Inspection on 04/09/07 for Mayfield Court

This inspection was carried out on 4th September 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Mayfield Court 31/01/07

Mayfield Court 10/01/06

Mayfield Court 22/09/05

Mayfield Court 17/02/05

Mayfield Court 16/09/04

Mayfield Court 24/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Mayfield Court Youens Way Knotty Ash Liverpool Merseyside L14 2EP Lead Inspector Mrs Julie Garrity Key Unannounced Inspection 4th September 2007 10:10 Mayfield Court DS0000025358.V346294.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 Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and 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 Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mayfield Court Address Youens Way Knotty Ash Liverpool Merseyside L14 2EP 0151 283 9090 0151 283 9091 admin@mayfieldcourt.org 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) Mayfield Fellowship Mrs Carole Ackers Care Home 29 Category(ies) of Physical disability (29), Physical disability over registration, with number 65 years of age (29) of places Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residents (PD) between the ages of 18 - 64 years within an overall number of 29 Residents (PD/E) over 65 years of age within an overall number of 29 Date of last inspection 31st January 2007 Brief Description of the Service: Mayfield Court is a large purpose built single storey home that was built providing residential care for 27 service users (residents as they prefer to be addressed) with a physical disability. The home is registered for younger adults There are 16 flats, each has a kitchen, seating and sleeping area along with a bathroom three of those flats are shared, two are shared by married couples. There are eight bedrooms none with ensuite facilities one of which is a shared room. Generally the home is a non-smoking establishment, the staff cannot smoke anywhere in the home. If a resident does smoke staff support this in accordance with appropriate health and safety needs of the other residents in the home. The communal facilities include communal lounges, a dining room, a kitchen and laundry facilities. Both the kitchen and laundry facilities have staff employed to work in this area. There is a courtyard area that residents use in summer months. There are parking facilities to the front of the building. Mayfield Court is located in a residential area of Knotty Ash. There are some shopping facilities within walking distance and a main bus route within 5 minutes walk. Riverside Housing Association owns the property and the care is provided by the staff employed by the Mayfield Fellowship. Mayfield Fellowship is a charity based organisation and has a board of trustees that meet regularly in order that the home can be well managed. The trust does not own or have management responsibility for any other care homes. The manager has been in post for over 5 years and is registered with CSCI. Fees for the service are on an individual basis and dependent on the assessed needs of the resident and the accommodation suitable to meet their needs. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit was carried out over a period of one day. The inspector arrived at the home at 10:10 and left at 18.50. The inspector spoke with 10 residents and nine staff. The inspector was accompanied on the inspection by an “expert by experience”. Experts by experience are individuals who have personal experience of either living in or supporting a relative in a care environment. In this case the expert by experience was asked to talk to residents and gather their opinions on what it feels like to live in Mayfield Court. The inspector completed the inspection by a site visit to Mayfield Court, a review of records available, these included care plans, medications, staff training, staff recruitment, policies and procedures, daily records, risk assessments and maintenance records. Records held in CSCI offices were also looked at. The main emphasis was discussions with residents, staff and management. The inspector followed an inspection plan written before the start of the inspection to ensure that all areas identified in need of review were covered. All of the Key standards were covered in this inspection, these are detailed in the report. Feedback was given to the care manager during and at the end of the inspection. The arrangements for equality and diversity were reviewed throughout the visit and are detailed in this report. Particular emphasis was placed on the methods that the home used to determine individual needs, choices and the practices that they put into place to meeting those needs. What the service does well: Mayfield Court is a well managed home that is run in a manner that helps the residents be independent. Residents are encouraged to attend meetings get involved in activities and raise concerns as examples. All the residents spoken with were positive about the care that they received. All the residents spoken with detailed that they enjoyed living in Mayfield Court. Residents made the following comments, “I don’t want to live anywhere else”,” I love to go out on day trips with the other residents.” and “treated with dignity and respect by everyone” Most of the staff have worked in the home for several years and all have been checked that they are suitable to work with the residents living in the home before they starting working. Staff are given training that meet the needs of the majority of the residents, supervision that helps staff gain skills and a good management team that puts the support of the residents first. