The registered manager was on duty and assisted with the inspection. The inspector spent an hour in the lounge with both residents and one showed the inspector his bedroom during a tour of the building. The staff were observed interacting with the residents before and during the evening meal. Two staff were interviewed in private. Records and care plans were sampled and the medication and financial systems were inspected. The providers monthly visit reports to the Commission, and other communication with the Home since the last inspection have all been considered as part of the assessment process. The families of both residents returned a questionnaire to the Commission. These indicated they were satisfied with the care provided, however one would like to see more residents move in and for there to be more opportunities for their son to socialise outside of the home. What the service does well: What has improved since the last inspection? The care information has been expanded. The staff have been working more consistently and this has already helped the residents develop and change some behaviours. Psychologist support has been arranged for one resident and this has also helped speed up personal development. One resident has started to build his own person centred care plan. Ways to help the residents communicate more easily are just being developed. Staff are becoming better trained about medication. Systems to help ensure the service is of a good quality have been further developed. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Written information about the Home is being made available to interested parties, but it is not available in a format that would be useful to prospective residents. Contracts are in place with the funding authority for both residents and Terms and Conditions are issued. The needs of prospective residents are being carefully assessed and they are being supported to visit and trial the service before moving in. EVIDENCE: Information about the Home is available in a Statement of Purpose and a Service User’s Guide. These contain the information required by the regulations. A version of this information is not available in a format suitable for people with learning disabilities. The manager and providers do not think this is necessary because any prospective residents visit the home several times before moving in and information is shared verbally. A format should be developed ready for any potential new residents. The same two men are resident in the Home, as at the time of the last inspection, and there are three vacancies. The manager reported that two young men have trialled the service. One has now been assessed as not being suitable, but the other is awaiting a funding agreement and it is anticipated he will move in soon. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 9 The records relating to one of these men’s assessment showed that detailed information has been collated through consultation with his family and the professionals involved in his care. A brief care plan and daily routine has been developed from this information to guide staff about his care needs during the trial visits and over night stays. A formal contract is in place with the funding authority for both residents. The Home’s Terms and Conditions document gives basic information on what residents can expect to pay for, and sets out the terms and conditions of occupancy. The resident’s representatives have reportedly been given a copy of this, but have not been asked to sign and return a copy. The information about what the residents have to pay for on top of the fees could be made more explicit. It is currently not clear what the resident will be expected to pay towards any holiday e.g. staff costs, or what contribution the residents will be expected to pay towards weekly transport costs. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents can be confident that their needs are being kept under review and are recorded in their care plans. They are being supported to take appropriate risks so they enjoy life and become more independent but they could be better enabled to make decisions about their lives. EVIDENCE: Comprehensive care plans and risk assessments are in place for both residents. The manager has invested a lot of time in developing these and the information is under appropriate headings and is very detailed. The plans are being kept under review and updated. Because the information is so extensive the manager needs to check that staff can locate the necessary information easily. 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 e.g. going horse riding, being prevented from harm by running into roads. One assessment that relates to a resident putting inanimate objects into his mouth should include the risk of choking. Both residents have short and long term goals e.g. overcoming a fear of dogs. One is to encourage the Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 11 resident to sit at the table throughout the meals to equip him to eat out in the community. Behaviour intervention plans have recently been developed and agreed with the providers in their capacity as parents and with the relatives of the other resident. These along with some input from a psychology student have already led to improved consistency. 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. Daily records are maintained to record the residents’ wellbeing. These are summarised by the two keyworkers each month. The plans are sampled during the monthly monitoring visits. The manager has acknowledged the areas that have been identified for improvement, such as including entries about progress with development goals. As the staff team is large consideration should be given to each resident having more than one keyworker to help develop the teams skills in care planning. Formal reviews have not been called by the funding authorities this year. The manager has had meetings with relatives about specific issues including development goals and behaviour intervention plans. External professionals have not been invited to these but for one resident a report was provided by the college tutor. In the absence of the external reviews the manager should ensure these are held in-house at least six monthly with input from all relevant parties (in line with standard 6.10). Following contact with one of the local council Person Centred Planning (PCP) coordinators a format is in place and one resident is being supported to start building up the information. A training DVD has been provided for use with the staff