Inspection on 05/08/08 for Mayfield

This inspection was carried out on 5th August 2008.

CSCI found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mayfield 07/09/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Mayfield 7 Horton Road Gloucester Gloucestershire GL1 3PX Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 5 and 7th August 2008 09:00 th Mayfield DS0000067085.V362060.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 Mayfield DS0000067085.V362060.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. Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mayfield Address 7 Horton Road Gloucester Gloucestershire GL1 3PX 01452 530004 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) enfys.groombridge@brandontrust.org www.brandontrust.org The Brandon Trust Enfys Groombridge Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (2), Sensory impairment (1) of places Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th September 2006 Brief Description of the Service: Mayfield is a large detached house, which is registered to provide care and accommodation for up to nine adults with learning disabilities. The home is close to the centre of Gloucester. Service users are supported to access local facilities such as the Post Office, shops and the library. The home has transport appropriate for service users needs and is close to bus routes and the railway station. There are two bedrooms on the ground floor as well as a bathroom with an adapted bath. The remaining bedrooms are on the first floor, along with additional bathroom and toilet facilities. The home has a spacious lounge, dining room and kitchen. There is also a large garden. The Brandon Trust runs the home. According to information from the inspection, fees are in the order of £1100 per week. Additional contributions are made towards the cost of transport. Prospective service users are given information about the home including copies of the Statement of Purpose and Service Users Guide. The latter includes some information about what is covered by fees. Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This inspection took place in August and included two visits to the home. Time was spent with people living in the home, interviewing staff and on the second visit talking to the registered manager. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). An Annual Service Review had been completed in May 2008 when people living in the service and their relatives, health care professionals and staff had returned surveys giving their views on the service provided. Some of this feedback has been included in this report. A range of documents were examined including care plans, medication and financial records, staff files, health and safety and quality assurance systems. Several quality outcome areas for this home were rated as excellent and a number of individual standards were also rated as excellent indicating that in some areas people are receiving a service providing high standards of care. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: People are involved in developing care plans that reflect their wishes and needs. There is a strong commitment to making information accessible and meaningful to people living in the home. Excellent use of photograph, symbol, Makaton and visual aids enable people to express themselves and determine their lifestyle and day-to-day activities. People living in the home are treated with respect and as individuals. They were observed choosing how to spend their time listening to music, doing art, helping lay the table and clearing away. Several people said they were looking forward to holidays. One person said staff were supporting them to go swimming and to go horse riding. People’s personal and healthcare needs are met in a way that is sensitive to their preferences. Staff are knowledgeable about the needs of the people they support. People living in the home said that they liked staff and relatives said they were very caring. Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Mayfield DS0000067085.V362060.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 Mayfield DS0000067085.V362060.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Satisfactory admission arrangements are in place that includes an assessment of people’s needs. Ongoing re-assessment of people ensures that the service is continuing to meet their changing needs. People need to have information about the service they receive and how much it will cost. EVIDENCE: There had been one new admission to the home who had been placed there on an emergency placement. We (The Commission for Social Care Inspection) had been informed at the time. There was evidence that assessment information had been collated by the home and that the placing authority had supplied their assessment of needs and care plan prior to admission. The AQAA stated, “As the manager I am responsible for ensuring that no one is disadvantaged by an admission due to lack of proper assessment and consideration of the needs and preferences of the individual/s involved. The person who moved into Mayfield had a care Management assessment that was completed by the care manager and the individual. An independent advocate was already appointed to work with the individual, and played an active role in ensuring the temporary placement was appropriate to meet the assessed needs of the person.” The registered manager confirmed that a new admissions policy and procedure was being put in place and waiting for Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 9 approval from Brandon Trust. There was also evidence that people involved in developing person centred plans were identifying changes to their needs, wishes and desires which included moving to different types of care provision. Where this had been identified people were being supported to move on with full consultation of other people involved in their care. Although people had a copy of their licence agreement with the housing association in place, they did not have an individualised copy of the terms and conditions that were in place with Brandon Trust. Mayfield DS0000067085.V362060.