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 6 The arrangements in the home are designed to promote the residents independence and for them to have influence over their lives in the home. The home supports the residents to express their views and involves them in the service that is provided and how that service is put into place. The building is suitable to the residents needs a variety of different combinations of living space for the residents, which supports them to spend their time where they wish to and how they wish too. Residents spoken with made the following comments, “you could eat what you want when you want and go out when you want”, “love to have lazy mornings and going back to bed during the day” and “encouraged to take part in things but like to do my own thing.” Outside space is available for residents to enjoy and the location of the home allows them to access the community independently. What has improved since the last inspection? What they could do better: The home does not have its own quality assurance system in place but does plan to recruit a manager to review quality in the home and develop a plan to identify the good practice and develop areas in need of improvement. Most of the areas in the home in need of improvement are not related to practice issues but to do with keeping up to date accurate information that is in formats that meet the resident’s needs and inform the staff of how to maintain their practice. This includes, residents staying for a short amount of time, protocols that inform staff, policies procedures, medication records, daily records, risk assessments and menus. It is of importance that the home reviews the recommendations raised within this report in order to sustain the development of quality in the home. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 7 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 Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2 and 3 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All residents who come to live in Mayfield Court have an assessment, done before they move in. The assessment is reviewed and updated every three months. This practice makes sure that staff can monitor the changing needs of the residents and plan support to meet their needs. Residents who return to the home for a short stay need to have their assessments updated before they come to stay in order for the staff to be aware of any changes in their needs and to determine if they can still meet those individual needs. EVIDENCE: Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 10 Two residents spoken with said, “have lived at Mayfield court for four years and love it” and “don’t want to live anywhere else.” The case manager said, “All new residents are assessed before they come to live in the home”. All the records viewed for the residents also contained an assessment that detailed their needs that was updated as needed and reviewed at least every three months. Up to date assessments started before the resident was admitted were available for all but residents who were returning to stay in the home for a short period of time (respite care). One resident said, “I have lived here many years, but I do remember someone coming to see me before I moved in and talking about Mayfield with me”. The care manager said, “Some of the respite residents have an assessment, one relative sends me details of any changes in the resident”. “We don’t have any formal assessments for returning respite residents, but we can develop a form that will help us”. A staff member spoken with said, “We have clients that return regularly, we use the information we had last time they were here”. Assessments were available for residents staying for respite care but were not dated from their return to Mayfield and had no records that it had been recently updated. Without an up to date assessment staff will not always be aware of what the residents needs are and if they can continue to meet the residents needs. There was information available in the home about the services that they provide. However this was not available in formats to meet all the residents needs. A member of staff spoken with said “no not all our residents would be able to access this independently, we read it to them”. Information for residents is available in each bedroom one that was viewed in a resident’s bedroom. This contained a lot of information. However this had been photocopied badly and was impossible to read the majority of it. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, 8 and 9 were reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are consulted with and supported to make decisions about their lives. Routines are generally flexible or in line with the residents wishes. Not all the care plans that detail the support for residents are in a format or in a location that meets their different needs and does not support them to access these independently. The management of risks needs to be further developed in order to identify and put into place actions to help reduce risks. EVIDENCE: Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 12 Four support plans for residents were viewed. Each plan has details that inform staff of the individual needs of residents and how to meet their needs. They are all up to date and have been reviewed at least three monthly. All the support plans are signed by the resident or their representative when written. All the plans are in a written, typed form and mainly in plain language. Which makes them easy to read for staff and some of the residents. Additional to the support plans is an activities plan that details individual personal preferences and choices and what activities have been undertaken. These showed a variety of activities undertaken such as holidays, swimming, football, cinema, theatre, going out and activities within the home. Residents spoken with said, “I can see my plan its in the office”, “They