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

This inspection was carried out on 8th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Murree Residential Care Home 08/06/09

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 13/03/2009.

CARE HOME ADULTS 18-65 Murree Residential Care Home 17 Marquis Close Wembley Middlesex HA0 4HF Lead Inspector Julie Schofield Key Unannounced Inspection 8 and 12 September 2008 09:25 th th Murree Residential Care Home DS0000061675.V365956.R02.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 Murree Residential Care Home DS0000061675.V365956.R02.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. Murree Residential Care Home DS0000061675.V365956.R02.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.V365956.R02.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 25th September 2007 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. The manager said during the inspection that the fees for the service provided are a minimum of £800 per week. This figure may rise, depending on an assessment of the individual needs of the resident. Murree Residential Care Home DS0000061675.V365956.R02.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 2 star. This means the people who use this service experience good quality outcomes. The inspection took place over 2 visits to the home. The first visit was on a Monday in September. It started at 9.25am and finished at 1.20pm. As the residents were out during this visit we arranged to call back later in the week, on the Friday, to speak with the residents. The second visit started at 8.15am and finished at 11.00am. During the inspection we also spoke with the registered manager, with her husband (who works in the home) and with a member of staff. We would like to thank everyone for their assistance and for their comments during the inspection. Records were examined 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 April 2007 was checked. At the time of the random inspection in September 2007 4 of the 8 requirements were still outstanding and the timescale for compliance for 2 of the requirements had been extended as the service had not had the opportunity to demonstrate that its working practices had changed. Prior to the inspection we received the Annual Quality Assurance Assessment (AQAA) that had been completed by the home and the information contained in the AQAA was used to inform the inspection. What the service does well: Quality assurance survey forms that had been completed by the residents next of kin included the following comments: We do liaise regularly. I am satisfied about the service. The service provided is according to my sons needs. Quality assurance survey forms that had been completed by the residents funding authority included the following comment: I feel that Murree House is a good home for my client. I am very satisfied. A letter on a residents file included a comment that the resident has been with you for over 6 months and he has made very good progress which there is no doubt that Murree has greatly contributed to. Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 6 When talking with residents they told us that they were satisfied with the service. They made positive comments 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 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. What has improved since the last inspection? What they could do better: During this inspection 8 statutory requirements were identified. The home must ensure that a copy of the minutes of the CPA review meeting is received and placed on file so that there is a record of the agreed goals and targets for staff to refer to and for the manager to use in monitoring the progress made by the resident. Risk assessments need to be reviewed on a regular basis so that they continue to meet the needs of the resident. Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 7 Residents enjoy helping with the preparation and cooking of meals and opportunities to do this need to be increased so that residents feel involved in the daily routines in the home and continue to develop their independent living skills. There is a need for some redecoration, (repapering and repainting), for residents to benefit from the upkeep of the home being maintained to a good standard. Continuity in members of staff working in the home is important to residents and providing a contract or statement of terms and conditions for members of staff helps to promote this. A more detailed training plan is needed so that the home can demonstrate that the training provided supports the aims and objectives of the home and enables members of staff to have the knowledge and understanding needed to meet the individual needs of the residents. Although the fire alarm system is currently tested on a regular basis this needs to be increased to a weekly test so that the health and safety of everyone in the home is protected. Although people working in the home have undertaken training in safe working practice topics this training needs to be refreshed at recommended intervals. 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. Murree Residential Care Home DS0000061675.V365956.R02.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.V365956.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 People who use this service experience good outcomes in this area. This judgement has been made using available 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. A 5-day trial visit to the home enables the prospective resident to sample life in the home and to decide whether the service provided is acceptable. EVIDENCE: One resident has been admitted to the home since the last key inspection in April 2007. There was evidence that the manager had attended meetings held in the hospital, prior to the discharge of the resident. She said that while in the hospital she had met the prospective resident on several occasions and that she had been given access to the person’s case file and had used this to help determine whether the home could meet the individual needs of the prospective resident. There were copies in the home of key documents, including the CPA care plan and risk assessment and the hospital treatment plan. An assessment of need, on which the care plan is based, was drawn up before his admission. The scope of the care needs assessment was Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 10 comprehensive and included the identification of cultural and religious needs, 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 and we saw that the 3 residents now living in the home enjoy amicable relationships. Murree Residential Care Home DS0000061675.V365956.