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, 9 and 10. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A person centred approach to care planning provides the opportunity for people to take control of their lives. Imaginative use of resources enables people to express their wishes and needs. Risks are being managed safeguarding them from possible harm. EVIDENCE: The care for three people was case tracked. This included reading their personal files, examining their medication and financial records, observing the care provided to them and talking to staff about the support they provide. The home was introducing new person centred plans to complement the “Planning for Life” and “Essential Lifestyle Plans” already in place. In time these would replace some care plans and risk assessments that had been altered by hand. There were indications on some plans that they had been sent for retyping. The AQAA stated, “We will be looking to better enable Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 11 people to make informed choices about their lives, to include; where they want to live, how they want to spend their time, what support they want and need.” Staff described the process whereby they involved people living in the home, their relatives and other healthcare professionals in the development of these plans. One person living at the home said that staff had supported them to type their plan after talking about their wishes and plans for the future. Good use was made of symbol, text and photograph throughout these plans and there was evidence that people had been asked to sign documents where appropriate. Each person had a series of care plans that provided a holistic overview of their physical, social, intellectual and emotional needs. Daily diaries reflected on each individual care plan providing a picture of how their needs were being met on a daily basis. This is good practice. Monthly reviews were taking place for each care plan but comments mostly ranged from ‘no change’ or ‘ongoing’, occasionally noting that changes had taken place but not what. It would be helpful if some of the content of the daily diaries was summarised and transferred to the monthly reviews commenting on what had been achieved, what had worked and what had not and what changes had been made. One key worker had produced a feedback sheet after the monthly review with areas of concern. This is good practice. There was evidence that annual reviews were taking place within the home with the key worker producing a report with the person living in the home. Handover sheets were also being kept which provided a snapshot of what each person was doing each day and how they were feeling. People were observed being offered choices and the opportunity to make decisions about their daily lives. As far as possible these were respected. Staff were observed discussing, negotiating and compromising with one person due to changes in their planned day and reaching a conclusion which was agreeable to the person. Staff provided opportunities for people to make informed choices using photographs, objects of reference or sign language to reinforce the spoken word. At all times staff were observed being open and approachable and peoples’ expectations indicated that staff would respond to their wishes and requests. Excellent systems for communicating with people were observed to be in place and to be continually evolving to adapt to people’s needs and responses. The new plans should also include reference to people’s choice about the gender of staff providing their personal care and whether they have keys for their rooms. Each person had a communication profile which for some included, “How I communicate” and for others information about ‘When I do this’, ‘It might mean’ and giving staff guidance about what to do. There were also excellent Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 12 examples of guidance for staff about how to support people with autistic spectrum disorder, giving step by step guidance about how they like to be supported at a multi sensory room or when they go out. Good use of picture was made in these documents to illustrate the support needed. Risk assessments were in place providing an analysis of hazards for a range of different situations, individualised to each person and relating to their care plans. These documents were regularly being reviewed. A missing person’s procedure was in place with most people having a profile that included a photograph. This needs to be reviewed to reflect changes of people moving out and new people moving into the home. Personal information about people living in the home was seen to be kept in the main office off the kitchen which had a keypad that restricted access. Although files were not locked away in cabinets good practice was observed to be in place with the office being locked when not in use. Mayfield DS0000067085.V362060.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home make choices about their lifestyle, and are supported to develop life skills. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. People have a nutritional diet and their diverse needs are catered for. EVIDENCE: In the kitchen a notice board provided a photographic timetable of activities for each person indicating that they were being supported to access a range of pursuits both inside and outside of the home. A community map was being put in place providing people with a pictoral map of what amenities and activities were available to them locally. Daily diaries confirmed whether people had chosen to participate in these activities and also identified when they had decided not to become involved. People were accessing college Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 14 courses including a gardening club, a sensory room, swimming, ten pin bowling, walks around their locality, shopping, cinema, drives and visits to places of interest. One person had identified in their care plan that they would like to be supported to go