CARE HOME ADULTS 18-65
Mulberry House 120 Barton Road Luton Bedfordshire LU3 2BD Lead Inspector
Mrs Louise Trainor Unannounced Inspection 7th July 2008 10:00 Mulberry House DS0000039287.V367991.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 Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Mulberry House Address 120 Barton Road Luton Bedfordshire LU3 2BD 01582 570569 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) no email as at 5.7.7 Complete Care Services Limited Ms Wendy Snow Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4TH January 2008 Brief Description of the Service: Mulberry House is located amongst a group of residential houses set back from the main road from Luton to Bedford in a residential area to the north of Luton. The home has access to local shops and public transport. The service was registered to provide residential care for eight people with learning disabilities. The service had been developed and operated by Complete Care Services Ltd for a number of years. The building has two storeys. The ground floor provides two bedrooms, a toilet, a large communal lounge/diner and a kitchen. Located on the upper floor is a staff area, a bathroom and six bedrooms. All of the bedrooms are for single occupancy and have en suite facilities. At the rear of the house is a garden with a small patio area. To the front of the property is a small garden. Copies of this report and others relating to this service can be provided on request. A copy of previous reports is available at the service. The fees for this home vary from £1200 per week, to £1600 per week, depending on the funding source and assessed need of the person. Mulberry House DS0000039287.V367991.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 2 stars. This means the people who use this service experience good quality outcomes.
This inspection was carried out in accordance with the Commission for Social Care Inspection’s (CSCI) policy and methodologies, which require review of the key standards for the provision of a care home for Younger Adults that takes account of service users’ views and information received about the service since the last inspection. Evidence used and judgements made within the main body of the report include information from this visit. This was the first Key Inspection for this service this inspection year, although a Random Inspection was carried out in April 2008. Regulatory Inspector Mrs Louise Trainor carried it out on the 7th of July 2008, between the hours of 13:30 and 18:30 hours. The focus of this inspection was to monitor further compliance of the requirements made at the previous Key Inspection in January 2008, and assess whether improvements seen at the Random Inspection carried out in April 2008 had been sustained. Evidence from the April inspection has been included in this report. There are presently seven permanent residents living at this home and all were present for periods during this visit. The personal files and documentation for one of the residents was examined in detail. The inspector also had the opportunity to informally chat with people who live at this home as well as staff who work at the home. Other documentation examined during this inspection included, documents relating to staff recruitment, training and supervision, Medication Administration Record (MAR) sheets and medication stocks, Personal Allowance records and quality assurance. A tour of the premises was undertaken. This was overall a very positive inspection and we would like to acknowledge how hard the manager and her team have worked to introduce changes over the past six months to improve standards in this home. We expect these improvements to continue. The inspector would like to thank everyone concerned for their assistance and support during this inspection. Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 6 What the service does well:
This home understands the importance of having sufficient information when choosing a home. The statements of purpose and service user guide are written in a format containing pictures and symbols so that the residents can clearly understand it. This service involves the residents in the planning of care that affects their lifestyle and quality of life, and the staff understands the importance of residents being supported to take control of their lives. Resident’s meetings are held at least once a month, and the people who live here are encouraged to give their opinions and contribute to making decisions about different aspects of life in this home. People who live in this home have the opportunity to develop and maintain important family and personal relationships, and staff practices promote individual rights and choices, but also consider the protection of individuals in supporting them to make decisions. Residents are encouraged to make themselves drinks and snacks. The file that we examined contained a risk assessment for this activity, and identified observation and support to ensure safe practices and to minimise the risk of scalding. Residents are encouraged to maintain contact with friends and family, and are supported to attend local community events, such as disco’s where they can develop new friendships. People receive personal and healthcare support using a person-centered approach with support provided based on the rights of dignity, equality, fairness, autonomy and respect. People are supported to maintain independence. Observations of staff / residents interactions indicated a relaxed atmosphere of companionship with a mutual respect. The residents all appeared content whilst going about their daily routines whether independently or with support from the staff team. This service has a complaints procedure on display that is easy for the residents to understand. Policies for safeguarding are available, and give clear guidance to those using them. Staff know when incidents need external input and who to refer to. The home provides a physical environment that is appropriate for the residents. The design allows for small clusters of people to live together in a Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 7 non-institutional way, and promotes privacy, dignity and autonomy for the residents. The manager has introduced a new system for recording staff supervision, whereby both supervisor and supervisee sign a record sheet. We looked at seven staff record sheets, all had had supervision during the past two months. What has improved since the last inspection?
