Inspection on 08/06/09 for Murree Residential Care Home

This inspection was carried out on 8th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Murree Residential Care Home 08/09/08

Murree Residential Care Home 20/04/07

Murree Residential Care Home 07/09/06

Murree Residential Care Home 06/10/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Murree Residential Care Home 17 Marquis Close Wembley Middlesex HA0 4HF Lead Inspector Julie Schofield Key Unannounced Inspection 8th June 2009 09:15 Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Murree Residential Care Home Address 17 Marquis Close Wembley Middlesex HA0 4HF 020 8903 1571 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) murreecarehome@ntlworld.com murreecarehome.co.uk Mrs Shahnaz Abbasi Mrs Shahnaz Abbasi Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Murree Residential Care Home DS0000061675.V375826.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 the following gender: Either 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: 3 8th June 2009 Date of last inspection Brief Description of the Service: Murree House residential care home provides personal care for up to 3 adults with learning disabilities. At the time of the inspection there were no vacancies. The property is off a road, which is part of a route linking Ealing Road with the North Circular Road. There is a barrier across this road, close to the home, and so access to the home by vehicle must either be from the North Circular Road or by using a detour around the barrier, if approaching from Ealing Road. There is space to park outside the home on the street. Although there is a paved area at the front of the house there is no dropped kerb. Inside the home there is a bedroom on the ground floor and 2 bedrooms on the first floor. There are bathing and toilet facilities on both floors. There is a kitchen and an open plan lounge/dining area on the ground floor. The office is on the first floor. The laundry room is in a building in the attractive garden at the rear of the house. Information about the service provided and the level of fees may be obtained, on request, from the manager of the home. Murree Residential Care Home DS0000061675.V375826.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 a one star – adequate service. This means the people who use this service experience adequate quality outcomes. The inspection took place on a Monday in June. It started at 9.15am and finished at 4.00pm. During the inspection we examined records, including case files and staff files, and the care of residents was case tracked. A tour of the building took place and compliance with the statutory requirements identified during the previous key inspection in September 2008 was checked. We spoke with the registered manager, two members of staff and each of the three residents, although feedback from 1 of the residents was limited. We would like to thank everyone for their assistance and for their comments during the inspection. What the service does well: When talking with 2 of the residents they told us that they were satisfied with the service. Positive comments were made about the support received from everyone working in the home, the meals served, the bedrooms and their generous sizes and their improvement in general health. They were pleased to have opportunities for going on holiday and for the choice of outings so that they could pursue their own interests and hobbies. We saw that the 2 of the residents have become good friends and enjoy each other’s company. We saw that the needs assessment and the care plan identified the individual needs of the resident including their cultural, linguistic and religious needs. There was evidence that these were met. The majority of staff working in the home were able to speak to an Asian resident in his first language i.e. Urdu. Support was given to the resident so that he could attend mosque. Meals served in the home included Asian dishes that were culturally appropriate. The resident was able to watch programmes on television that were broadcast in Urdu. An escort is provided when residents need support in the community. Relatives are made welcome when they visit the home and an elderly relative has celebrated their birthday in the home with the resident. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Seventeen statutory requirements were identified during this inspection. Although reviews of the care plan and placement were taking place copies of the minutes of meetings had not been received so it was not possible to determine whether the service that is now provided has taken into account the targets and goals agreed during the meetings. It is important that residents are encouraged to develop their independent living skills by being encouraged to take part in the preparation of meals and the practice of locking the kitchen door for certain periods needs to be reviewed. Menu planning needs to incorporate more variety and food records need to be complete. Safeguarding procedures must continue to be followed and after the police investigation into an allegation of abuse is complete the home will need to carry out its own internal investigation. The management structure in the home is not clearly understood by all members of the staff team and the registered manager needs to ensure that her position is understood. When new members of staff are recruited the application form needs careful checking so that the full work history is established and the procedure protects the welfare of residents. Induction training needs to incorporate all aspects of safe working practices and all members of staff must undertake infection control training. This is important because due to the size of the care home there will be times when a member of staff is the only person on duty and responsible for the health and safety of residents. A more detailed training plan is needed for the home and when training courses are undertaken a copy of the attendance certificate needs to be placed on the member of staff’s file so that staff training profiles can be developed. