Inspection on 31/07/08 for Menna House

This inspection was carried out on 31st July 2008.

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

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

Menna House 08/08/07

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 MIXED CATEGORY MAJORITY ADULTS 18-65 Menna House Menna Grampound Road Truro Cornwall TR2 4HA Lead Inspector Diana Penrose Unannounced Inspection 09:30 31st July 2008 Menna House DS0000069008.V365659.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 Menna House DS0000069008.V365659.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. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Menna House Address Menna Grampound Road Truro Cornwall TR2 4HA 01726 883478 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) Spectrum Miss Annabella Veress Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of either gender whose primary care needs on admission to the home are within the following categories: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 5. Date of last inspection 8th August 2007 Brief Description of the Service: Menna House is a care home providing accommodation and care for up to five adults, of either gender, with a learning disability. The registered provider is Spectrum, an organisation that provides specialist services for people with Autistic Spectrum disorders. Menna House opened in March 2007 and is being set up as a home where people who already have a reasonable level of independence can continue to develop their personal and social skills. Spectrum currently employs a manager and a team of staff to run the home on a day-to-day basis. External, on-call managers are available to provide specialist input, support and advice where necessary. The home is located in the village of Menna ten miles from the city of Truro. The home has a vehicle to provide transport for residents who need to access resources in the wider community. The home is a two-storey building. All the bedrooms have en suite bathroom facilities. The bedrooms are on the first floor. People using the service must be able to negotiate stairs. There are good facilities for staff sleeping in and the home has a dedicated office on the ground floor. The home has two lounge areas, separate dining area, family room and extensive gardens, which includes a vegetable plot for service user’s use. The garden is securely fenced. The home has some parking space at the front of the building and some further down the drive. There is a communal kitchen and ample storage space in the home. Suitable laundry facilities are located in a separate next to the kitchen but accessed from outside. The manager stated that the current range of fees is from £932.19 to £2833.56 per week. Service users are responsible for purchasing personal items such as toiletries. Menna House DS0000069008.V365659.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 1 star. This means the people who use this service experience adequate quality outcomes. An Inspector visited Menna House Care Home on 31 July 2008 and spent five and a quarter hours at the home. This was a key inspection and an unannounced visit. The focus was on ensuring that resident’s placements in the home result in good outcomes for them. It was also to gain an update on the progress of compliance to the requirements identified in the last inspection report dated 08 August 2007. All of the key standards were inspected. On the day of inspection five people were living in the home. The methods used to undertake the inspection were to meet with the people using the service, staff and the manager. Records, policies and procedures were examined and the inspector toured the building. Information received from and about the home since the last inspection, including surveys from residents and staff, have also been taken into consideration when making judgements about the quality of outcomes for the people living in the home. The people using this service expressed satisfaction with the care and services provided. What the service does well: Assessments prior to moving into Menna House are undertaken and based on the individuals health, social and personal care needs, including needs relating to their religious, ethnic and cultural backgrounds, to ensure they can be met in the homes setting. Detailed care plans are developed for each resident that are reviewed every month, six monthly reviews also take place with the resident, family and relevant professionals. Residents are encouraged and supported to develop their skills and independence in many ways. They have opportunities to make decisions about important aspects of their lives, with assistance from staff, if they need it and are supported to take risks so that they can enjoy fuller and more active lives in and out of the home. Residents have clear information on what is expected of them and their rights as residents of a care home. They are aware, for example, that they will be expected to help out with household tasks such as cooking and cleaning, so that they can develop their skills and independence and know what to do if they wish to make a formal complaint about something they do not like. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 6 Staff manage resident’s monies and a suitable system is in place with the process verified monthly at Spectrum head office. Residents participate in the planning of the menus and help staff to prepare meals. They have free access to the kitchen so that they can make drinks and snacks for themselves when they wish and are encouraged to live and eat healthily. Some staff members have catering qualifications or experience, which helps with the provision of nutritional meals. Residents are appropriately supported with their personal care so that they maintain their dignity. Staff were observed to assist them with their needs quietly and unobtrusively. The home provides a comfortable, clean well-maintained environment with a homely atmosphere. Residents are encouraged to personalise their rooms and have been involved in the decoration and furnishing of the home. The grounds are tidy and there is ample space for outdoor activities. An area of the