At the previous key inspection in January 2008 we identified concerns that some of the care plans and risk assessments, although well written, had not been reviewed or updated for over a year. In particular we were concerned that the only resident, who was self-medicating, and also managed her own money, did not have risk assessments in place for these activities. This individual’s file was examined again during the Random inspection visit in April 2008, and reviews had taken place and risk assessments were appropriately in place. The menus in the home have been reviewed since our last Key Inspection in January, and a new ‘Client Choice’ form has been introduced. This is completed on a one to one basis with each individual, each weekend, so that everyone’s choices are considered when planning for shopping and meal preparation. As detailed elsewhere in this report, the manager is presently looking at new ways to make more of the daily tasks in the home responsibilities for the residents with support from staff, rather than the residents expecting staff to do it all, only helping when they feel like it. Since the last key inspection the deputy manager has worked hard to develop an audit system for the medication in this home. This clearly identifies that stocks reconcile correctly, and cross-references with the individual’s Medication Administration Record (MAR) sheets. Since our last inspection to this home the complaints policy has been reviewed. It has now been produced in a pictorial format so that residents can clearly understand what they need to do, and whom they can speak to if they are not happy with any aspect of their care. The manager showed us the garden, where residents have recently planted potatoes, peas, beetroots and other vegetables in an allocated area. At the previous key inspection it was reported that the homes laundry facilities were insufficient. The home has now purchased a new ‘industrial type’ washing machine, more appropriate to the needs of the home. The system for the recruitment of staff had raised concerns at the last key inspection, where two staff were identified as not having the correct home office paperwork to be employed. Since this time the manager has reviewed all
Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 8 staff documentation, and a number of staff have left following a probe into the authenticity of their documents. The manager demonstrates a clear understanding of the key principles and focus of this service. She is enthusiastic and is striving to make continuous improvements to promote the health, safety and welfare of the residents who live in this home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 People who use this service experience good quality outcomes in this area. This home understands the importance of having sufficient information when choosing a home. The statements of purpose and service user guide are written in a format containing pictures and symbols so that the residents can clearly understand it. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home has a Service User Guide and Statement of Purpose that had been reviewed and updated in March 2008. Everyone who lived in the home had been issued with a Service Users Guide that had been simply written and translated into pictures and symbols using a computer programme. It is also on display in the dining area and is easily accessible to anyone entering the home. The manager explained that the computer programme that they have purchased, has been registered for use on the residents computer in the home as well, so that any documents they are using or reading, can be translated into pictorial format so that they can understand them more easily. Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 11 There have been no new residents admitted to the home since August 2007. Therefore as the present service user files had been inspected to confirm pre admission assessments, tea visits and trial periods, which were evidenced at the previous inspections, these particular documents were not re inspected during this visit. Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 People who use this service experience good quality outcomes in this area. This service involves the residents in the planning of care that affects their lifestyle and quality of life, and the staff understands the importance of residents being supported to take control of their lives. We have made this judgment using a range of evidence, including a visit to this service EVIDENCE: At the previous key inspection in January 2008 we identified concerns that some of the care plans and risk assessments, although well written, had not been reviewed or updated for over a year. In particular we were concerned that the only resident, who was self-medicating, and also managed her own money, did not have risk assessments in place for these activities. This individual’s file was examined again during the Random inspection visit in April 2008, and reviews had taken place and risk assessments were appropriately in place.
Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 13 During this inspection we case tracked a different resident. This involved a close examination of their personal file, which they agreed to, a chat with them about what it was like living in Mulberry House, and observations of staff interactions with them and the care and support they received. There was a recently reviewed care plan in place. This contained a very detailed description of needs and the level of support required. It identified that this person was an affectionate and sociable person that enjoys going out. It detailed the different day centres that they attend, as well as their particular friends and their preferred leisure activities. The information relating to personal care needs, was specific in detail. It identified that this person generally required verbal support to bath and shower, although needed some physical assistance to wash their back, and dry their hair. They were able to brush their bottom teeth, but due to some coordination difficulties needed assistance to brush the top. Likes to use mouthwash, however this needs to be kept on top of the wardrobe out of reach or they will use it excessively. They dress independently, however need some assistance with clasps and clips on clothing. Needs help when they wear make up, and enjoys having nails painted. This person communicates well verbally, does know and understand some Makaton and can write simple words. They can prepare cereals and toast independently for breakfast, but need observing to make hot drinks to ensure safety from scalding. Enjoys working in the kitchen. Information relating to this persons behaviour was clear, and included guidelines for de-escalation and also identified triggers, so that these could be avoided. There were clear directions to follow if medication was required, as this may interfere with their normally steady mobility. There was a diagnosis of their condition and a medical history with follow up details where appropriate. The care plan also identified that although this person was not able to manage their finances overall, they could understand ‘what they could buy for a pound’ if they were at the shops. There were strict security measures in place to enable this person to have their own ‘card account’. There were numerous risk assessments in place relating to an array of situations. These included, working in the kitchen, walking up and down stairs, bedroom door key, going to the cinema, self harming, going on the bus, getting lost and crossing the road. These had all been reviewed over the past few months, and accurately described the potential hazards and how they should be minimised. Resident’s meetings are held at least once a month, and the people who live here are encouraged to give their opinions and contribute to making decisions about different aspects of life in this home. We were shown notes taken from a recent residents’ meeting, they indicated that all residents had attended and participated to some degree. Topics discussed included, menus, a new activity book, days out and holidays. Opinions were sought and recorded from everyone on each subject.
Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 14 The menus in the home have been reviewed since our last Key Inspection in January, and a new ‘Client Choice’ form has been introduced. This is completed on a one to one basis with each individual, each weekend, so that everyone’s choices are considered when planning for shopping and meal preparation. The care staff are responsible for preparing the meals and daily packed lunches for the people who live in this home. Although residents do sometimes assist with the meal preparation, this is only when they feel like it, it would be encouraging to see more involvement and responsibility for these residents in the kitchen, such as preparing their own packed lunches. Each resident has a ‘House Day’ each week, where they do personal and household chores, Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 15 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 People who use this service experience good quality outcomes in this area. People who live in this home have the opportunity to develop and maintain important family and personal relationships. Staff practices promote individual rights and choices, but also consider the protection of individuals in supporting them to make decisions. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: When we arrived to carry out this inspection, there was only the manager, one carer and one resident at home. Three of the residents had gone to college to sign up for their next years courses, two were at their day centre placements and one had gone shopping with the deputy manager. At 13:45, the mini bus arrived home, with the shoppers and the three residents that had been to college.
Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 16 One was keen to tell us how she had opted either for cookery or ‘the coffee shop’ for her next years choices. She proudly showed us a certificate that she had already been awarded for being ‘the friendliest person in the coffee shop’. Another told us that she was hoping to do arts and crafts next year as she had already done cookery. There is a new activity folder in the home, and the residents collect leaflets and information on activities they would like to attend. Presently this included; a butterfly park, theatre trips and a railway centre. They hope to visit some of these places during the coming months. An activity book has been introduced and is completed on a daily basis to identify who has done what. Recent extracts detailed. “28/06/08 – all went to fete, 29/06/08 – all went to car boot, 30/06/08 – 2 went to farm and 1 went shopping, 2/07/08 – music man visited home, 03/07/08 – indoor activities.” This was a great improvement on the last key inspection, however we would like to see this progress further so that the residents were doing more individual activities. On the 14/06/08 all of the residents and four staff went on holiday to Norfolk, details of trips to Pleasure Wood Hills, Picnics, Swimming and pottery painting indicated that there were a variety of activities to suit everyone. One resident showed us the trinket pot she had painted. Residents are involved in planning the weekly menus and shopping lists, and also go on the shopping trips. However the manager discussed involving the residents more. At present some of the residents think it’s the job of the staff to prepare meals, put the shopping away and do the other general household chores. The manager is presently looking at new ways to make more of these tasks the responsibility of the residents with support from staff, rather than the residents expecting staff to do it all with input from them only when they feel like it. This is a positive initiative and we look forward to seeing how it progresses. The menus identified a wide range of meal choices, and the fridge and freezers were well stocked, with both fresh and frozen produce. Residents are encouraged to make themselves drinks and snacks. The file that we examined contained a risk assessment for this activity, and identified observation and support to ensure safe practices and to minimise the risk of scalding. Residents are encouraged to maintain contact with friend and family, and are supported to attend local community events, such as disco’s where they can develop new friendships. One resident has recently been featured in the local paper, following her achievement in winning a painting competition. She had won first prize out of 11,000 entries, and was rightfully very proud. Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 People who use this service experience good quality outcomes in this area. People receive personal and healthcare support using a person-centered approach with support provided based on the rights of dignity, equality, fairness, autonomy and respect. People are supported to maintain independence. We have made this judgment using a range of evidence, including a visit to this service EVIDENCE: Observations of staff / residents interactions indicated a relaxed atmosphere of companionship with a mutual respect. The residents all appeared content whilst going about their daily routines whether independently or with support from the staff team. One resident was busy writing a story in a book, and every now and then went to staff to show off her work, and share her knowledge of the contents. Another was walking with a zimmer frame and required some physical assistance, the level of support required for him varies from day to day depending on his mood.
Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 18 The file that we examined during this inspection gave clear details of how much assistance and support was required for one individual both physically and emotionally. It made reference to ‘home visits’ when increased emotional support maybe required. The documentation in this file also evidenced that ageing, illness and death had been addressed, and although most of the decisions relating to this had been completed with close relatives, this resident did have her own understanding of what death was, which she demonstrated when she talked to us about her dog that had died and was now in heaven. Staff were sensitive to her emotions while she talked about this, and were able to support her to move on to other topics without her becoming distressed. As detailed elsewhere in this report, the manager is presently looking at new ways to make more of the daily tasks in the home, responsibilities for the residents with support from staff, rather than the residents expecting staff to do it all, only helping when they feel like it. For example residents like to go shopping, but they aren’t always forthcoming with unloading the shopping and putting it away in the kitchen. They assist with their laundry, however we saw staff bringing the washing in off the line when it rained. The manager is trying to instil that these activities are part of the process of day-to-day life, and that although residents do not always feel like doing these chores, they should be encouraged as part of their care to enhance the development of independence. It is however difficult to strike a balance between the individual’s development and how far individual’s choices dictate what they do. Since the last key inspection the deputy manager has worked hard to develop an audit system for the medication in this home. This clearly identifies that stocks reconcile correctly, and cross-references with the individual’s Medication Administration Record (MAR) sheets. During this inspection we were introduced to this system, which is working efficiently and effectively. We checked the MAR sheets of four of the residents; all had been clearly completed with two signatures for each administration, omission codes had been applied appropriately, and stocks reconciled correctly. Each resident has a completed profile that includes a colour photograph, allergies, identification marks and other personal details to ensure the correct person receives the correct medication. Our only concern relating to medication in this home was that there is presently no facility to store or appropriately record controlled drugs on these premises, and although there is presently no residents prescribed controlled drugs in this home, there is a very real possibility it could happen at any time. If a resident were to be prescribed controlled drugs, the home would be breaking the law relating to the storage and records of this particular drug. We have therefore made a requirement for this to be installed.
Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People who use this service experience good quality outcomes in this area. This service has a complaints procedure on display that is easy for the residents to understand. Policies for safeguarding are available, and give clear guidance to those using them. Staff know when incidents need external input and who to refer to. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Since our last inspection to this home the complaints policy has been reviewed. It has now been produced in a pictorial format so that residents can clearly understand what they need to do, and whom they can speak to if they are not happy with any aspect of their care. This policy includes outside agencies, with contact details, and time frames in which they should receive a response. There had been no complaints recorded since the last inspection. This home now has a clear policy on safeguarding, and the staff that were interviewed at the Random Inspection in April 2008 were able to demonstrate their understanding of reporting processes. Unfortunately we did not have the opportunity of interviewing any different staff during this inspection. The manager has been unable to secure training from the local safeguarding coordinator, however has resourced a new distance learning training pack for staff, which includes question and answer papers that are sent away for marking before a certificate can be awarded.
Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 20 The home has one resident who looks after her own money. She has a safe in her bedroom for this purpose, and the process has been risk assessed. Money for all the other residents is held in a locked cupboard. Each person has his or her own wallet that is security tagged. To open a wallet this tag must be broken and then replaced when closing the wallet. The new tag number is recorded each time the wallet is opened and funds are added or removed. Records show that for each transaction a new tag number had been entered. This is an efficient security system, which enables all staff to access funds for the residents at any time, and carries a clear audit trail of each time the wallet is opened. Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 People who use this service experience good quality outcomes in this area. The home provides a physical environment that is appropriate for the residents. The design allows for small clusters of people to live together a non institutional way, and promotes privacy, dignity and autonomy for the residents. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: During this inspection we toured the premises both inside and out. It was clean and comfortable with a homely atmosphere. The manager showed us the garden, where residents have recently planted potatoes, peas, beetroots and other vegetables in an allocated area. The communal lounge diner is a spacious room, with a large dining table at one end and a lounge area at the other. We noted that since the last Key Inspection, in the lounge area of this room, a tabletop football game and a
Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 22 table with a chalkboard top have been introduced to provide extra recreational activities for the people who live here. There is also a computer system and stereo unit set up in this area of the home. The manager told us that she has made arrangements for a pictorial programme to be installed onto this computer, so that residents can use the system more easily. The kitchen is clean and tidy, with sufficient space for residents to work on developing their skills supported by staff. Due to the behaviour of one resident in the kitchen area, an agreement has been drawn up for it to be kept locked when not in use. This agreement had been signed by all residents. At the previous key inspection it was reported that the homes laundry facilities were insufficient. The home has now purchased a new ‘industrial type’ washing machine, more appropriate to the needs of the home. We visited the room of one of the residents, each individual’s room has an en suite bath or shower room. She advised us that she had chosen the colour herself. She had recently bought a new flat screen television and a new bed for her room, and she talked about getting a new chair. The room was personalised by photographs of people who were special to her, and personal belongings, including a pottery trinket box that she proudly told us she had painted herself. She had a white board on her wall, with picture and word attachments. With help, she was able to attach the correct day of the week and the activity she would be doing that day to it. This acted as an ‘activity calendar’ and a memory jogger for her. Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People who use this service experience adequate quality outcomes in this area. There is enough competent staff to meet the needs of the people who live in this home. The manager recognizes the importance of training, however is not always in a position to provide this training. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The normal staffing allocation in this home is three care staff plus a manager during the daytime hours, and one carer at night supported by a ‘sleeping in staff’. The manager told us that she is presently fully staffed, but is hoping to bring in an extra person between 08:00 hours – 17:00 hours, to assist with activities. The system for the recruitment of staff had raised concerns at the last key inspection, where two staff were identified as not having the correct home office paperwork to be employed. Since this time the manager has reviewed all staff documentation, and a number of staff have left following a probe into the
Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 24 authenticity of their documents. The manager had not been able to locate where they had gone. During this inspection we examined the files of three new staff, all of which had the appropriate checks and paperwork present. This included; fully completed application forms, at least two appropriate references, Criminal Record Bureau checks, Home Office documents for overseas staff, passports and various forms of identification and proof of addresses. The manager has introduced a new system for recording staff supervision, whereby both supervisor and supervisee sign a record sheet. We looked at seven staff sheets, all had had supervision during the past two months. The manager however does not receive any sort of supervision at present. She told us that she and the manager from a local sister home are hoping to make arrangements for peer support and supervision. Since the last key inspection the manager has been researching different training resources. She is introducing distance learning courses in a variety of subjects, including, challenging behaviour, Infection control, food hygiene, Moving and Handling and Health and Safety. Most of these courses involve watching a DVD presentation and using workbooks, and being supported by the manager. We are concerned that the manager, although competent in her role is not trained to train specialist subjects such as challenging behaviour and restraint. In this environment where these skills are essential for the safety of the residents and the staff, a budget should be provided to resource accredited trainers to deliver these subjects. Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42, 43 People who use this service experience good quality outcomes in this area. The manager demonstrates a clear understanding of the key principles and focus of this service. She is enthusiastic and is striving to make continuous improvements to promote the health, safety and welfare of the residents who live in this home. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Since our last key inspection in January 2008 there have been vast improvements in the way this home has been managed. The manager and her team have worked hard to introduce new systems to the service, which efficiently protect the residents. Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 26 In the previous key inspection report dated 04/01/08 we identified that the manager had failed to authenticate crucial recruitment documentation, when appointing staff to this home. Since this time the recruitment policy has been reviewed and the documentation of all employees has been reviewed. During a Random Inspection in April 2008 nine staff files were inspected and all appropriate information had been collated and checked. During this inspection we checked three new staff files. These also contained appropriate documentation that had been authenticated. There had also been a review of the Complaints policy and the Safeguarding policy. These documents now contain a clear guidance for staff, and the contact details of Safeguarding personnel. All incidents and accidents are now being reported appropriately both to the Commission for Social Care Inspection (CSCI) and the Safeguarding Team where appropriate Evidence indicated that Health and Safety checks are being carried out and recorded. These include; weekly fire call point tests, water temperature checks daily, fire equipment monthly, monthly emergency lighting tests and fridge and freezer temperatures daily. There is a maintenance book that clearly identifies the date that issues had been reported and the date work was carried out. The fire risk assessment was reviewed in May this year, and ten staff attended a fire drill that was carried out in March 2008. Risk assessments have been improved, and records show that they are being reviewed regularly to reflect individuals changing needs. Daily records are completed on each resident every twelve hours. These are clearly dated and signed. The manager is addressing quality assurance in the home. In addition to the views of the residents, which are collated after each monthly meeting, in October 2007 she had sent out twenty questionnaires to families and other professionals that work with the service. Since the last inspection she has prepared an audit report addressing issues that were raised through the questionnaires. We note that one issue was relating to relatives not having the opportunity to meet the Provider Mr Ralphs. At the time of this audit report this had still not been achieved. Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 2 32 2 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 3 3 3 3 3 3 Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement People in this home must be protected by the appropriate storage and recording facilities for controlled drugs. People who live in this home must be cared for by staff that have received specialist training to safely meet their needs. Timescale for action 31/10/08 2. YA32 5(b) 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA39 Good Practice Recommendations The home should consider arranging meetings that include relatives, staff, residents and the provider. Mulberry House DS0000039287.V367991.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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
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