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Inspection on 24/08/06 for Muston Road (70)

Also see our care home review for Muston Road (70) for more information

This inspection was carried out on 24th August 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff of Muston Road continued to provide the service users with a relaxed informal environment in which they were able to live meaningful lives at their own pace. Whilst all of the service users had complex physical and emotional needs this does not prevent them from having the opportunity to participate in a range of social activities. It was evident that although physical restraint had been used on several occasions on service users who were displaying aggressive behaviour, it was undertaken as a last resort, when all other methods had proved ineffective and there was concern for the safety of the service user(s). The staff had been trained in the use of restraint techniques designed specifically for each service user. Good standards of recording were employed following the use of restraint. The restraint techniques had been developed in conjunction with the service users` placing authority and the service users` relatives thereby ensuring that the use of such techniques were agreed and properly monitored. The staff treated the service users with respect and spoke to them in a mature manner. They encouraged the service users to answer questions for themselves and make decisions and choices no matter how minor. Thereby providing them with a degree of independence regardless of disability. The staff continued to encourage and enable the service users to make full use of local facilities and by doing so had assisted the service users to become an integral part of the community. A relative of a service user summed up their feelings by saying "I wish that he`d (service user) been somewhere like this years ago and he would have been further on."

What has improved since the last inspection?

The requirements and recommendations made during the previous inspection had been addressed. The staff continued to be provided with a range of training courses on statutory and professional subjects thereby improving their professional competence. The manager had successfully completed a National Vocational Qualification in care at level 4. The manager had continued a team building process with the staff, which had culminated in an enthusiastic and knowledgeable staff team that had a good understanding of the needs of the service users. He had further provided the staff with personal responsibility for the running of the home by delegating appropriate tasks. Alternative methods to the use of physical restraint, such as the use of diversionary or calming techniques, had been further developed. The quality assurance process had been also further developed thereby enabling the manager to make assessments as to the quality of the service provided. Improvements in terms of redecoration and refurbishment had been made to the premises, which consequently improved the environment for the service users.

What the care home could do better:

There were no shortfalls in the service provided that had not been identified by the registered manager and action taken, or proposed to be taken, to address them.