horse riding and they confirmed that they had visited a stables. People were being supported to attend church on a regular basis. Staff confirmed that an art therapist and reflexologist visited the home on a regular basis. The home had recently become involved in a local ‘Fairshares’ scheme and staff said this had proved successful providing the opportunity to hold a coffee morning and outings and to mix with other volunteers. People were observed being supported around their home. One person liked drawing and painting and had been supplied with their own desk. Another person with a sensory disability had been provided with a personal television. This person loved the sensation of helium filled balloons and staff confirmed that they have access to a regular supply. Others were helping around the home, making drinks and clearing away. One person said they enjoyed cooking and helping with the shopping. According to daily diaries others were supported to help clean their home and help with the laundry. Visiting relatives said they were always made to feel welcome and visited as often as they could. They met with their relative in the main lounge and were offered refreshments. Record of contact with families was kept on each person’s files and it was evident that staff were supporting people to maintain contact by post, telephone or visits. Care plans and risk assessments confirmed that people were being supported to develop personal relationships. As mentioned excellent total communication approaches were evident around the home. A notice board in the dining room provided people with a picture of the evening meal. People were being supported to purchase items of food or drink for their individual use from the house’s budget. Each person had a cupboard and allocated space in the freezer to store this and had chosen pictures to display on the cupboards to reflect the contents. Cupboards had a key and lock. People were observed discussing their meal choice with staff and it was evident that alternatives to the main meal were being provided. Menu choices were recorded for each person on their personal files. A dietician had been involved for people suffering from constipation and natural remedies such as dried fruit or juice recommended. During the visits people were offered these as well as fresh fruit and other snacks. Staff were promoting a healthy lifestyle including freshly produced meals alongside frozen products. People were observed helping themselves to salad to go with their main meal. Some people liked to go out for the occasional meal and staff confirmed the cost of this came from the house’s budget. Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, 20 and 21. People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Personal care support is offered in a way that responds to people’s needs and preferences, promoting people’s dignity. There are some improvements in the administration of medication that need to be implemented to safeguard people from the risk of error or possible harm. EVIDENCE: The way in which people would like to be supported with their personal and healthcare needs was clearly identified in their care plans. Staff meeting minutes evidenced that the way in which personal care was delivered was being monitored and addressed as issues arose. For instance staff were given guidelines about discretion and respect for the individual when asking them if they needed to use the toilet. Flexibility around times for getting up were observed with one person deciding to have a leisurely start to the day, a soak in the bath and late breakfast. Guidelines were in place for male staff should they need to provide personal care and how this should be offered respecting the dignity of the person they were supporting. Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 16 Assistive technology such as specialist equipment or adaptations had been provided to some people living in the home. An assisted bath was available on the ground floor and the home had identified the need for a wet room on the first floor. Advice was being provided from other healthcare professionals where needed. It was evident that the changing needs of people were being monitored and that strategies were being developed to support people should they be needed, this included obtaining the relevant equipment. Staff said that wherever possible this would only be used when the person’s needs indicated that they could no longer cope safely without the use of additional aids. A listening device was in place in the office. The registered manager said this would be used when people had been discharged from hospital or needed monitoring during the night. A protocol providing guidance for the use of this was not in place. Entries in daily diaries and the handover sheet indicated that at times staff were identifying bruising or scratches to people. Whilst maps were in place for people’s feet there was no evidence that body maps were being used to monitor these issues. People with a Community Psychiatric Nurse appeared to have regular contact with good communication evidenced between the Nurse and staff. People had access to advocates and staff had received information about the Mental Capacity Act and were knowledgeable about consent and the need for best interests meetings. Each person had a health action plan in place and robust records were kept for healthcare appointments indicating regular access with Doctors, Opticians, Dentists and Chiropodists. Outcomes of appointments were recorded. The home had frequent contact with the local Community Learning Disability Team and was seen to be implementing monitoring forms as requested by them. Where people had refused treatment this was being recorded with the reasons why. Staff were working creatively to support people with their healthcare appointments. Excellent records were in place detailing best interests work with people living in the home particularly around health care and possible treatment. Relatives said that the staff had supported their relative through sickness, keeping them informed