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Evaluating comprehensive care plans on a regular basis ensures that changes in the needs of residents are identified and can be addressed and regular reviews of the placement confirm that the care home continues to be able to meet the individual needs of the resident. A copy of the minutes of the CPA 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 the opportunity to exercise choice in their daily lives. Responsible risk taking contributes towards the resident leading an independent lifestyle. Reviewing the risk assessments on a regular basis would reassure the resident that the risk management strategies continued to address safety issues. EVIDENCE: Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 12 Three case files were examined. Each contained a care plan that had been developed by the home and that was based on the care needs assessment. We noted that the format of the care plan had been changed since the last key inspection and was more detailed. The plan included identifying a goal, identifying any possible triggers or behaviour to monitor and identifying the support to be provided by the staff team. Care plans addressed the personal, health care and social care needs of residents, including religious and cultural needs. We saw that the minutes of recent review meetings were on file and that social workers and/or reviewing officers had attended the meetings. There were also copies of the minutes of review meetings that had been convened by the home and that these had been held on a regular basis. With the permission of the resident, their relatives are invited to attend the meetings. Minutes of placement review meetings were also on file but not the minutes of each of the CPA meetings that had been held. Each file included copies of a weekly summary of the care plan, which recorded the goals set at review meetings. These recordings were up to date. The home operates a system of key working and there were records on file of meetings that have taken place between the resident and their key worker. Residents told us about the choices they made and decisions they have taken in their lives and we saw during the inspection that this was encouraged. Residents were asked what they would like to do on both a daily basis and as part of planning for the future. Advice was given, in some cases, to enable the resident to make an informed decision and supporting the resident in this way is part of encouraging independence. Two of the residents manage their finances and the family of the other resident helps this person. The staff team provides assistance with budgeting, where this is needed. One of the residents was knowledgeable about the income they received and discussed how they spent this money. Any limitations on facilities in the home are recorded in the care plan. 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 recently attended risk assessment training. The risk assessments that we saw included areas such as handling sharp objects, misusing the telephone, fear of dogs, excessive eating and drinking and road safety. The format was comprehensive and included evaluating the risk, the likelihood of occurrence and risk management strategies. However, the assessments lacked evidence of being subject to regular review. 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.V365956.R02.S.doc Version 5.2 Page 13 Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Taking part in activities, pursuing new interests 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. Residents are encouraged and supported to become more independent by making decisions and by having their wishes respected. Residents have access to a diet that is varied and wholesome and which meets their personal preferences and their cultural and religious needs. Support to help prepare and to cook their own meals would give residents more opportunities to involve themselves in the daily routines of the home. EVIDENCE: Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 15 We discussed the residents’ individual day care programmes with the manager. One of the residents attends college on 3 days per week and is studying computing. On the other 2 days he attends psychotherapy sessions and visits the library etc. The other 2 residents attend a day centre on 2 days per week and college on 3 days per week. One of the residents said that he enjoys going to the day centre, which is within walking distance of the home. The manager said that at the day centre there are opportunities to play sports, to take part in light exercise and in dance sessions. One of the residents has previously worked part time on a voluntary basis and said that he would like some paid employment. This has been discussed with his care manager. He has had an assessment interview with a member of the Job Centre. A resident said that they went to do their personal shopping in Wembley and that they visited the building society and had lunch while they were out. Another resident said that he travelled into central London and that he visited a library there and went to the cinema. Another resident likes to go to the local cinema to watch Asian films and goes to a local mosque, with a member of staff to support him. While 2 of the residents are able to travel independently the manager said that the third resident has begun “travel training” to encourage his independence. The home has the use of their own 8 seater vehicle and residents use this in addition to taxi cards and public transport. Other community facilities used by residents include the church, parks and museums. Residents use local restaurants and these are appropriate to their religious and cultural needs and to their individual preferences. One of the residents enjoys African-Caribbean food. Residents’ names are included on the electoral roll and residents have voted in the local elections. When relaxing in the home one of the residents enjoys reading or writing poems and essays. He also likes playing card games ad dominoes. We saw that the television in the lounge received satellite channels, including a Pakistani television station that broadcast programmes in Urdu. During the inspection 1 of the residents that speaks Urdu was watching a film broadcast on this channel. The manager said that residents like to go out for a walk as exercise. Residents have gone on trips to the British Museum and to the War Museum and these were venues that they had chosen. One of the residents has also visited Regent’s Park Mosque. A resident said that that the manager had organised a holiday about a year ago to Hampshire and that they had all gone together and enjoyed themselves. One of the residents had recently enjoyed a holiday in Manila with members of his family. Residents receive visits from their relatives and friends at Murree House and they also go to visit family and friends, either independently or with the support of staff. When residents receive visitors they are able to entertain their visitors in their room or in the lounge. An elderly relative that visits a resident had their birthday celebration recently in Murree House. Residents make and receive telephone calls so that they can maintain relationships and Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 16 friendships. The manager is aware of the need of residents to express their sexuality and is supporting a resident that is receiving relationship counselling. Residents have developed their own daily routines, to accommodate their day care programmes, and they confirmed that their privacy was respected when they were in their rooms. Residents said that they like to listen to music or to watch television when they are in their rooms relaxing. They have door keys to both their own room and to the front door. The manager confirmed that residents were responsible for keeping their rooms tidy and that they were encouraged to do their laundry and ironing. One of the residents likes to help water the garden. We saw a copy of the menu plan. It is drawn up with the assistance of the residents. It was varied and wholesome and included Asian meals. Meal times are flexible, according to the daily routines of the residents. We saw this during the inspection when breakfast was taken. Daily records are kept of what the residents eat. A risk assessment is in place for a resident that finds it difficult to control their intake of food and fluids. One of the residents said that the meals are very good and that both the manager and her husband are good cooks. He said that he would like to do some cooking, as this is something that he enjoyed doing before admission to residential care. Another resident said that the food served in the home was satisfactory. Murree Residential Care Home DS0000061675.V365956.R02.