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 7 Although a programme of refurbishment is taking place one of the residents has requested painted walls in his bedroom rather than wall paper and as the wall paper is lifting at the seams this would be a good time to make the change. We have asked for a copy of the employer’s liability insurance certificate as the certificate that was on display during the inspection expired the next day. We also requested a copy of the 2009 development plan. We have asked for clearer copies of the record sheet for the administration of medication to be provided to avoid mistakes being made. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 8 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 Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A comprehensive assessment of the needs of the resident, prior to admission to the home, enables the home to determine whether a service, tailored to the individual needs of the resident can be provided. Trial visits to the home prior to admission enable the prospective resident to sample life in the home and to decide whether the service provided is acceptable. EVIDENCE: No new residents have been admitted to the home since the last key inspection in September 2008. However, at the last key inspection we looked at the admission process for a newly admitted resident. Key documents had been requested and received including the CPA care plan and risk assessment. The manager had attended meetings held in the hospital, prior to the discharge of the resident and had met the prospective resident on several occasions. An assessment of need, on which the care plan is based, was drawn up before the resident’s admission. The scope of the care needs assessment was comprehensive and included the identification of cultural and religious needs, Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 10 general health and medication, personal care and domestic skills, social contact and communication, community skills, leisure and day care, financial arrangements, behavioural problems and general attitude and risk management. An integral part of the pre-admission process is an opportunity for the prospective resident to visit the care home. The prospective resident visited the home on a 5-day trial leave basis. The case file included information about the content of this visit. Observations were made about the activities that he took part in, the medication that he was taking and his behaviour during the visit. While visiting the home he was accompanied by a member of staff from the hospital. Towards the end of the 5-day period his family came to see him and it was recorded that they were satisfied that his religious and cultural needs were being met. The manager confirmed that the residents already living in the home were positive about the admission. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Regular reviews of the care plan and placement confirm whether the care home continues to be able to meet the individual needs of the resident. A copy of the minutes of the review meeting on the case file would assure residents that the members of staff in the home are aware of and are working in accordance with the goals agreed. Residents have opportunities to exercise choice in aspects of their daily lives but restrictions on access to and use of facilities in the home limits their capacity to develop independent living skills. Responsible risk taking contributes towards the resident leading an independent lifestyle. EVIDENCE: Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 12 We looked at each of the 3 case files. Each file contained a care plan assessment and a care plan. Each of the residents’ care plans and placement has been recently reviewed in 2009 by the funding authority following a safe guarding referral and the home is waiting for a copy of the minutes of some of these meetings. One of the reviews proposed that the resident moves to a supported living environment. There was also evidence that the home had carried out regular internal reviews. We spoke with the manager about the residents’ care plans and if there were any restrictions placed on facilities in the care home or on the residents’ lifestyles. The manager confirmed that residents were not allowed to bring knives into the care home. We noticed that the door to the kitchen was locked and the manager said that at times one of the residents overeats and would go into the kitchen and eat slabs of butter or cheese etc. They would also add a small amount of water to a jar of coffee and then drink this. This pattern of behaviour lasts for a few days at a time and she said that at these times the kitchen door is kept locked, although 1 of the other 2 residents has a key. When asked about the other resident that did not have a key to the kitchen she told us that their hands shook and that they would not be safe to make a drink or snack without supervision. We looked at the residents’ ability to take decisions and the manager confirmed that 1 of the residents managed their own financial affairs. Another resident has their own account but is supported to manage this. The third resident is supported by their family and any money spent on behalf of this resident is reimbursed