about their condition and enabling them to regain their independence. They were delighted with the support provided by the home at this difficult time. Systems for the administration of medication were examined and found to be mostly satisfactory. Staff had completed training in the safe handling of medication. Medication was dispensed in blister packs with additional medication in boxes. Stock records were maintained for the latter. Two people had countersigned any handwritten entries. Spoiled medications were identified on the administration record and in the returns book. Any mistakes Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 17 were noted and action taken recorded. We had been kept informed of any medication errors. Staff explained the procedure in place for administering medication to people and this was satisfactory. Each person had a medication profile and a protocol for the administration of ‘as necessary’ medication. It did however appear that when people leave the home during the day and need to take medication staff put this into a compliance aid. The home must make sure that they put in place the following: • A risk assessment alongside a written procedure, this should include which staff are permitted to put medication into a compliance aid, what containers are to be used, how the containers are to be labelled and what other information is to be given • A clear record of all staff involved in each stage of the procedure and the actions taken. A list needs to be in place with staff names and their corresponding initials so that any entries on the administration record can be identified. The temperature of the medication cabinet needs to be monitored to ensure that it is below 25°C. Some homely remedies were seen to be in place and although the home’s homely remedy policy said that a record must be in place authorised by the home’s Doctor or Pharmacist this could not be found on the first visit to the home. The registered manager confirmed that one had been in place but could not be found. One person was being supported to self medicate and staff explained how they were being supported to put medication into a compliance aid and then administer the medication themselves. A risk assessment and protocol were in place providing clear guidance about how this was to be carried out and who had responsibility for each task. A self-medication consent form was also in place. The home had two copies of a BNF but the most recent copy was dated 2005. The AQAA stated, “We have recently led a request within the organisation to contribute to the Mencap survey death by indifference. We have a particular interest in the rights of people to access equality in healthcare. Two staff members have been involved in working with the Gloucester health promotion team to improve the understanding of healthcare providers, to the particular issues of importance for people with a learning disability. One member of the team has with a householder in another home developed the When I die booklet which is actively being promoted for publishing by the Health Facilitation team for Gloucestershire.” Each person had details on their care plans about their personal wishes in respect of dying and death. Mayfield DS0000067085.V362060.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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place, which enable complaints and concerns to be raised by people living in the home or on their behalf. Appropriate safeguards are in situ that help protect people from the risk of harm and abuse. EVIDENCE: The home has a complaints policy and procedure that had been produced in a format using text, picture and symbol. The document called “I want to complain” was displayed in the entrance hall. The home had a complaints file in place but had not received any complaints since the last inspection. This was confirmed in the DataSet supplied with the AQAA. People were observed discussing any concerns they might have directly with staff who listened to them giving them immediate feedback to resolve their concerns. Relatives indicated that they would talk to the registered manager if they had a complaint. The AQAA indicated that all staff had attended training in the safeguarding of adults and the registered manager said that refresher training had been identified for this year. The AQAA stated staff were provided with guidance about the whistle blowing policy and procedure during induction. New staff confirmed this. The home had worked with the local adult protection team to ensure the safety and well being of one person living in the home. Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 19 Guidance was in place for people who may become anxious providing staff with known triggers, diversions and action to take. The home does not use physical intervention. Staff spoken with had a good understanding of how to support people through their anxieties. Financial records were examined for the three people case tracked. Robust records were in place with evidence of regular checks. Staff were observed at handover doing a daily check. Receipts were obtained for all expenditures and could be clearly cross referenced with records. Each person had a financial support record in their care plan which indicated whether they needed support to manage their personal finances. People have a bank account which was regularly being audited. The registered manager said that savings accounts were being put in place for some people. Mayfield DS0000067085.V362060.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,29 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. Improvements in infection control would prevent people becoming ill due to poor hygiene. EVIDENCE: A walk around the environment including communal areas and some people’s rooms was conducted. The home had been redecorated throughout internally and externally and new flooring fitted in many areas providing a much lighter ambience to the home. People’s rooms were decorated to reflect their interests and lifestyles. A sensory environment had been provided for one person in their room. Assistive technology was being researched and resourced where necessary and seen to be in place throughout the home where needed. The home appeared to be responsive to the changing needs of people living there. Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 21 Issues identified at the previous inspection had been actioned including making sure hazardous products were stored securely, stripping and varnishing the dining room table and chairs and replacing the boiler in the kitchen. The registered manager had identified that sofas and chairs in the lounge need replacing. Feedback from healthcare professionals indicated that they had concerns about the lack of privacy for meetings in the home having to use communal areas. At the time of the visits the home was clean and tidy with no offensive odours. Laundry facilities were next to the kitchen and staff indicated that they walk through the kitchen to wash their hands in the nearest hand washbasin. There was a sink in the laundry that staff said was used for washing mops etc. Consideration should be given to supplying antibacterial scrub in the laundry should staff be dealing with soiled laundry. Likewise it was noted that in communal toilets/hand washing facilities towels were being used. Liquid soap was being provided. The AQA A confirmed that the home was in the process of implementing the Department of Health’s ‘Infection control guidance for care homes.’ Mayfield DS0000067085.V362060.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 35. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are met by a competent staff team, who have access to a comprehensive training programme that provides staff with the opportunity to gain knowledge about the diverse needs of people living at the home. Improvements need to be made to recruitment and selection processes to make sure people are safeguarded from possible harm. EVIDENCE: There were areas of this outcome group that were excellent such as staff awareness of their roles and responsibilities and training. The quality outcome for this area was affected by occasional shortages in staffing levels and shortfalls in recruitment and selection. The DataSet indicated that 50 of staff have a NVQ in Health and Social Care and that a further 20 were doing their awards. New staff confirmed that they would be registering to complete a NVQ as soon as they had completed their Learning Disability Qualification and induction programme. Staff said that Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 23 a comprehensive induction both within the home and with Brandon Trust was in place with time spent shadowing staff in the home. Staff were observed being accessible and respectful to people living in the home. When questioned they were knowledgeable about their needs as well as the systems in place within the home. Surveys sent as part of the Annual Service Review indicated that staff were approachable, friendly and helpful and that people were well cared for. Staff had delegated responsibility for key tasks such as Total communication, health and safety audits, medication administration and people’s health and welfare. This has had positive effects throughout the home developing a staff team. Healthcare professionals returned three survey forms. These provided much positive feedback. Comments included that the staff were warm and caring, and had individuals best interests at heart. During the first visit a member of staff was unable to do a shift, staff arranged for most of the shift to be covered but there were a few hours when only two staff were on duty. Staff said that this was a rare occurrence and that wherever possible bank staff could cover staff shortfalls. Surveys from people living in the home indicated that choices could be limited due to lack of staff at times. This was also confirmed in staff surveys that indicated that more staff were needed in order to more fully meet peoples needs and offer more one to one support. The AQAA stated, “We have been short of permanent staff due to maternity leave, staff leaving the service to pursue new careers/live abroad. Staff sickness has also impacted on the staffing levels and the consistency of permanent staff available. The reduction in staffing levels agreed for this home has reduced by just over one whole time post.” There was evidence on staff files that absence was being proactively managed and monitored with each staff member having a return to work interview after a period of sickness. Recruitment and selection information for two new members of staff were inspected. A front sheet was provided with evidence of dates when documents were obtained. This confirmed that staff had not been appointed until two satisfactory references and a Criminal Records Bureau (CRB) check had been received. The application form, which was used for these people, asked for a 10-year employment history. A full employment history must be requested. One person had not provided a reference from their last employer in care and another reference request had been sent to the referee’s personal address rather than the care home. This is not good practice. A Criminal Records Bureau check was observed on one person’s file, this could now be destroyed. CRB checks should be kept separately from personnel files and securely. Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 24 Brandon Trust provides a comprehensive training programme that staff can access. One member of staff said, “Training is very good.” Monthly reports by the Brandon Trust have provided evidence of relevant training being provided for staff and individual training records in the home confirmed this. Copies of certificates were kept on staff files. There was evidence that the registered manager was monitoring training needs and highlighting refresher training as well as more specialist training. In the past twelve months staff had attended training in ageing, care of the dying, assistive technology and sight loss. Equality and diversity, learning disability and race awareness had been highlighted as training needed in the future. Mayfield DS0000067085.V362060.