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 People who use this service experience good outcomes in this area. This judgement has been made using available 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 are 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: One resident attends to his own personal care needs although the other residents require encouragement and prompting with their personal hygiene. The manager said that although 1 of the residents had been reluctant to bathe they were now enjoying a regular shower. We saw that each of the residents was clean and tidy and the resident that was going out for an appointment was smartly dressed in a suit. He confirmed that he purchases his own clothing and decides what to wear each day. He told us that he was aware of the need Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 18 to present a smart appearance. Residents decide when they go to bed at night and when they get up in the morning and we noted that the times in the morning varied, according to personal choice and the time that the resident needs to leave the home to travel to their day care centre or college. One of the residents discussed his health since living in the home. He said that he had a stoke last year and described the support and prompt attention that the manager and her husband had given. We saw him during the previous inspection when he had just returned home from the hospital and agreed with him that since then he had made a good recovery. He now looked well and was smiling and appeared to be relaxed. He said that his memory was better and during conversations with members of staff this was evident. The home has a copy of the report produced by the speech and language therapist, which includes strategies for improving communication with the resident. Case files contained evidence of access to health care facilities in the community. Medication reviews have taken place with the psychiatrist. If necessary, residents have an escort when attending out patient appointments at the hospital including the gastroenterology, ultrasound and cardiology departments. Appointments with the dentist and with the optician are arranged. When needed, the resident has seen their GP. Residents also have access to routine health screening e.g. blood tests. Only 2 of the 3 residents take prescribed medication and members of staff support them to do this. We saw that the storage of medication was safe and secure. Medication administration record sheets were examined and were up to date and complete. Each of the members of staff that administer medication has received training from the pharmacist. Murree Residential Care Home DS0000061675.V365956.R02.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 outcomes in this area. This judgement has been made using available 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 e.g. the CSCI. The manager said that no complaints have been recorded since the last inspection. The manager said that the procedure is discussed as part of the admission process and that information about the procedure is included in the service users’ guide. The residents were aware of their right to complain if they were not satisfied with the care received and said that they would speak to the manager if they had any concerns. One of the residents previously said that they would also speak to a person who was independent of the home. Residents confirmed that they were satisfied with the service being provided. All of the people working in the home have enhanced CRB disclosures. There is a comprehensive protection of vulnerable adults policy in place. The policy also includes a whistle blowing procedure. The policies and procedures manual Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 20 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, her husband and 1 of the other 2 members of staff have undertaken training in the protection of vulnerable adults by attending an external training course. The fourth person has received awareness training as part of their NVQ level 2 studies. It is recommended that this member of staff attend an external training course. The manager has also completed training in safe guarding adults and 2 of the other 3 persons working in the home have started this course of training. The manager said that there have been no allegations or incidents of abuse since the last inspection. She confirmed that restraint is not practiced in the home. When asked what they would do if there was something that was worrying them residents said that they would speak to the manager. Murree Residential Care Home DS0000061675.V365956.R02.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, 27, 28, 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents enjoy a comfortable and “homely” environment with pleasant communal facilities. A programme of redecoration would assure 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. EVIDENCE: 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 Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 22 and ventilation were suitable for the time of year and weather conditions. We noted that the wallpaper in bedrooms and communal areas was beginning to appear worn and starting to lift at the seams. Some of the woodwork needed repainting. The manager said that redecoration had been planned and would be taking place soon. 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. During the inspection one of the residents was relaxing in their room, watching a television. We spoke to residents about their rooms and they were satisfied with the accommodation. One resident said that when he first visited the home there were 2 vacant rooms and that he had chosen the ground floor room. He said that he had made the right choice and that he liked the size of the room and the fact that with the large window the room is light and bright. 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 lovely 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. During the inspection residents relaxed in the communal areas. The home was clean and tidy and 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. Persons working in the home have undertaken training in respect of infection control procedures. Murree Residential Care Home DS0000061675.V365956.R02.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 People who use this service experience good outcomes in this area. This judgement has been made using available 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 staff on duty to support the residents and to meet their needs. Recruitment practices safeguard the welfare of residents. 