by the family, on production of receipts. We examined the financial records of the resident that receives support from the home and noted that satisfactory records were kept and that these were up to date. When we looked at the case files we saw that they contained risk assessments that had been drawn up by the manager. The manager has attended risk assessment training. The risk assessments that we saw included areas such as handling sharp objects, vulnerability when travelling in the community independently, walking in the middle of the road, picking up rubbish in the street and bringing it back into Murree House and road safety. The format was comprehensive and included evaluating the risk, the likelihood of occurrence and risk management strategies. We noted that these had all been reviewed in 2009. One file contained a Full Risk Assessment that had been drawn up by the Health and Social Services Department. Another file contained a Risk Overview that had also been drawn up prior to the residents admission to the home. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16, 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Taking part in activities and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle that meets their religious and cultural needs. Residents are encouraged and supported to maintain contact with their family and friends. Taking part in the daily routines in the home encourages residents to develop independent living skills and more opportunities such as supporting residents to help prepare and to cook their own meals need developing. Residents have access to a diet which meets their personal preferences and their cultural and religious needs. EVIDENCE: Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 14 When we spoke with 2 of the residents they said that they went to a centre, which was within walking distance of where they lived, on 3 days per week. Activities at the centre on a Monday include sessions on drama and exercise and on communicating. Wednesday sessions include swimming and a visit to the park and the Friday activities include a religious session. In addition, the 2 residents go to college on a Tuesday. The third resident lives a more independent lifestyle and goes out each day by himself. His activities include visiting the library and attending college. He does a computer class one day per week and attends a creative writing workshop on 3 evenings per week. One of the residents likes to attend a church on Sunday and another resident attends the mosque with their family members. Three of the members of staff are able to support the resident that attends mosque with prayers in the home. Residents use community resources and facilities including parks, swimming baths, places of worship, restaurants, shops and cinemas etc. They travel on public transport or use dial a ride or walk. They also are able to use the vehicle, with 8 seats, that the home has available. One of the residents is having travel training, organised by the college, to enable him to use the train. The manager said that the names of the residents are all on the electoral roll and one of the residents told us that he had voted at the recent elections. Two residents enjoyed a holiday in Scotland last year and 1 resident made several trips abroad. The manager said that she has helped a resident apply for a passport and that residents will choose the venue for the annual holiday this year. When asked about outings the manager said that she was planning a trip to Brighton later in the week but the exact day would depend on the weather. Previous trips have taken place to the British Museum, Neasden and Ealing. One of the residents had spent their childhood in Ealing and wanted to go back to see some of the familiar landmarks. We saw that there are board games etc for residents to use when they are at home and a member of staff told us that he went swimming with the residents. One of the residents confirmed that he kept in touch with a friend that he knew prior to being admitted to the home and that the friend had visited him at Murree House. He also visits a close relative and the relative comes to see him at Murree House. The manager confirmed that the family of one of the other residents comes to visit him. We have previously seen one of the residents entertain a family member visiting them, in the privacy of the resident’s room. During the inspection a friend of one of the residents that attends the day centre called to the home so that they could walk there together. When we reviewed the refurbishment program we noted that bedroom furniture in one of the bedrooms had not been replaced. The resident said that he prefers the existing furniture and he told me that “old is good, new is bad”. The manager told us that residents are encouraged to exercise choice and that one of the residents likes to choose fruit and vegetables from the shops along Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 15 Ealing Road and bring them back to Murree House to be cooked at mealtimes. Residents choose what clothing to wear each day. They can choose whether to spend time privately in their room or to sit in the lounge and enjoy company. They are encouraged to keep their rooms tidy and with support, to make the bed. One of the residents helps when the shopping is purchased and will help with the hoovering. Another resident will sometimes water the plants in the garden. One of the residents has a key to the front door and their bedroom door. When asked about the meals that are served in the home one of the residents told us that they were “good”. One of the residents said that they liked to cook and that they still did some