team. The folder seen included work sheets for basic maths and things the resident had made e.g. a Christmas card. The worker did not seem clear that some of the contents were the person centred plan. It may be better to separate this into a folder of the resident’s choice and arrange dedicated keyworker sessions to complete it. The care plans contain communication assessments that explained how the residents communicate their needs e.g. staff need to get eye contact before communicating. There were examples of the residents being given choices in their daily lives e.g. what they wanted to eat and drink, the times the get up and go to bed etc. People with Autism do not cope well with unlimited choice, however opportunities to develop choice making skills could be increased if total communication methods were introduced. Networking with other specialist services would help develop the service in this area more quickly. One resident has speech but does not use it to his full potential at times. He became very animated when a member of staff arrived and spoke some Italian with him. As part of meeting his cultural and communication needs this interest should be further explored. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 12 Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are being provided with opportunities for personal development. They are being provided with suitable in-house activities but arrangements for outings need to be further developed. Staff respect the residents’ rights and responsibilities in their daily lives. Both are being supported to maintain close links with their families. Nutritious meals that the residents like are being provided and mealtimes are relaxed. 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. The courses he is attending are changing this year to give him new opportunities for development. This worker finds options for day activities during college holidays. This summer a local project was accessed twice a week that included animal care and horticulture. This was reportedly a great success. He often uses the second lounge as a games room and plays table football with staff. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 14 He also has specific hobbies he enjoys and he will spend time watching his favourite videos and listening to CDs. His care plan referred to a disco, bowling, horse riding and swimming but the care summary for May only mentioned a meal out, weekly parental contact and shopping trips. Summaries should cover why any planned activities did not take place. The resident went on a short break during the summer with his keyworker and had a birthday party recently with a bouncy castle. Staff reported that a friend from college has been for tea a couple of time but that this is not a regular arrangement. When there are only two staff on duty this resident cannot be offered outings unless the other resident comes out as well, which is rare, or unless one of the staff on duty has been approved to support the other resident alone in the Home. In addition to these restrictions staff reported that for various reasons some opportunities for outings are missed. Currently this resident pays any costs for accessing activities. Consideration should be given to funding some activities as part of the care package. The other resident has a totally flexible activity routine apart from horse riding regularly and having contact with his family. He enjoys the large garden and has sensory equipment in his bedroom. He was not offered an outing on the day of the inspection and had not been out the previous day. Over recent inspections a picture has emerged that there are different views about what activities this resident enjoys and can cope with. With the current involvement of the psychology team it would be beneficial to carry out a planned assessment where different activities are trialled by different staff so the most successful set ups can be identified. Other services with residents who have similar needs should be contacted to find out what they access locally. No activities except the college arrangement were indicated on the July rota and only two staff were on in the evenings and at weekends. It would be beneficial to establish an activities budget to promote forward planning. If staff meetings were held monthly they could be better used to monitor activities and to facilitate creative planning. The manager reported that the residents’ independence is being encouraged. Care plans confirmed that goals are in place. For one resident these were skills based such as pouring drinks, dressing and buttering toast. With the psychology input the other resident was being supported with personal care and using a cup for drinks. Staff were seen to offer the beaker during the inspection with good results. The goals are being kept under review and both residents have shown personal development, which is very positive. Staff spoken with put this down to recent clarification about a consistent approach and no changes in the staff team. Staff were seen to interact pleasantly with the residents, however some spoke to one resident in a parental like manner rather than adult to adult e.g. calling him ‘a little monkey’ when he would not get up to help set the table. Staff referred to both residents as boys and lads. This indicates that some staff lack Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 15 adult learning disabilities work experience and could benefit from further training. As discussed at a previous inspection the manager reports that one resident reacts negatively to any suggestion he is a man. This is clearly an area that needs to be addressed if this is the case and psychology support should be accessed if needed and a goal plan developed. There are many areas of need that are being addressed and developed and those working in the Home have different views about these. It would be very beneficial for the professionals currently involved to hold surgeries at staff meetings. Each resident’s family could attend some of these to ensure their views are considered but some should give the staff the opportunity to discuss their views and ideas in private. The menu seen showed a good variety of nutritious meals are being provided. Staff cook the meals and weekly local shopping is purchased by the providers. The deserts on the menu were frequently high in calories. The manager reported that one resident is being encouraged to have a lighter option. Alternatives to the menu are recorded. Food preferences are included in the care plans. As part of the total communication work a set of photographs of preferred meals should be developed to encourage residents to choose the meal they want. The evening meal was observed from a distance. The atmosphere was relaxed but the staff chatted mainly to each other. One resident is being encouraged to stay seated at the table until everyone has finished. Staff asked him once to return but when he got up again they left him. They may want to consider if their conversation affects his ability to sit once he has finished. It was positive that the residents both helped clear their plates from the table. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 16 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): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are being provided with good personal care in a very personalised way. Their health needs are being met with some input from external professionals. Medication is being safely managed. EVIDENCE: 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 and have two baths a day. Both have bathroom facilities that are used exclusively by them in different parts of the building, which helps maintain their privacy. Staff were observed to turn off the listening monitor while assisting one resident with personal care so the people in the lounge could not hear anything. Both residents were well presented and appropriately dressed. The care plans contained detailed information about the way the residents’ personal care should be provided. This showed a great attention to detail e.g. how toenails will be cut. The aim is to provide support in a consistent way that the residents’ prefer. It is positive that with recent psychology input the way one resident’s personal care is being provided is becoming more age appropriate and dignified manner that is providing him the opportunity for personal development. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 17 Records and discussions provided evidence that health appointments are being priorities. One resident has been to the dentist twice in the last year. The continence nurse is involved with one resident. Weights are being monitored periodically. One chart showed the resident had lost a significant amount of weight in the last year. The need to loose weight was not included in his health action plan. Weight, nutritional and how exercise is being provided should all be identified as part of promoting a healthy life style. One resident has recently been to see a consultant about a medical condition and the other had been to a well-mans health check. Daily records showed their health and general wellbeing are being monitored. The care plan for one resident contained clear information about epilepsy and the staff action needed to respond to a seizure. Staff spoken with felt they would benefit from further training in epilepsy. It is positive that the support of external professionals in care planning has been arranged through the community team. It is not clear how long this arrangement will last so the providers may need to consider how the input of experts will be provided long-term to ensure the positive work with residents’ behaviours continues. The medication is being appropriately stored and the key kept securely. Records seen were up to date and showed doses are being given as prescribed. Two staff sign for each dose that is administered to help reduce the risk of errors. It is very positive that more in-depth staff training for medication administration and management is now being provided for staff through the ‘Safe Handling of Medicines’ distance-learning course. Some staff have yet to start this. The manager assesses each workers competency before allowing them to administer medication. A record of these observations and tests are kept and she reported that she has recently reassessed all staff. Medication is checked periodically by the supplying pharmacist and the last audit in February 06 did not highlight any shortfalls. Medication is also checked during the monthly provider’s monitoring visits. This process identified the need to keep internal and external medication separately in the cabinet and this has now been actioned. Care plans contained medication profiles that include the reason the medication has been prescribed. One plan referred to the use of invasive medication. Discussions with the manager showed the information had not been updated to show the arrangements. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Arrangements could be further developed to demonstrate that residents and their representatives concerns are listened to and acted upon. Arrangements are in place to help protect the residents from abuse in most areas. Those relating to resident’s finances are not yet satisfactory. EVIDENCE: There is a complaints procedure in place but this has not been developed into a format suitable for the client group e.g. using symbols or a video. One resident has been provided with symbols of sad and happy faces but the manager reported that this confused him. The complaints information should be developed into an accessible format, as other residents will move in at some stage. Both current residents have relatives and keyworkers to advocate for them. No formal complaints have been received by the Home or the Commission since the last inspection, however one resident’s relatives have periodically expressed concerns that their son does not have regular opportunities to socialise outside of the Home with a peer group. The manager reported to have discussed this with them, however he is still only attending one social event per month. Concerns raised by representatives should be recorded along with details of the action taken to address them. No Adult Protection issues or incidents have been raised since the last inspection. An Adult Protection procedure and Whistle Blowing policy are in place. The staff handbook contains these and staff are given a copy of the General Social Care Council code of conduct. Both staff spoken with said they would report any abuse immediately. Some staff have attended an adult Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 19 protection training course in 2005. Staff who have started since then are being provided with training by working through a workbook. A training video should be considered to support the workbook and generate team discussions at the training sessions. This subject is also included in the Learning Disability Award Framework that new staff are doing. The manager has attended a more in depth course in 2005. As detailed under Standard 41 below the record keeping systems for the management of residents’ finances need to be more transparent and robust to help reduce the risk of financial abuse. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 20 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, 27, 28, 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The residents are living in a clean, attractive and well maintained home that gives them the opportunity to live in the community in a small family style situation. They have private and personalised bedrooms and good sized communal facilities. EVIDENCE: The Home is situated close to the town’s amenities in an established residential area. It is on a busy road so the front door and access to the front of the house from the garden are kept secure. The house has three good-sized communal rooms, an office, large kitchen, laundry, two communal toilets and bathrooms. There are five bedrooms, two of which have en-suite facilities and one which has a bathroom next-door. One of these is currently used as a sleeping in room for staff. The property is being well maintained internally and externally and it is fitted with suitable 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 needed and two of the baths have a Jacuzzi facility. One communal room is used as a games room and this has doors leading onto a patio area in the large enclosed garden. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 21 Consideration should be given to further enhancing the facilities with a sensory garden area and a sensory room or area. The residents were seen to move around the Home freely and they have access to the kitchen. The laundry is kept locked but it is large enough for residents to use with staff support. The Home was clean and tidy and suitable infection control systems are in place e.g. fridge temperature checks and the use of protective clothing. Staff reported that any repairs needed are dealt with promptly. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 22 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The residents are being protected by the Home’s recruitment practices but there are some areas for improvement. Suitable staffing levels are being provided to meet the residents’ support needs in house, but outings are being limited. The residents are benefiting from a well supported staff team but the arrangements to train staff could be improved to help further develop the service. EVIDENCE: At least two staff are on duty at all times when the residents are at home. At night one worker is awake and one sleeps-in. In all, eleven permanent staff are employed as well as the manager and assistant manager. Permanent staff are asked to cover gaps were possible. Agency staff are not used but if any gaps cannot be covered by the staff team two bank workers who are relatives of the providers are used. There are currently no staffing vacancies and there has been no staff turnover since the March 06 inspection. The number of staff will need to be increased when new residents are due to move in. One resident has a dedicated worker for support while at college. The rota submitted before the inspection was for May. This showed that only two staff worked each weekend and in the evenings. One resident usually needs two staff with him at all times because of his medical condition. Three staff have been approved by the provider to stay in the house with this Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 23 resident alone but as detailed above activities still seemed to be limited at times due to staffing. The working patterns are unusual in that the worker sleeping in often has not worked the evening shift or is not on duty the next morning. In some cases a worker is coming back to sleep-in after working a morning shift. These shift systems can tire staff and do not help provide consistency for the residents, which is so important for people with Autism. The rota shows that staff have half an hour to hand over between shifts. The handover process was observed during the inspection and this was carried out in private and appropriate information was shared about the residents’ wellbeing and activities. One new worker has been employed since the last inspection so this file was sampled. This showed that the applicant had completed an application form and had been interviewed by the manager and assistant manager. Records had been made of the interview and how the answers linked to the skills specification. It is positive that the worker had been recruited with a special need, however there was no record of how this being discussed with the applicant or any agreement about what support was going to be provided with some work tasks. Two references had been obtained prior to them starting work. No reply had been received from one other request. This related to a position with vulnerable people up to 2002. No record had been made of what efforts if any were made to follow this up e.g. checking the internet for the company’s correct address or phone number etc. A POVA First check had been obtained but there was no evidence of this on the file. A copy was submitted to the Commission following the inspection. It was positive that a risk assessment had been completed detailing why the manager felt it was safe for the worker to start prior to his CRB check being received, however she was not aware of any exceptional circumstances in the home at the time that justified the worker starting before a satisfactory CRB check had been returned. The legal framework for the use of POVA checks was clearly explained to the provider and the assistant manager during the last inspection and it was also covered in the inspection report. The manager must ensure there is clear evidence of why a POVA First check has been used and which worker supervised the person on shift until the CRB was been received or she is in breach of the regulations. The two staff were spoken with in private. Both reported that a good standard of care is provided for the residents. On being questioned gaps in both staffs’ training needs were identified e.g. one has not attended moving and handling or autism training after being employed for two years. There was also evidence that activities are not being prioritised. They felt the staff team morale is reasonably high. They found their regular supervision sessions helpful and could approach at least one person in the management team if they have any problems. The last staff meeting was in April. These should be held more frequently to allow residents’ needs and the care strategies to be discussed