garden has been set-aside for residents to grow their own vegetables. Recruitment procedures are robust, relevant checks are made to ensure people are safe to work with vulnerable adults and the records required by legislation are held. There are a suitable number of staff employed and an activities rota that can be adjusted if levels drop for any reason. Staff said there is a wide range of training on offer and that they are supported in their roles by the management team and head office staff. What has improved since the last inspection? The manager has been successful in her application and is now registered with the Commission for Social Care Inspection. She has worked hard to comply with the requirements and recommendations set at the last inspection. Care plans are reviewed monthly with resident’s comments included. Boots the chemist has provided training for staff in the administration of medicines. Spectrum have also provided a level 3, distance-learning course in medicines, via Newcastle College. Only staff that have received appropriate medicines training are allowed to administer medicines to residents. All of the medicine administration record charts inspected had been signed appropriately on this inspection. A copy of the The Royal Pharmaceutical Guidelines for care homes and a BNF medicines reference book have been provided and are available to staff. All notifiable events are now reported to the Commission in compliance with Regulation 37 of the Care Homes Regulations 2001. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 7 The minimum staffing levels have been reviewed and the activities rota has been produced to ensure that suitable activities are provided according to the number of staff available. Although training has been on hold for a few months this area is being addressed with less gaps in the training records. The manager and her deputy have attended multi-agency training in the protection of vulnerable adults. The number of staff qualified to at least NVQ level 2 has increased despite an increase in staff turnover. Of the eleven staff employed two are qualified to NVQ level 2 and three are close to completing the course. Additionally the deputy manager has achieved NVQ level 3 and is the in house NVQ assessor. The manager stated that all staff get enrolled onto NVQ courses following their induction period. Staff are given a copy of the GSSC code of conduct and there is a sheet that staff have signed on the notice board, acknowledging they have read it. No fire doors were seen wedged open during this inspection. The water leak in the hallway has been repaired and the décor made good. The manager said that there is now an established team of staff and the residents are very settled with them. She said parental contact is better and there is a better relationship with outside agencies such as Commission for Social Care Inspection and the Department of Adult Social Care. What they could do better: It is evident that work has been done to improve the system for the use of medicines in the home. However the Commission are concerned about the number of issues and errors that have been reported in respect of medicines since the last inspection, many have been in recent months. The registered manager needs to review the procedures to ensure staff are fully aware of them and their own responsibilities. She must make sure that staff are fully assessed as competent before they can administer medicines to the people using the service. Daily records have not been kept up to date and there are gaps in the recordings. These records are legal documents and should be concurrent, gaps allow for information to be inserted retrospectively and may lead to errors. Records are maintained for all transactions in respect of resident’s money although there are no signatures to show who has recorded the transaction, this was discussed with the manager and a recommendation made to include this in future. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 8 A fire door labelled, to be kept shut, was seen open. It goes across an alcove to two other rooms with fire doors. This was discussed with the manager who said she will check if it has to be shut at all times or if an automatic closer can be fitted or the sign removed. The room in the loft space is no longer used as an office, the door was not locked and, this was discussed with the manager, as the steep open, wooden stairs could be dangerous if residents were to access this area. She said the door is normally locked and agreed to ensure this is always the case. A good range of training is provided however the registered manager must ensure that statutory training takes place at the intervals stipulated by legislation, for example moving and handling training should be annually rather than three yearly as currently provided. The Annual Quality Assurance Assessment required by the Commission for Social Care Inspection was not returned by the registered provider, when requested. In future this document must be returned on time so that is can be used to inform future inspection reports and service reviews. 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. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 9 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) Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 10 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are assessed prior to their admission so they can be confident that the service will meet their health, personal and social care needs, including needs relating to their age, religion, cultural and ethnic backgrounds, abilities, gender and sexual orientation. EVIDENCE: There have been no new people using this service since the last inspection when the assessment process was deemed good. No issues have been raised to the Commission in respect of this standard or via surveys. Surveys from relatives and key workers state that all residents had a transition period (introduction) when moving into the home. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 11 The assessment records for one person were shown to us and they were very thorough in respect of her needs and dealing with the transition from another facility. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 12 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): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people using the service are included in the planning of their care, which addresses their health, personal and social care needs, including needs relating to their individual and diverse backgrounds (age, religion, culture and ethnicity, abilities, gender and sexual orientation). They are able to take safely managed risks and make important decisions about their lives so that they develop their skills and independence. EVIDENCE: One resident’s file was examined in detail but others were looked at. It is evident that people are involved in the planning of their care, along with family and relevant professionals, as they have signed the care plans and review Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 13 documents. Resident’s views are also recorded as part of the monthly and six monthly review process. Care plans have specific headings to address health, personal and social care needs, including individual and diverse needs. It is in written format plus a picture format. It provides the person with specific goals to work towards, and informs and directs staff on how to support the person to achieve their goals and maximise their skills for independent living. The documentation is very lengthy so a summary of the individual’s care needs and how to address them has been developed and kept in their bedroom. The manager and staff said this is very helpful when new staff are employed or if bank staff need to be utilised as it gives an easy reference without looking through the large files. Daily records have not been kept up to date and there are gaps in the recordings. These records are legal documents and should be concurrent, gaps allow for information to be inserted retrospectively and may lead to errors. We observed residents being asked what they would like to do and staff supported them in making decisions. The records show that residents have choices available to them and make their own decisions on how to spend their time. One person wanted to make buns during the inspection and a care worker assisted her with this. She also wanted to make a cup of tea for the inspector and was supported to do this. The registered manager said that discussion regarding life in the home tends to be carried out informally with residents between review meetings. We were shown the process for the safekeeping of resident’s monies. The manager, and her deputy told us, that the staff manage all resident’s monies for them. Each resident has an individual bank account, which is managed by the staff or the individual’s family. Cash is held in separate locked cash tins for each person. The money checked, during this inspection, for one resident was 19 pence more than that recorded on the sheet. Records are maintained for all transactions although there are no signatures to show who has recorded the transaction, this was discussed with the manager and a recommendation made to include this in future. Receipts are kept for all purchases and were seen with the records. Each month the money and records are taken to Spectrum headquarters for verification, they were all ready to go on the day of inspection. The manager and one of the care staff talked about how people are encouraged to take reasonable risks. There are also written risk assessments in the care files. The registered manager said that residents are involved in the running of the home as much as possible, for example they all chose the colours for the decoration of their rooms and the furniture for them. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 14 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): Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 15 12, 13, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people using the service are able to take part in a wide range of activities in and out of the home, which are appropriate to their ages and individuality. This enables them to develop their skills and confidence. They are supported to maintain valued social and family contacts so that they are not isolated or institutionalised. They are provided with a wholesome and varied diet so that they enjoy their meals and stay healthy. EVIDENCE: People’s care plans and daily records provide good evidence that their interests and abilities are fully considered in planning the daily activities. The information is held in either word or picture format as a “daily activity rota” so that residents can follow their routine more easily. Some CSCI surveys from relatives, staff and residents state that ‘attending activities is reliant on staff availability and hence some activities are cancelled’. The manager stated that the activity rotas have been re-designed and now ensure that suitable activities are always provided, there is flexibility in the rota to allow for the number of staff available. Staff said that the people using the service can be assisted to access voluntary employment opportunities, college and a variety of sports. They go for walks and pub lunches as well. They all went out during this inspection even though the weather was wet. There are photographs on the dining room walls of residents enjoying different types of activities; it is not clear how old the photographs are. The manager and staff talked about activities in the garden where there is a barbeque area, a vegetable garden tended by the residents, and a swing and trampoline for their use. People’s daily care records show that they access a wide range of community resources with staff support, according to their individual needs and abilities. We were told that the people using the service are encouraged to maintain valued contact with their families and friends, with staff support as necessary, their daily care records confirmed this. They are able to make telephone calls in private if they wish and there is a family room for privacy when people have visitors. One resident talked about her parents visiting. We were shown photographs of residents, relatives and staff enjoying a barbeque in the garden to celebrate a