but not as much as before they were admitted to the home. The manager told us that halal meat is served in the home, in accordance with a resident’s religious and cultural needs. Residents are able to request a take away meal if they wish and there are shops and restaurants within a reasonable distance. The resident that spends time in London said that he eats out a lot of time and makes a snack in the evening e.g. noodles so he said there is no need to cook. We looked at the menu and noted that residents have some choice. However, the same menu sheet is used each week and this is used to record what 2 of the residents eat as any changes are noted on the sheet. We saw that the menu sheet recorded chicken curry, chicken biryani and chicken tikka for the Asian resident. Although the manager said that a book is used to record what the 3rd resident eats when they are in the home the manager was unable to find this during the inspection. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive prompting with personal care in a manner, which respects their privacy and dignity. Residents’ health care needs can be met through access to health care services in the community. Residents’ general health and well being is promoted by staff that assist the resident to take prescribed medication in accordance with the instructions of the resident’s GP. EVIDENCE: During the inspection each of the residents left the care home in the morning and we noted that they were all clean and tidy. One of the residents that is self caring was immaculately turned out. When we asked a resident about his general health he said that he had been very well lately but told us that some time ago he had been unwell and the manager had called the GP and the resident had spent a short time in hospital. The manager said that although a Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 17 resident did initially have problems with their personal hygiene the resident has been encouraged to wash, take regular showers and to change their clothes as needed. One of the residents is self caring while members of staff prompt and support the other 2 residents with personal care tasks and provide direct assistance where needed. Residents have access to health care services in the community. However, only 1 of the residents has regular dental check ups as the second resident refused to attend their appointment and the 3rd resident refused to open his mouth to allow the dentist to examine his teeth. Residents have had appointments for check ups with the optician and 1 of the residents has spectacles. Chiropody appointments are also arranged. One of the residents had an appointment with their psychiatrist on the day of the inspection. Residents have CPA meetings. Two of the residents receive assistance with their medication and the other resident does not take any medication. We looked at the records of administration and the manager said that the pharmacist supplies the forms that are used for the daily recording. We noted that the printing of the tables was off centre and that the quality of the printing was poor. The page was covered in dots, which made the recording difficult to read. The manager said that she has spoken to the GP and to the pharmacist about this problem. However, the recordings were up to date and complete. The storage of medication is safe and secure. The pharmacist supplies the medication for one of the residents in a dosette box and this facility has also been requested for the other resident. The manager has confirmed that each member of staff has received training in the administration of medication. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are aware of their right to complain if the care that they receive is not satisfactory. An adult protection policy and training contributes towards the safety of residents. EVIDENCE: There is a complaints procedure in place. The procedure includes timescales for resolution of the complaint and advises the complainant of their right to refer to other agencies. The manager said that no complaints have been recorded since the last inspection. The manager has previously told us that the procedure is discussed as part of the admission process and that information about the procedure is included in the service users’ guide. Two of the residents have previously confirmed that they are aware of their right to complain if they were not satisfied with the care received. She said that she talks with residents on an informal basis either individually or when they are together in the home. One of the 2 residents previously said that they could also speak to a person who was independent of the home if necessary. There is a comprehensive protection of vulnerable adults’ policy in place. The policy also includes a whistle blowing procedure. The policies and procedures Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 19 manual contains a policy for supporting residents with challenging behaviour. The home has a copy of the local authority’s interagency guidelines in the event of abuse. Training records demonstrate that the manager and 2 members of staff have undertaken training in the protection of vulnerable adults by attending an external training course in addition to their NVQ studies. The other 3 members of staff have received awareness training as part of their NVQ studies. It is recommended that these members of staff attend an external training course. The manager has also completed training in safe guarding adults and said that 2 members of staff will attend this training. An anonymous allegation of verbal, emotional and physical abuse was made directly to the Commission for Social Care Inspection (CSCI), under the whistle blowing procedure. The CSCI was the previous regulatory body for care homes and this was replaced in April 2009 by the Care Quality Commission, which took over its duties. The allegation was referred to the local authority under the safeguarding adults’ protocol. A resident confirmed parts of the allegation. A member of staff has been suspended from duty pending an investigation being carried out by the police and at the time of the inspection the police investigation was ongoing. Meetings have been convened by the local authority and the suspension of the member of staff was discussed with the safeguarding co-ordinator and the chairperson of the safeguarding meeting. The outcome of the police investigation will determine whether any further action may be required. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy a comfortable and homely environment with pleasant communal facilities. An ongoing programme of refurbishment assures residents that the maintenance of the property is kept to a good standard. Single bedrooms provide residents with privacy and a room sufficient in size in which to relax. Residents live in a home where standards of cleanliness are good and where bathing and toilet facilities are appropriately placed. Training for all members of staff in infection control procedures would assure residents that good hygiene practices are carried out. EVIDENCE: Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 21 The home is close to local shops and transport facilities and its appearance is in keeping with neighbouring properties. We carried out a tour of the premises and noted that the home was bright and airy. The home was comfortably furnished and the decor provided a homely atmosphere. Lighting, heating and ventilation were suitable for the time of year and weather conditions. Each resident had their own single bedroom. One of the 3 bedrooms is situated on the ground floor, at the front of the house, and the other 2 bedrooms are situated on the first floor. All 3 bedrooms are above the minimum of 10 square metres and are spacious. Residents were generally pleased with their rooms although one of the residents said that he would prefer to have plain walls without wallpaper and we noted that the edges of the wallpaper were “lifting” at some of the seams. There are bathing and toilet facilities on both ground and first floor. There is a shower room, containing a toilet and wash hand basin, leading off from the dining area, on the ground floor. There is a bathroom, containing a toilet and wash hand basin, on the first floor. Each of the bedrooms contains a wash hand basin. There is a combined lounge and dining area, which is comfortably furnished and decorated. The kitchen is a separate room. Residents have access to a garden at the rear of the house, which has a patio and lawn area, borders and mature shrubs. There is a combined office and sleeping in room for staff on the first floor. When asked about the house one of the residents told us that it was “always tidy and clean”. The home was free from offensive odours. The laundry facilities are situated in a building in the garden and include hand-washing facilities. The washing machine has a sluicing cycle. There is an infection control policy in the home’s policies and procedures manual. Some of the people working in the home have undertaken training in respect of infection control procedures. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has exceeded the target of 50 of its staff competent to an NVQ level 2 standard. The rota demonstrated that there were sufficient members of staff on duty to support the residents and to meet their needs. Thorough checks during the recruitment process would assure residents that their welfare was safeguarded. A more detailed training plan would reassure residents that the training undertaken by members of staff helps them to perform their duties efficiently and effectively and to meet the needs of the residents. EVIDENCE: We reviewed NVQ training for members of staff and 1 member of staff confirmed that they have almost completed their NVQ level 2 training. Another member of staff confirmed that they have completed their NVQ level 4 training. Of the 5 members of staff working in the home (excluding the Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 23 manager), 2 members of staff have completed their NVQ level 4 training, 1 has completed level 3 training, 1 has completed level 2 training and the fifth member of staff is currently undertaking level 2 training. We looked at the rota for week commencing the 8th June. The staff team consists of the manager and 5 members of staff, although 1 member of staff is currently suspended. There are male members of staff and female members of staff. One of the residents speaks and understands both Urdu and English and 3 of the 6 persons working in the home speak Urdu. The rota confirms that there is at least 1 person on site at most times during the day, even when residents are out of the home. There is always a member of staff on site when residents are present. Staffing levels are sufficient to meet the needs of the residents and to allow for choice of activities and availability of a member of staff to act as an escort etc. Three members of staff are drivers and able to drive the home’s vehicle. Four staff files were examined. Two of the members of staff had an enhanced CRB disclosure and 2 members of staff are working with a pova first check, but under supervision. We noted that there was an application form on each file but one form was incomplete as there was a reference on file from a nursing home that was not listed in the employment