and consistency Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 24 ensured. Now there is psychology input it would be positive for these professionals to periodically hold surgery slots in meetings. This would allow the team to ask them questions about the residents’ behaviours and give feedback on the current intervention plans. New staff are being enrolled on the Learning Disability Award Framework. NVQs continue to be promoted and nearly half of the staff now hold a qualification. Some staff have recently completed distance learning courses for infection control and health and safety. In-house training is through workbooks for adult protection. Staff spoken with confirmed they had attended first aid and in house fire awareness training. Neither had received moving and handling training and one had never taken part in a fire drill. More in-depth medication training is now being provided, which is positive. Both workers said they had not received training on Autism Spectrum Disorder (ASD) since working at the Home. The provider reported that this is covered during the LDAF foundation, but one worker had not done this. Information is available in the Home but staff said it is optional to read this and workshop sessions are not held to help them understand the content and how it applies to their work. One of the providers is reportedly developing a workbook on Autism to use as a training tool for the staff. The Home has been open for over two years so is it essential that the staff now receive training and become specialist support workers in line with the stated focus of the service. There was no evidence of what the First Aid course covered, but the manager reported that this does cover the basics of dealing with an epileptic seizure. Professional epilepsy training has been tried but the provider reported that this was not very useful so it is now given in house. There was no evidence of these sessions or what they had covered. The staff spoken with felt they would benefit from in-depth professional training in this area. The community team could be contacted to see if the epilepsy nurse could provide training that focuses on the needs of the one resident with epilepsy. Staff reported not to have had training about challenging behaviour although the provider reported that all staff have attended the Studio 3 course. From observations and findings from the inspection staff would benefit from total communication training and planning sessions with the psychologists. There continues to be mixed messages during inspections between the provider, the manager and the staff team about the level and effectiveness of the training provided. A full review of training is needed and it would be beneficial if this was conducted by an independent person. The training plan should be reviewed to address the gaps identified in a timely manner. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 25 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): 37, 39, 40, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are benefiting from a well run Home. Systems to consult the residents’ representatives and monitor the quality of the service are now in place. The residents’ rights and best interests are being safeguarded by the Homes policies and record keeping, but their financial records and arrangements need to be improved. The health and safety of residents is being promoted, but training gaps need to be addressed. EVIDENCE: There are two managers who split the role between them, although the registered manager retains overall accountability. For the purpose of this report any reference to the manager relates to the registered manager and the second manager has been referred to as the assistant manger. The manager holds the Registered Managers Award and the assistant manager is due to commence this shortly. The person carrying out the monthly visits provides the manager and assistant manager with support sessions. Both company directors Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 26 take an active role in the management of the Home. One of the providers gives formal supervision sessions bi-monthly. A member of the management team is on call at all times to provide the staff with support. Until now the main way quality has been monitored has been through the monthly unannounced visits carried out by an experienced external professional. The providers should be commended for this investment which provides an objective checking process. This process has proved to be effective with the manager developing an action plan when any areas for improvement are identified. A quality assurance system that includes audits and feedback questionnaires to stakeholders has now been developed. The effectiveness of this cannot yet be assessed. Each review period should result in a report that is shared with stakeholders and the Commission. It needs to show a cycle of improvement. Currently there are no service aims in place for the year ahead. It is good practice to have aims for improving the service that have been developed with the staff team and can be reviewed in staff meetings to foster a shared team owership. The providers need to ensure they respond positively to the views they have already received from stakeholders such as the request from one resident’s relatives for more social opportunities. A comprehensive set of policies and procedures are in place. The manager reported that these have been kept under review and updated as required. These are shown to staff during their induction and they are required to read and sign them. Some policies are also included in the staff handbook. The records seen are detailed throughout this report. Those sampled contained appropriate and useful information. The standard and frequency of record keeping are routinely checked during the monthly monitoring visits. A copy of the staff rotas are now being kept on the premises in line with the regulations. A sample of one resident’s financial records were seen. These showed details are being kept of expenditure along with receipts. The manager balances the records when a page is completed. She reported that she checked more frequently than this but currently does not sign the book to evidence this. The resident is paying for all the activities the staff take him to e.g. horse riding. Records showed he goes out to eat weekly and pays between £5 and £9 a time. He regularly spends £9 for horseriding. The resident is not able to give informed consent about how his money is used and therefore the manager needs to be prudent about