talk to me about it, but I struggle to read it” and “ I would like a plan that had pictures as well, that would be nice”. Residents said they have support plans, which are looked at every three months, but they have an activities folder, which is looked at weekly. They can see their person centred plans or activities folders when they want to. Staff spoken with said, “We talk to them about everything, they make their own decisions”. “We really need to be making everything person centred, including care plans”. Risk assessments were in place for activities such as using bed rails. These did not state that the bedrails were specifically suitable to the bed or how the plan was monitored. Risk assessments regarding self-medication were not in place for everyone and this means that some identified areas of risk do not have a plan in place that informs residents and staff of how to reduce identified risks. The Risk assessments were also written in printed form, kept with the support plans in the main office and as such are not available in different formats that would assist residents in accessing them independently. Other discussions with residents showed that there is no particular routine with the exception of meals times, residents can come and go as the please. Residents spoken with enjoy sitting in the gallery area, were the activities coordinator does most of the daily events, such as a newspaper club. One resident, “you could eat what you want when you want and go out when you want.” The same resident said they, “love to have lazy mornings and going back to bed during the day.” Another resident said, “You can go out when you wants, and can do what you want to do”. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11, 12, 13, 14, 15, 16, and 17 were reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 14 Residents are encouraged to have the life style that they choose, however on occasions their point of view has not been noticed or not actioned in a manner that can give them confidence that service provided meets the personal expectations. Meals are of good quality and several of the residents are happy with the meals. Information regarding meals and the quality of meals does not always meet the choices, preferences and needs of some of the residents. There is a project in place that the management intends will address this very soon and when implemented this should fix the current problems with the diets provided. EVIDENCE: Residents spoken with gave examples of how they influence their lifestyle. One couple have lived in the home for a number of years and recently married. Several of the residents explained that they go on holiday or go and stay with friends. Many have hobbies such as bingo, going to Chester zoo and going to the cinema. These activities and lifestyle choices are supported by the home. Records show residents are asked the day before what they want to eat, there is some variety in the choices of meal selected. Residents said, “I am asked what I want but by the time the meal arrives the next day I haven’t a clue what it was I ordered”. “Most of the time it just arrives with everything on the plate sometimes there’s stuff on the plate I didn’t ask for and don’t like”. Menus showed in some instances food that at least one resident said was “boring and bland such as fish fingers”. Residents asked for things such as better vegetarian meals not just more vegetables, fajitas, curry, pasta etc. They also requested more fresh fruit as apposed to tinned fruit and puddings that did not come with custard. Menus were not readily available to residents and did not show specialised diets such as vegetarian, diabetic or semi-solid. One resident said, “You could eat what you want when you want”. Minutes of meetings show that whilst meetings have occurred in the last year there have been four meetings but not at regular intervals that would support residents to be aware of when the meetings were to occur. The last meeting concentrated on the quality of the food provided and took place in August. In the minutes some of the residents had said that they were not particularly happy with the food and had made suggestions to promote this. There were no actions detailed as to when this was to start. One service user had asked when it would start but a date was not given. The new menus have not yet started. Staff spoken with said, “Meetings aren’t held regularly we should think about holding them on a monthly basis”. It is good practice that the home has taken the time to find out residents points of view but not giving them full information or actioning their points of view promptly does not promote their needs. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 15 Questionnaires have been sent in early April. Six have been returned. These were contained in a file in the administrator’s office. One resident had said that they thought the service was poor but this had not been acted on at all. The care manager said, “that bit on the questionnaires has been missed it will be addressed”. The other five residents were happy with the service they received. One resident spoken to had not received a questionnaire. Not addressing issues raised in questionnaires does not promote residents choices. Activities records viewed showed a variety of different forms, these have included holidays, days out, daily activities such as newspaper group. Activities records do not detail development of daily living skills such as cooking own meals, making drinks etc. There is specialised and general facilities in the home to make individuals lives more independent, such as Sky TV and specialised computers that assist in communications. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 were reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to attend healthcare appointments and have access to health care services when they are needed. This practice makes sure that physical and mental health is monitored and maintained in a manner that is lead by the resident’s choice. In general the management of medications is safe with the exception of clients staying for a short time and some written instructions to staff. Medications are accurately given to residents and those who wish to manage their own medications are supported to do so. EVIDENCE: Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 17 Records in the home show that residents are supported to access healthcare as needed. Support plans included details about health care such as accessing hospitals, involvement of district nurses and other relevant medical staff. Residents said, “If I need to see the doctor I can go myself”, “I just ask the staff” and “they are always making sure I get to my appointments and make sure I get there”. One resident was returning to the home from hospital the day after the site visit, the staff organised the district nurses to attend to give the staff advice, guidance and support. This is good practice as it helps staff care for the resident on their return. The care manager has written the actions that staff need to take in order to undertake a specialised task. Unfortunately the care manager does not have relevant training or qualifications in this area. The guidance written was inaccurate, did not follow the latest guidance sent to the home from the hospital and had no input from the nursing staff also involved in this specialised area of care for the resident. The home has tried to obtain nursing input and had resolved to write this guidance to help the staff. However as yet they had not been reviewed by the relevant nursing or medical staff to make sure that the residents care in this area was correct. Residents are supported and encouraged to manage their own medications. A resident spoken with said, “I take care of my own pills”. It is good practice that the home supports individuals to maintain their independence in this manner. However risk assessments for this practice were either not available or had not been reviewed to make sure that residents were still managing this safely. Medication records were reviewed. Records were generally accurately maintained, with the exception of handwritten records, which did not detail all the instructions staff needed to give medications properly. An audit of the medications showed that medications were being given to the residents accurately and some complicated medications were also accurately given. The policy and procedure regarding medications does not included medications for residents leaving the building, respite or how to fill out medication records. As such it is difficult for staff to be aware of the proper ways to manage medications. This was seen regarding medications for a respite resident, which had been given by the home without confirming with the doctor that these were correct and that the home had received from the family all the medications that they needed to give. This is not good practice, as it does not support staff to give out medications safely. Training records seen show all staff that give out the medications have received training. The home does not do regular audits on how the medications are being dealt with but does do a check on the amount of medications. This is good practice but does not given enough information to make sure that all staff are monitored as competent to give out medications. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 were reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that any concerns they have will be recognised and dealt with in order to make them feel safe. Training for staff supports resident’s confidence and helps to make sure that staff are aware of how to protect residents. Staff are not fully aware of the responsibilities for dealing with serious concerns and run the risk of compromising any investigations that may need to be done. EVIDENCE: All of the residents spoken with explained that there are now forms available in each bedroom, were they can raise anonymous concerns and that these are dealt with. Residents spoken with said, “If ever I had something needing sorting out I just told one of the staff. They are great”, “it was all sorted quickly” and “I had a problem, was fixed.” “They are great staff no problems”. The approach that the home takes means that residents feel able to raise their concerns. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 19 Mayfield Court has a complaints procedure, a copy of this is available in the home. It is in a printed format and is not suitable to meet the needs of all the residents in the home. Residents meetings are also an opportunity for residents to raise concerns and influence services. Questionnaires available in the home showed that one individual had raised a concern that had been missed by the home. All other complaints or concerns had been recorded and addressed with full information given to the individual raising the complaint. There has been 11 complaints made to the home all of which have been investigated and addressed. The quality of written records detailing the investigations varied. All staff have received training in protecting vulnerable adults. This is covered in induction, policies in the home, regularly updated training and in staff meetings. The policies and procedures regarding protection of the residents are in place. Discussions with staff showed that they were aware of how to raise concerns but were unsure as to whose responsibility to investigate it was. A recent incident was appropriately reported by the home, however records were unclear and those that were available showed that initially care staff had not deal with the allegation in line with the guidelines from social services. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 were reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mayfield Court is well maintained, clean and tidy. There is suitable equipment available that helps to maintain residents independence and promote safety. Staff are aware of the ways to maintain good hygiene levels and are able to do so to a good standard. EVIDENCE: Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 21 Residents spoken with said, “I love living here, its clean, fresh, lovely pictures” and “It’s a lovely clean home”. There is regular audits on the home that helps say what actions such as redecoration needs to be done. However there is no action plan developed from this that would detail to the residents when as an example their bedroom were to be decorated or when the areas identified were to be completed. A tour of the home showed that in general it is well maintained with different areas for the residents to use. Such as different lounges, dining rooms. The residents and staff said that the dining room was “too small”. They are considering making different sittings in the room and looking at different ways of accommodating the residents in the dining room. The home is no smoking, the smoking area is located in the garden area. Residents spoken with said, “it would be nicer the dining room were bigger”. Most of the bedrooms have ensuite facilities and reflect the resident’s personal choices with personal items. Several rooms have sky television as the resident’s needs or request and computers that assist in the resident’s communication. There are also separate flats viewed that have been personalised by the residents, thier own personal items had been brought into the home. Residents spoken with said, “I have a computer, TV and sky, lots of things in my room”, “I have all the things I need in my room” and “I have all the things I like in my room”. Equipment in the home is extensive, there has been a lot of money spent quality moving and handling equipment to keep both staff and residents safe. This includes special equipment in the bedrooms and bathrooms. Both staff and residents were pleased with the level of equipment staff found it helped them transfer residents safely and residents felt safer with the equipment in place. The kitchen and laundry were viewed. Both were clean and tidy and had regular cleaning schedules in place. Both had equipment that enabled them to supply good services to the residents. Some residents do their own washing in their flats and staff support this as needed. The main kitchen is not accessed by the residents to prevent the possibility of spreading infection. The home has policies and procedures to deal with hygiene and all staff have just received training in preventing cross infection. The kitchen staff have received the guidance from environmental health that supports them to monitor all food produced. Some items of food in the freezers had not been labelled for expiry date appropriately but all fridge items were. The proper labelling of food items can assist in the staff making sure that food stocks in the home are properly managed. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 34 and 35 were reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All the staff have been checked before they start working to make sure that they are suitable to work in Mayfield Court. There is training available that provides staff with the skills that they need to meet the resident’s needs. EVIDENCE: Staff have a range of training to support the residents with some of their care needs and to ensure the smooth running of the home. Many staff have completed training in a qualification specific to staff working in care and other Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 23 staff are in the process of completing this qualification. Some further training to meet the needs of residents such as diabetes has been done. When first recruited all staff work supervised to make sure that they can meet the role that they were recruited for. They are monitored regularly and given additional training if needed. The majority of staff have worked in the home for over three years and this provides a stable staff team. Staffing files examined contained records that each member of staff is checked properly before they start working in the home. This includes police checks, checks on fitness to work with adults, references and a working history. One staff file showed that there was a need to determine if they presented any risk to the residents before they were able to work. However there were no records in place and the management were unaware if this had been done. All staff that start working before the police check is completed are supervised until the police check is done and there are records in place that show who they were supervised by each day. Staff and residents spoken with confirmed that there is always enough staff available at all times. Staff said that they could arrange to take residents out to things such as local shops as there is usually enough staff to cover this. Residents said that they “Staff are lovely” and “they are there when we need them”. One resident was due to return to the home the day after the site visit. Staff were aware that the residents needs had changed and had arranged for additional staff to be on duty. Staffing levels are not regularly monitored in order to determine that staffing levels are suitable to meet the needs of the residents. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 were reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 25 Mayfield has a good management team that are aware of how to support residents and an understanding of how to maintain the residents safety. Quality is seen as an important aspect and resident’s points of view and wishes are asked for, however these have not yet been used as part of a quality assurance system that will increase the quality of the service provided. EVIDENCE: The manager is registered with the Commission, has a qualification in management and has been in post for over five years. This maintains a consistent management approach and supports staff and residents to express their views. There is a structured staff team that also includes a care manager a facilities manager and a rehabilitation manager within the home. The home did undergo a formal quality assurance scheme but felt that it was more designed to check the systems in the home rather than the opinions and feelings of the residents living there. They do not have a formal quality system in place but are recruiting a quality assurance manager to develop this in the future. There are regular residents meetings and opportunities for residents to express their opinions. Staff are also able to give an input in regular staff meetings. As yet the information given by all these areas is informally acted on and addressed and none of the minutes detail what actions have been taken. Questionnaires were sent in spring of 2007 six of these have been returned, these were not used to inform the practices of the home. Policies and procedures are available in the home and staff are able to access and read this. These are not available in different formats that would support the residents to be involved in their development or be aware of the contents and some had not been updated since 2002. Staff receive regular training in health and safety, certificates were seen on staff files that supported this and staff detailed the training in this area that they had done. Fire safety training is regularly done, however no evidence was seen that residents also receive fire training or any other health and safety training that they might find useful. Residents spoken with could not recall if they had been involved in fire safety. Certificates of maintenance such as gas and electricity are available and up to date, which helps maintain the safety of the home. Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 2 4 X 5 X 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 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 2 40 X 41 X 42 X 43 3 3 3 3 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mayfield Court Score 3 3 2 X DS0000025358.V346294.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations Consideration needs be made to making the information in the home such as service users guide, minutes of meetings, care plans, risk assessment policies and procedures in formats that enable the residents to access these easily. The home needs to develop a procedure and policy that details how respite residents will be re-assessed before they return to the home in order that the home can make sure they meet the needs of residents. This needs to include the management of respite residents in order to maintain their safety. The activities and rehabilitation plans should be reviewed and expanded to make sure that they fully cover the needs and promotion of independence of residents and were DS0000025358.V346294.R01.S.doc Version 5.2 Page 28 2. YA3 3. YA16 Mayfield Court applicable provide a structured plan that staff can follow in the absence of activities organiser. This will also make sure that key workers are able to better plan days out and social activities of the residents who need their support. 4. YA17 Consideration should be in place to include specialist diets on the menus and to provide menus as a reminder to residents in a format that meets their needs. The minutes of a recent meeting regarding resident’s choices about food needs to be actioned promptly. Medications management should be reviewed, although audits are in place these may need to be expanded to make sure all aspects are covered. A clear understanding of good practice is in place and these need to be followed at all times by all staff. All residents should have risk assessments in place for any medications they deal with and are regularly reviewed to make sure that the support is appropriate. All medications need to checked with the prescriber before staff give them for the first time. Complaints investigations need to have full records maintained as to the processed of the investigation and any evidence that informs the outcome kept. Staff should have full awareness of the protection of vulnerable adults processes and how this will be investigated. They should also make sure that they inform the manager of all concerns expressed by the residents at anytime and staff need to not start their own investigations. Management needs to be aware of the policy and procedure in place in Liverpool and refer POVA complaints to social services in accordance with the policy. Where staff are recruited into the home and the checks in place raise concerns the individual needs to be risk assessed before working in the home in order to safeguard the residents. Consideration should be made in including the residents who wish to in training events including aspects such as fire training and protection of vulnerable adults training. Protocols written to guide staff should have the appropriate expert in put in place to make sure that they provide staff with the correct skills to care for residents. 5. YA20 6. 7. YA22 YA23 8. YA34 9. YA35 Mayfield Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Court DS0000025358.V346294.R01.S.doc Version 5.2 Page 30 - 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. 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