relative’s birthday. Nutritional needs and preferences are assessed as part of the care planning process. The menu we were shown spans three weeks and shows that nutritious and varied meals are on offer. There are limited choices on the menu and this was discussed with the manager. She said that alternatives are always Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 16 available but they are looking to develop a menu that includes choices. She told us that a new member of staff is a chef and that some other staff have worked in catering positions previously so there is a wealth of knowledge and experience in providing good food. We were told, by staff that residents are encouraged to participate with shopping, planning and the preparation of meals. They also help with washing up and setting the table. The home has a domestic kitchen, the freezer has been moved to a room that used to be the office and it is intended to make this a larder. The manager said that this will enable residents to have more freedom to access the kitchen to prepare drinks and snacks. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 17 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): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The personal and healthcare needs of people using the service are well met so they are able to live full and active lives in and out of the home. Medication systems and records have improved but the number of medication issues reported to the Commission is a cause for concern as residents maybe at risk. EVIDENCE: We were told that all of the people using the service require some personal care support or prompting. Their personal care needs are included in their care plans with a summary held in their rooms. There are suitable en suite facilities to each bedroom with either a shower or a bath and these allow for privacy to be respected. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 18 Residents are all registered with a GP, their health is monitored and all events recorded. The manager said that visits to the dentist and optician take place regularly and other appointments are attended as required. Spectrum has a medication policy that is available in the home. An up to date copy of the the Royal Pharmaceutical Guidelines for care homes has been obtained since the last inspection, along with a recent copy of the BNF reference book, these are available to staff. Patient information leaflets for medicines administered are also available to staff and have been laminated for ease of use. Residents do not currently self-administer their medication. Medicines are supplied by a local pharmacy and they have provided training for staff. Spectrum also provide a level 3, distance-learning course in medicines, via Newcastle College. The deputy manager told us that staff are supervised administering medicines and a competency sheet is signed. The manager told us that only staff that have received training are allowed to administer medicines to residents and that they have to watch residents while they take their medicines to ensure, as far as possible, that they have been swallowed. One person per shift is the dedicated key holder and a sheet is signed when the keys are given to another member of staff. Two members of staff undertake the ‘medicine round’ and each signs a separate medicine administration record chart. Receipt of medicines, administration and disposal records were seen and were maintained appropriately. Individualised protocols have been put in place for some ‘as required’ medicines and the deputy manager said she is working on others. There are suitable medication storage facilities. There are currently no controlled drugs held, if there were a specific cupboard that meets the legal requirements would have to be provided. There have been fourteen issues regarding medication reported to the Commission since the last inspection on 08 August 2007 and another reported during this inspection. Four are instances when medicines have been found in various places and may have been spat out, other issues are residents receiving extra tablets, tablets being omitted, one incident of tablets given to the wrong person and tablets missing. This is of serious concern, as it was at the last inspection. The manager said, and it is acknowledged, that they have worked hard to get staff trained and improve systems in the home. The deputy manager said she audits the medicines on a monthly basis but feels she should perhaps do this weekly as medicines are so important and the process must be carried out correctly. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 19 Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 20 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): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people using the service are listened to and respected, their views, concerns and complaints are taken seriously and acted upon. There are formal and informal systems in place to ensure that they are able to feel safe in the home. EVIDENCE: The complaints procedure in place has been updated and issued to the people using the service. Staff have signed to say they have read the procedure and this was shown to us. The manager said both staff and residents have opportunities to raise concerns before they become serious problems. A file was shown to us that held thank you letters and compliments from relatives, visitors and managers from Spectrum head office. Residents had the opportunity to speak to the inspector during this inspection to make their views known. They have completed surveys for the Commission with the help of their key workers and no concerns have been raised. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 21 The home has written procedures to guide staff on what to do if they suspect a resident is at risk of abuse. There are records to show that staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting and appropriate checks are made. Residents are not isolated in the home, but take part in a range of activities in the local community and have relationships with people from outside of the home that they can communicate serious concerns to. Spectrum has a whistle blowing policy. The manager and her deputy have attended the Multi Disciplinary Adult Protection course and the rest of the staff bar one have attended some abuse training. It is noted that five staff are due for an update of their training. There is one safeguarding issue ongoing at the moment. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 22 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): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides people with a clean, safe domestic environment so that they can develop their skills and independence in a non-institutional setting. Consultation with the people using the service has lead to communal and private areas being furnished to a comfortable and high standard, which suits them. EVIDENCE: Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 23 A member of staff showed us around the home and one resident showed us her room; which was personalised with her belongings, she said she chose the colours for her room herself. The home is a domestic dwelling and all bedrooms have been provided with en suite facilities. The furnishings and décor of the home are good and the home is kept clean and well maintained. The people using the service seem very happy in the home and surveys are complimentary about the environment. The grounds are tidy and there is ample space for outdoor activities. The barbeque and greenhouse areas have been made safe with wooden fencing around them. There is plenty of seating for residents outside. The environmental risk assessment at the last inspection identified that the gateway to the home needs to be moved closer so that access is safer for residents. The manager said that the deputy manager has drawn up a plan and cost analysis for this and the request has been submitted to Spectrum head office. Some COSHH substances were not locked away in the laundry, the outside door was open along with the outside door to the kitchen. A member of staff said no resident goes into the laundry unsupervised. He said the doors are only open when staff are in the kitchen. One tumble drier was out of order but was repaired during the inspection. One toilet had no means for drying hands other than the toilet roll and this was mentioned to staff. Later in the day a cotton towel was provided. Staff said a clean towel is usually provided daily. A fire door labelled, to be kept shut, was seen open. It goes across an alcove to two other rooms with fire doors. This was discussed with the manager who said she will check if it has to be shut at all times or if an automatic closer can be fitted or the sign removed. The room in the loft space is no longer used as an office, the door was not locked and, this was discussed with the manager, as the steep open, wooden stairs could be dangerous if residents were to access this area. She said the door is normally locked and agreed to ensure this is always the case. Staff have good sleeping in facilities and lockers have been provided for them to store their belongings, in the office. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 24 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): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There appear to be sufficient numbers of staff on duty at all times, training provision has lapsed recently but the organisation normally offers a variety of training to staff. The home’s recruitment policies and practices are fair, safe and effective so residents can be assured that staff are suitable to work in a care setting. EVIDENCE: CSCI surveys completed by staff say that an increase in staff is required as they often work on minimum levels and at times activities are cancelled because of insufficient staff. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 25 The manager stated that staffing levels have been reviewed as required at the last inspection. The rota showed that there are generally four staff on in the mornings, three in the evenings and two overnight (one sleeps in). On the day of the inspection there were five staff on duty and a member of staff said this does happen sometimes and allows for residents to be taken out more. The manager said there has been quite a high turnover of staff but she now has an established team and the residents are settled with them. Bank staff help to cover sickness or annual leave. The care staff are responsible for all personal care duties plus, with the residents assistance, cleaning and cooking tasks. Staff were observed to interact and communicate well with the people using the service. They were confident, calm and patient in their manner. Staff commented that they enjoy working at Menna House, they work well as a team, with good support from the manager. They did not appear to be rushed on the day of the inspection and they managed to take all of the residents out. The number of staff qualified to at least NVQ level 2 has improved despite an increase in staff turnover. Of the eleven staff employed two are qualified to NVQ level 2 and three are close to completing the course. Additionally the deputy manager has achieved NVQ level 3 and she is working towards level 4 in management and care. She is also the in house NVQ assessor. The manager stated that all staff are enrolled onto NVQ courses following their induction period. The Company has had a short break from training provision recently but the manager told us that a new schedule commences in September 2008 and staff are already booked on to courses. Staff said the training provision with Spectrum is very good and the deputy manager said the training department are very supportive to staff. They said there is training specific to the residents available regularly although there are not many opportunities for attending external courses. See also the following section of this report. The electronic recruitment records for three new members of staff were accessed on a computer screen. All staff have completed an application form and a health questionnaire and interview records assure equal opportunities. The documents required by legislation are held. There are induction, supervision and training records for staff in paper format. Staff now have copies of the General Social Care Councils Code of practice and have signed a sheet, on the notice board, to state they have read it. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 26 Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 27 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): Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 28 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager is competent to run the home and the health and safety of residents and staff is generally promoted, extra vigilance regarding the use of medicines and statutory training for example will provide further safeguards. There are quality assurance systems in place and people’s views are accounted for in the day-to-day running and development of the home, the Annual Quality Assurance Assessment requested by the Commission was not returned on time. EVIDENCE: Annabella Verris is the current manager and she has been in post for 15 months. She has been registered with the Commission for Social Care Inspection since January 2008. She has achieved NVQ level 3 in care and is working towards the Registered Managers Award. The manager stated that she normally works opposite shifts to her deputy and the shift leader is in charge when neither of them are on duty. She works different days each week, not just Monday to Friday and works with the residents as well as administration. Staff spoke highly of the manager and said she is supportive, survey results were positive in respect of the management of the home. Annabella interacted and communicated well with residents during the inspection, in a calm, confident manner. She has tackled areas for improvement identified in the last report but the number of medicine issues that occur in the home are of concern to the Commission. The manager said the home has an annual development plan. She also said that quality assurance questionnaires are sent to the resident’s parents and social workers annually and results have been very positive. She said the people using the service are asked their views at each monthly and six monthly review meeting; comments were seen in the reports. Another Spectrum manager visits the home each month to inspect the home and talk to people; a report is compiled in line with regulation 26 of the Care Homes Regulations 2001. The last report was given to the Inspector and it is very thorough, there are several issues for the management team to address and they said they are working towards them. Meetings are generally held with staff each month and the file of minutes was shown to us. The deputy manager said she undertakes an audit of the Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 29 medicines each month and she had a file with her findings in it. She also said the pharmacist visits regularly. The manager said she had completed an Annual Quality Assurance Assessment (AQAA) for the Commission, this is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives the Commission some numerical information about the service. The manager said that her completed AQAA had been sent to Spectrum head office; unfortunately this was not received by the Commission until 05 August 2008 which was four days past the date due in the reminder letter. It has not therefore been used to inform this report. The home appears to provide a safe environment and there are written individual and environmental risk assessments in place to minimise risks to residents and staff working in the home. Maintenance of the home and its equipment and inspections undertaken by Environmental Health have been satisfactory. All relevant fire checks are carried out and service and equipment checks are up to date. There were no fire doors wedged open during this inspection. Statutory training is provided by Spectrum and we were shown a training matrix that is displayed on a notice board in the office. It has records of when staff have attended training sessions. It showed that: • All staff have attended fire warden training but this is not annual, the manager stated that fire training also takes place during in house fire drills. • Two people have yet to complete food hygiene training • One person has not yet attended infection control training • Three people have not attended medicines training; the manager advised us that these people do not administer medicines. • One person has not attended POVA training and five people are due to attend again • Staff have attended moving and handling training but this is only provided on a three yearly basis. Discussion took place with the manager who said she will look into why this statutory training has not been provided annually. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 30 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 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 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 3 40 X 41 X 42 2 43 X 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Menna House Score 3 3 2 X DS0000069008.V365659.R01.S.doc Version 5.2 Page 31 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. 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 3 4 Refer to Standard YA6 YA7 YA20 Good Practice Recommendations Daily records should be written concurrently with no gaps for staff to complete retrospectively to ensure accurate legal documents All transactions in respect of people’s monies should be signed to show who is accountable The registered manager needs to review the medicines procedures for the home and ensure that all staff administering medicines are fully competent to do so to avoid errors occurring The homes environmental risk assessment identified that the gateway needs to be moved closer to the home so that access is safer for residents. This has been reviewed and action needs to be taken to move the gate. 5 YA24 Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 32 6 YA32 50 of the staff team should be qualified at minimum of NVQ level 2 Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 33 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. Menna House DS0000069008.V365659.R01.S.doc Version 5.2 Page 34 - 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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