how his limited allowance is spent. It should not subsidise the Home’s activities or food budget. This resident has been on a short holiday with his keyworker. The manager reported that she could not remember what the resident paid towards this trip and no records were available to clarify this. The providers reported afterwards that he sent her a memo but this was not forwarded to the Commission to clarify the charges made. The manager also did not know what money is taken from the residents’ Disability Living Allowance towards transport costs. The Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 27 resident’s bank card is held in the Home. Access to the PIN is limited and two staff sign any cash entries in the records. The bank statements are being held by the provider who is a signituary on the account. The bank statements need to be kept or copied for the Home and evidence kept to show they are crossreferenced against the in-house records. All records relating to charges made in relation to the residents’ care must be available for inspection by the Commission or during the regulation 26 visits. The care plan should include details of how each resident’s finances are being managed so the system is fully transparent. Regular checks to monitor health and safety (H&S) hazards continue to be carried out e.g. fire alarm tests. These are monitored during the monthly visits by the providers’ representative. Appropriate infection control arrangements are in place e.g. handwashing and laundry systems. Regular checks are in place to reduce the risk of Legionella. The manager and providers have risk assessed the hazard posed to residents from radiators and hot pipes and have judged that these do not need to be covered. It is considered good practice to cover hot surfaces particularly in areas used by people with epilepsy. This risk needs to be kept under review particularly as new residents move into the Home. Fire drills are being held every six months. The manager has just started to record the names of staff taking part in these drills. The staff spoken with had not taken part in a drill. These records should be used to ensure all staff take part in a drill at the frequency detailed in the fire risk assessment. The manager has attended a professional fire awareness training course. Other staff are provided with training through an in-house workbook. Annual refreshers are shown as planned on the training plan. Some staff have yet to be provided with training on some H&S areas as detailed under ‘staffing’. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 28 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 2 2 3 3 x 4 4 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 4 25 4 26 x 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 x LIFESTYLES Standard No Score 11 3 12 2 13 3 14 x 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 x 3 x 3 3 2 2 x Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 29 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA33 YA12 2 YA41 YA23 17 Regulation 18 Timescale for action Ensure the rotas are arranged in 30/09/06 a way that enable the residents can access activities outside of the Home regularly. All records relating to residents’ 30/09/06 monies or charges made to them or their relative must be held in the Home and available for inspection. Bank statements should be cross-referenced against the records kept by staff. All staff must take part in regular 30/09/06 a fire drills. Provide all staff with Autism 31/12/06 training. Review all training in line with the Home’s Statement of Purpose and make arrangements to fill any gaps in a timely manner. Requirement 3 4 YA42 YA33 YA32 YA35 YA33 13, 18 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 30 No. 1. Refer to Standard YA1 Good Practice Recommendations Develop the Service User’s Guide and the Terms and Conditions of residency into a format suitable for people with a learning disability. (Brought forward). The representatives of residents should be asked to sign their agreement to the Terms and Conditions of residency and a copy held in the Home to evidence this. The content should contain clearer information about what extra charges the residents are going to be charged for above their standard fees. Further develop communication methods to help the residents communicate and make choices e.g. using objects of reference and pictorial communication aids. (Brought forward). Update the care plan regarding the use of invasive medication. Develop the complaints procedure into a format more suitable for people with a learning disability. (Brought forward). All staff should access the free local training in total communication methods. Improve the level of epilepsy training provided and keep clear records to evidence this. Review the staff teams working patterns and ensure staffing changes during each 24 hr period are kept to a minimum to provide consistency for the residents. Increase the frequency of staff meetings to improve communication and consistency, and to plan activities. Arrange for the psychologist to periodically hold surgery slots in staff meetings to discuss the effectiveness of the current intervention plans and any other issues. If possible relatives should be included at some of these. Ensure evidence is kept of what the exceptional circumstances were when a new recruit starts work before a satisfactory CRB has been returned. A copy of the PoVA check must be held on the recruitment file and be available for inspection. Keep evidence that robust efforts have been made to follow up all appropriate references. As part of the quality assurance process improvement aims DS0000059194.V301614.R01.S.doc Version 5.2 Page 31 2. YA5 3. YA11 YA7 YA19 YA20 YA22 YA32 YA35 4. 5. 6. 7. YA33 YA11 YA6 8. YA34 9. YA39 Matrixcare 10. YA41 YA1 YA12 YA23 for the service should be developed with the staff team and the progress reviewed periodically. The manager should sign each time she balances the residents’ expenditure records e.g. weekly. The providers should provide the manager with an activities budget. Review the use of residents’ limited personal funds to access activities. Record clear details of how residents’ finances are being managed in their care plans. Matrixcare DS0000059194.V301614.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Worcester Office The Coach House John Comyn Drive Perdiswell Park Worcestershire WR3 7NW 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.V301614.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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