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 discussed with the manager the progress made by the staff team in achieving NVQ qualifications. The manager said that she has 3 members of staff working in the home, including her husband. One member of staff has completed their NVQ level 4 training. Another member of staff has completed their NVQ level 3 training and is waiting to commence level 4 training. The third member of staff has completed their NVQ level 2 training. The home has Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 24 exceeded the target of 50 of carers achieving an NVQ level 2 or 3 qualification. During the two visits we observed the interaction between residents and members of staff. There was a good rapport and members of staff treated residents with courtesy and respect. Members of staff were knowledgeable about the needs of residents and about the individual resident’s likes and dislikes. One of the residents said that he received good support from the members of staff and that he got on well with the manager and with her husband. The home accommodates 3 residents that participate in day care programmes during the week. We looked at the rota for week commencing the 8th September. The staff team consists of the manager and 3 members of staff. 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 4 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. We looked at the personnel files of 2 members of staff. They each contained an application form, with a photograph of the member of staff. Each file contained 2 references and 1 of the 2 references was from the most recent employer. The file contained proof of identity i.e. passport details. Both files contained an enhanced CRB disclosure. We noted that the file did not contain a signed contract/terms and conditions of service. A training plan for 2008 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 have been kept for courses undertaken by the manager and members of staff. Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager demonstrates her competence by continuing to develop her understanding, skills and knowledge through further training. 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. Refresher training in safe working practice topics would reassure residents that their health, safety and welfare is safeguarded by members of staff. Regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use. EVIDENCE: Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 26 The manager is an RGN with 12 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 (and her husband) 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 safeguarding adults, health and safety and the Mental Capacity Act. 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 looked at each of the residents’ case files and saw that the home sends out survey forms to the funding authority and to the next of kin regarding the quality of service provided. Comments from both the funding authority and the next of kin were positive. As this is a care home for 3 residents feedback from the residents is usually given on a day-to-day basis. Residents speak directly with manager or with her husband. However, they also have opportunities to give feedback on the quality of the service provided during meetings with their key worker, during discussions with a member of staff or during review meetings. The minutes of a review meeting contained the service users viewpoint and it was recorded that the resident was happy at the home, participates and understands his routines very well. The manager provided a copy of the annual internal audit report that she had completed. It was brief and included a review of the service provided in the home but did not look at issues connected with the property and its maintenance or future developments in the service. There was a valid certificate for the employers liability insurance cover for the home. There were also valid certificates for the Landlords Gas Safety Record, the testing of the portable electrical appliances, the electrical installation, the fire extinguishers, and the fire alarm system. There were records to demonstrate that the emergency lighting and the fire alarms were tested on a monthly basis. The testing of the fire alarms included a fire drill, which involved an evacuation of the home. A copy of the fire risk assessment was made available. This was very brief in format. We discussed training for members of staff in safe working practice topics. This year the manager and her husband have refreshed their training in respect of manual handling, food hygiene, first aid, infection control, fire safety and health and safety. The manager said that the other 2 people working in the home are due to refresh their training later in the year. Murree Residential Care Home DS0000061675.V365956.R02.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 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 4 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 2 X LIFESTYLES Standard No Score 11 X 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 3 X 3 X 3 X X 2 X Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 28 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 12(1) Requirement A copy of the minutes of the CPA review meeting is needed to 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. Risk assessments need to be subject to regular reviews to reassure residents that risk management strategies continue to address issues of safety. 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. To assure residents that the home continues to provide a pleasant and attractive environment in which to relax a programme of redecoration is needed. To assure residents that members of staff working in the home have a secure employment DS0000061675.V365956.R02.S.doc Timescale for action 01/12/08 2 YA9 13(4) 01/12/08 3 YA17 16(2) 01/12/08 4 YA24 23(2) 01/01/09 5 YA34 12(5) 01/12/08 Murree Residential Care Home Version 5.2 Page 29 6 YA35 18(1) 7 YA42 23(4) 8 YA42 18(1) status the members of staff must be provided with a statement of terms and conditions or contract. To assure residents that 01/12/08 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. To assure residents, members of 01/11/08 staff and visitors to the home that their safety is promoted and protected the testing of the fire alarm system must be carried out on a weekly basis. To assure residents that the way 01/01/09 that each member of staff works is based on currently acknowledged best practice each member of staff needs to refresh their training in safe working practice topics at the recommended intervals. 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 2 3 Refer to Standard YA6 YA23 YA42 Good Practice Recommendations That the annual internal audit report includes a review of issues connected with the property and its maintenance and explores future developments in the service. That each person working in the home attends an external training course in respect of the protection of vulnerable adults procedures. That the fire risk assessment is developed in more detail and that risks associated with the premises are included. Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Murree Residential Care Home DS0000061675.V365956.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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