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People benefit from a home that provides a person centred environment with some areas which provide an excellent quality of care. Improvements in some key areas would benefit people ensuring their safety and welfare is promoted at all times. Quality assurance systems involve people living in the home. EVIDENCE: Since the last inspection manager had successfully been through the registration process. She has considerable experience in the field of learning disability. She has a Diploma in Social Work, Registered Manager’s Award and was a NVQ assessor. She had completed Mental Capacity Act Training, coaching skills, managing investigations and diversity and equality as part of her continuing professional development. Staff surveys commented on “how Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 26 well the home was run” and that the registered manager was “approachable” and “excellent”. Brandon Trust has a quality assurance programme in place that included unannounced visits to the home by a number of representatives of the Trust. One commented, “ the home continues to provide an excellent environment where service users are clearly happy.” Audits were seen to be in place monitoring health and safety systems and monthly room checks. An audit and action plan for the home for 2008/2009 was in place that identified key actions for this period of time. These actions were being signed and dated as they were met. People living in the home, their relatives and other people involved in their care have access to a quality assurance feedback form providing them with the opportunity to be involved in the quality assurance process. The DataSet provided information about health and safety systems. Robust processes were seen to be in place within the home. Regular checks and servicing of equipment were being completed. The home had a fire risk assessment and individual risk assessments. These latter documents indicated a ‘stay put’ procedure and stated as agreed in discussion with the fire service. This guidance is contrary to the Regulatory Reform (Fire Safety) Order 2005 and further advice must be sought about whether these risk assessments need to be reviewed. Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 27 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 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 2 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 3 LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 2 X 3 X 3 X X 2 X Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 28 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. Standard YA5 Regulation Requirement Timescale for action 30/09/08 2. YA20 3. YA20 4. YA33 5(1)(ba)(bb) Each person should have an individual statement of terms and conditions giving them information about the service they receive and the payments that are due. 13(2) When people wish to take 30/08/08 medication out with them when leaving the home for part of the day or several days, risk assessments and procedures must clearly state which staff can do this and how containers are to be labelled. This is to safeguard people from possible harm. 13(2) Medication must be 30/08/08 administered to people safely, making sure that where homely remedies are used these have been recorded for each person and authorisation given by their Doctor or the Pharmacist. This is to protect people from possible harm. 18(1)(a) The number of staff on each 30/09/08 shift must be maintained at a level to meet the needs of people living at the home. This is to safeguard them from DS0000067085.V362060.R01.S.doc Version 5.2 Mayfield Page 29 5. YA34 19(4) Sch 2.6 6. YA34 19(4) Sch 2.3, 4 7. YA42 23(4A) possible harm and to support them in their day-to-day activities. Before new staff are appointed a full employment history must be obtained. This is to safeguard people from possible harm. Where staff have previously worked in care prior to employment the reason for leaving must be obtained in writing from previous employers. This is to safeguard people from possible harm. Fire risk assessments must comply with the Regulatory Reform (Fire Safety) Order in respect of whether people can be left in their rooms at the time of fire. This is to make sure people are safe and not at risk of harm. 30/08/08 30/08/08 30/09/08 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 YA6 Good Practice Recommendations Monthly reviews should include reference to the outcomes referred to in daily diaries rather than commenting ‘no change’ or ‘ongoing’. New person centred plans should include information about the gender of care staff providing care and whether people have access to keys for their rooms. Each person should have a missing person profile in place. Body maps should be used to monitor bruising or scratches to people living in the home. A protocol for the use of a listening device should be in place. Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 30 2. 3. YA9 YA18 4. 5. YA20 YA20 6. 7. YA24 YA30 When medication is put into compliance aids to take out of the home for short periods, a clear record should be kept of staff involved in each stage of the procedure. A list of staff names with their corresponding initials should be in place. An updated version of the BNF should be obtained. The temperature of the medication cabinet should be monitored and recorded. Consider how privacy may be provided when having meetings in the home. Provide anti bacterial scrub/hand wash in the laundry. Provide paper towels in communal toilets/hand washing facilities. References should be provided from the referee’s business address (ie care home) and not personal address. Criminal Records Bureau checks should be kept separately form personnel files and in a secure location. 8. YA34 Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mayfield DS0000067085.V362060.R01.S.doc Version 5.2 Page 32 - 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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