history. Each file contained 2 satisfactory references and passport details. Where necessary the right to work and to reside in the UK was established. While we were talking with a resident he said that a member of staff that was on duty, and had been employed since the last key inspection, “was a good man” and that they got on well. The resident said that they had “hit it off straight away”. He also spoke well of 2 of the other carers describing a male carer as “a good bloke”. We talked with a new member of staff that had been working at Murree House for approximately 4 weeks and he confirmed that he was able to speak a number of languages including Urdu. A training plan for 2009 was available. It consisted of one sheet of paper and was a record of the training proposed, started or completed by each person working in the home. More detail is needed if it is to demonstrate that the training undertaken enables people working in the home to perform their duties efficiently and effectively and to meet the needs of the residents. Copies of attendance or achievement certificates were not always kept on the staff file. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. By continuing to develop her understanding, skills and knowledge through further training the manager assures residents that ways of working within the home benefit from an awareness of current best practice. A clear management structure in the home is needed to assure both residents and members of staff that the person setting standards and monitoring the quality of care is the registered person. Systems are in place to gather feedback on the quality of the service provided to enable the service to develop in ways that meet the changing needs of the residents. Training for all members of staff in safe working practice topics is needed to reassure residents that their health, safety and welfare is safeguarded. Regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager is an RGN with approximately 13 years experience of supporting adults with learning disabilities, in a care setting. She has worked in residential and nursing homes and also in a day centre. The manager has completed an RMA course and her certificate was seen during a previous inspection. The manager is able to speak and/or understand Urdu, Hindi, Punjabi, Arabic and Gujarati. Since the last key inspection the manager has continued to update and develop her skills and understanding and has attended short training courses in respect of infection control and risk assessing. She has previously attended equal opportunities training and sexuality awareness training for members of staff working with adults with mild to moderate learning disabilities. We asked a member of staff about support and he said that he could always get help and support but referred to telephoning the manager’s husband for guidance and when he talked about the manager he used the term “he” and not “she”. We discussed quality assurance systems in place in the home. The information provided about the development plan was in respect of 2008 as the manager said that she was still working on the 2009 plan. An annual quality assurance questionnaire is sent to family members and other stakeholders and although these have been sent out this year the home is waiting for any replies. We were able to see responses received in 2008. This is a care home that accommodates a maximum of 3 residents and the manager said that feedback is obtained from residents on an ongoing basis. More formally feedback is given during review meetings, key working sessions and can be recorded in the suggestions book. Family members are able to make any comments when they visit the home or if they telephone. We saw that members of staff had undertaken training in safe working practice topics but the new member of staff had yet to receive training in respect of food hygiene, fire safety or infection control. When a satisfactory enhanced CRB disclosure is returned they would be able to work unsupervised and as this is a care home accommodating a maximum of 3 residents they could be the only person on duty. There was a valid certificate for the employers liability insurance cover for the home, until the day of the inspection. The manager said that this had been renewed and that she was waiting to receive the new certificate. There were also valid certificates for the Landlords Gas Safety Record, the testing of the portable electrical appliances, the electrical installation, the fire extinguishers, Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 26 and the fire alarm system. There were records to demonstrate that the emergency lighting and the fire alarms were tested on a weekly basis. The testing of the fire alarms included a fire drill, which involved an evacuation of the home. When speaking with a resident we were told that there had been a pest control problem in the home towards the end of 2008. He said that a rat had been seen. When asked, the manager was at first reluctant to confirm this when she joined us with the resident but then said that the appropriate course of action had been taken and that the advice regarding storage of food items in the kitchen was being followed. The resident appeared to be irritated that the reluctance to confirm his information could look as though he had not been telling the truth. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 2 X Version 5.2 Page 28 Murree Residential Care Home DS0000061675.V375826.R01.S.doc NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement A copy of the minutes of the review meetings convened by the local authority is needed. This will reassure residents that members of staff are aware of goals that have been agreed and are providing the correct support to the resident so that progress towards meeting targets and achieving goal can be made. Timescale for action 01/08/09 2. YA6 15 The manager must demonstrate 01/08/09 (and record) that locking the kitchen door is the most suitable way to enable residents to be supported. This will assure residents that restrictions are not being placed on their use of or enjoyment of facilities in the home unnecessarily. To assure residents of the opportunity to develop their independent living skills residents must be encouraged and supported to help in the preparation and cooking of their meals. A more varied menu needs to be DS0000061675.V375826.R01.S.doc 3. YA16 16 01/08/09 4. YA17 16 01/08/09 Page 29 Murree Residential Care Home Version 5.2 developed so that the same menu sheet is not used each week. This will offer residents more choice and enable them to choose from a list of healthy options. 5. YA17 17 01/08/09 After serving a meal the record of what each individual resident has eaten must be kept up to date and available for inspection. This will enable the home to demonstrate that residents have a balanced and varied diet that meets their religious, dietary and cultural needs and their preferences. When the care home contacts the pharmacist a new medication recording sheet that has blank spaces/boxes in which to record and is free of dots is requested. This will enable the records to be clear and easy to read and therefore monitor. When dealing with the ongoing allegation of abuse the manager must continue to follow safe guarding procedures. This will ensure that the residents are in a safe environment. When the police investigation is complete the manager must ensure that an internal investigation into the allegations is carried out to determine whether disciplinary action is required. This will ensure that the safety and well being of residents is maintained. As part of the continuing refurbishment programme the wallpaper is removed from the walls in the room where some of DS0000061675.V375826.R01.S.doc 6. YA20 13 01/08/09 7. YA23 13 01/08/09 8. YA23 13 01/10/09 9. YA24 23 01/09/09 Murree Residential Care Home Version 5.2 Page 30 the edges of the paper are “lifting” at the seams and the walls are painted in a colour of the resident’s choice. This will enable the resident to enjoy their private space. 10. YA30 13 When undertaking induction training infection control procedures are included. This will ensure that all members of staff are aware of good hygiene standards of hygiene and can put these into practice to promote the health and safety of residents. 01/09/09 11. YA34 19 When recruiting a new member 01/08/09 of staff a thorough scrutiny of the application form and the information provided is carried out to ensure that a complete work history is recorded and checked. This will enable the home to safeguard the welfare of residents. To assure residents that members of staff have the necessary skills, knowledge and understanding to perform their duties and to meet the needs of the residents a more detailed training plan is needed that links training with the aims and objectives of the home. After completing a training course a copy of the attendance certificate must be placed on the staff file. This will enable the home to demonstrate that members of staff have received relevant training and are competent to carry out their duties. The registered manager must DS0000061675.V375826.R01.S.doc 12. YA35 18 01/09/09 13. YA35 18 01/08/09 14. YA37 12 01/08/09 Page 31 Murree Residential Care Home Version 5.2 ensure that all members of staff are clear about lines of responsibility and reporting in the care home and that as registered manager she provides the guidance and support needed by new members of staff. This will enable her to carry out her duties as a registered manager, in accordance with the legislation. 15. YA39 24 That when the 2009 development plan is completed a copy is sent to the CQC to demonstrate that quality assurance systems are used to inform changes that take place in the service provided. To assure residents that the way that each member of staff works is based on acknowledged best practice each member of staff needs to undertake training in safe working practice topics and safeguarding procedures during their induction. 01/10/09 16. YA42 18 01/09/09 17. YA42 25 When the employer’s liability 01/08/09 insurance certificate is received a copy is sent to the CQC to demonstrate that the safety and welfare of residents, members of staff and visitors to the home is promoted. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 32 1. 2. 3. YA19 YA23 YA23 4. YA37 That the manager continues to encourage residents to have a dental check up so that their teeth can maintain a good condition. That each person working in the home attends an external training course in respect of the protection of vulnerable adults’ procedures. That the person carrying out the internal investigation into the allegation of abuse is a person that is independent of the home so that the manager is not subject to a conflict of interest. That the manager confirms correct information quickly so that a resident does not have to repeat their comments or feel that the Inspector may be given the impression that the resident is not telling the truth. Murree Residential Care Home DS0000061675.V375826.R01.S.doc Version 5.2 Page 33 Care Quality Commission London Region Citygate Gallowgate Tyne and Wear NE2 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.london@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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