CARE HOME ADULTS 18-65 Muston Road (70) 70 Muston Road Filey North Yorkshire YO14 0AL Lead Inspector Mr M. A. Tomlinson Key Unannounced Inspection 24th August 2006 09:30 Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Muston Road (70) Address 70 Muston Road Filey North Yorkshire YO14 0AL 01751 474740 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) www.wilfward.org.uk The Wilf Ward Family Trust Mr Michael Clements Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 4 residents with a Learning Disability some of whom may also have Physical Disability Date of last inspection 20th October 2005 Brief Description of the Service: Muston Road is a large detached property situated on a main road into Filey. It is within walking distance of the town centre. A former hotel on two floors, it provides accommodation for four residents. There are three large bedrooms without en-suite facilities and a separate flat with its own facilities. A large private and secluded garden is situated to the rear of the premises. There is no passenger lift. The staff provide care for adults with learning difficulties most of whom have complex needs and challenging behaviour. While the staff seek to promote independence among residents, all require some assistance with personal care including help with washing, dressing and bathing. Should nursing care be required on a short-term basis then it will be provided by the community healthcare services. The staff team takes responsibility for the catering, cleaning and domestic services in the home. Residents are encouraged to help according to their individual capabilities. Social activities are arranged in-house and at external locations. Some residents attend formal day care placements. All are registered with the local medical practice in the town. The staff team has developed a good relationship with the Community Learning Disability Team who provides a valuable resource and input into the home. The local health authority owns the premises. The Wilf Ward Family Trust, a registered charity, provides the care and services. The current fee for service users is £1471.00 per week. Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit formed an integral part of the annual ‘key inspection’ process for the home undertaken by the Commission for Social Care Inspection (C.S.C.I.). Information contained in this report was obtained through discussions with the home’s management, the staff, limited discussions with the service users, and telephone discussions with relatives of all the service users. Due to the service users’ limited communication skills reliance was place on observing them during their daily routines. The report also reflects comments made in three Comment Cards returned from health and social care professionals and the information provided by the registered manager in the pre-inspection questionnaire. The report also includes information obtained by the C.S.C.I. prior to and subsequent to the inspection visit. A number of statutory records were examined. What the service does well: The staff of Muston Road continued to provide the service users with a relaxed informal environment in which they were able to live meaningful lives at their own pace. Whilst all of the service users had complex physical and emotional needs this does not prevent them from having the opportunity to participate in a range of social activities. It was evident that although physical restraint had been used on several occasions on service users who were displaying aggressive behaviour, it was undertaken as a last resort, when all other methods had proved ineffective and there was concern for the safety of the service user(s). The staff had been trained in the use of restraint techniques designed specifically for each service user. Good standards of recording were employed following the use of restraint. The restraint techniques had been developed in conjunction with the service users’ placing authority and the service users’ relatives thereby ensuring that the use of such techniques were agreed and properly monitored. The staff treated the service users with respect and spoke to them in a mature manner. They encouraged the service users to answer questions for themselves and make decisions and choices no matter how minor. Thereby providing them with a degree of independence regardless of disability. The staff continued to encourage and enable the service users to make full use of local facilities and by doing so had assisted the service users to become an integral part of the community. A relative of a service user summed up their feelings by saying “I wish that he’d (service user) been somewhere like this years ago and he would have been further on.” Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 7 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 Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sound procedures are in place to ensure that prospective service users will be well assessed to enable the registered persons to make a considered decision with regards to the appropriateness of the proposed placement. EVIDENCE: The three service users had been accommodated at Muston Road since its’ initial registration in 1993. Prior to this they had been accommodated in a long-stay hospital. The original assessments undertaken on the service users prior to their placement had been archived and consequently were not available during the inspection visit. The Wilf Ward Family Trust (Referred to in the rest of the report as ‘The Trust’) had over the years developed a comprehensive admission and assessment process that was contained in the Policy and Procedure manual and was readily available to the registered manager and the staff. The registered manager demonstrated a sound understanding of this process and placed emphasis on the need for accurate pre-admission assessments in order Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 9 to ensure the compatibility of a new service user with the existing service user group and the home’s ability to meet their needs. In general any new placement would be made in conjunction with the local authority and phased in over a period of time. Since their admission into the home the service users had been re-assessed on several occasions to provide confirmation that the home continued to be able to meet their needs. This had been particularly necessary when the service users had been through a period of extreme challenging behaviour. It was evident that these assessments had been used to amend the respective care plan. The Trust had no formal contracts with the Service Users. Each service user was, however, provided with an individual contract for care implemented by the placing authority. A copy of the statement of the service users’ terms of conditions of residence was included with the care records. Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are provided with comprehensive care plans that are tailored specifically to their needs thereby enabling the staff to take appropriate action in order to meet those needs. EVIDENCE: All of the service users had a plan of care that had been developed by the home’s staff with input being provided by health and social care professionals who also had a direct interest in the care of the service users. This meant that the service users were provided with multi-agency support as a safeguard to their welfare. As identified at the previous inspection, the service users’ care plans clearly identified their needs, abilities and preferences along with the actions to be taken by the staff to meet those needs. They also contained a range of information on each service user, including risk assessments, which enabled the staff to have a good understanding of each service user. The Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 11 manager stated that he was intending to get the staff to develop a ‘scrap book’ that would pictorially depict the service users’ activities for use as a means of reminiscence and pictorial ‘evidence’ for their relatives and others involved in the service users’ care. The staff maintained a daily diary on each service user that provided an account of their daily routines and activities. Where appropriate the content of the diaries were cross-referenced into the respective care plan. The records contained evidence that the care plans had been regularly reviewed. A Social Services’ Care manager also confirmed this. This ensured that the care plans were current and meaningful. Two of the service users had very limited communication skills. It was observed, however, that this did not unduly restrict their ability to make their views and wishes known to staff. On occasions this had been presented through their behaviour, which could be, in one case, quite aggressive. Many of these instances had required the staff to use physical restraint on the service user concerned to minimise the possibility of harm to the service user and/or themselves. All such instances of the use of restraint had been fully recorded in the respective care plan and the Commission for Social Care Inspection informed. The staff had received training on the use of physical restraint by an independent company. Each member of staff had been provided with a handbook on the use of physical restraint. This was specifically tailored for each service user and was called the ‘Specific Behaviour Management Plans’. In addition to a written explanation the document also included photographs demonstrating how the restraint should be employed. In the preface to the document it emphasised that staff should only resort to physical restraint when all other methods, such as the use of distracting and defusing, have proved to be ineffective. It also stated that the use of physical restraint should be in proportion to the harm it was intended to prevent. From discussions with the manager and staff it was evident that these guidelines on the use of restraint had been adhered to and that there were acceptable strategies in place for dealing with potential volatile situations. The registered manager provided examples where it was possible to defuse a situation without the need for restraint. The staff maintained ‘behaviour charts’ in an attempt to establish a pattern of behaviour and identify its’ possible cause. This enabled them to become more pro-active, recognise the ‘triggers’ for certain behaviour and consequently take appropriate pre-emptive action such as a diversionary technique. Due to their degree of disability, two of the service users could only make limited decisions and choices with the assistance of the staff. It was observed, however, that they were encouraged to make such decisions and that staff endeavoured not to make them on their behalf. An example provided was the service users use of money. The possibility of obtaining independent advocates for these service users was discussed with the manager. It was evident that the use of advocates had been considered but had not been Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 12 considered feasible due to the service users lack of communication skills and behavioural problems that would require a very skilled advocate to have meaningful contact with them. In general the service users allocated ‘key workers’ undertook the role of advocate. The service users were encouraged to assist with the daily routines in the home particularly with the shopping thereby providing them with contact with the local community. Muston Road (70) DS0000007840.V309137.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are provided with the opportunity to develop their personal and social skills, regardless of disability, by participating in a range of activities. EVIDENCE: Since the current manager came into post, the atmosphere in the home had become less tense and confrontational. On the day of the inspection visit, for example, the service users looked relaxed and at home in their environment. It was observed that the staff supported the service users with commendable patience and understanding thereby enabling them to live their lives at their own pace. Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 14 The staff provided examples of how the activities for the service users had been further developed particularly with regard to their contact with the local community. Good relationships had been fostered with the immediate neighbours and they had recently attended a garden fete held by the home. Their relatives praised the service users’ lifestyle and their comments included: “ I am very pleased and happy at the way he (service user) is looked after. He enjoys getting out and meeting people. We are kept informed by the staff and they keep us up to date. We discuss things with the manager. I wish that he’d been somewhere like this years ago and he would have been further on”; “They (staff) bring him (service user) home about every two weeks and stay for a meal. The support staff take him out a lot – he enjoys that. He likes watching his television in his room. He can say a few words and the staff can tell what he is saying. I am very happy” and “She (service user) is doing much better than she was. She could do more for herself – she used to cook and look after herself (See Personal and Healthcare). I realise that its’ a slow process. She’s getting out more. She has visited me, as I can’t get to see her as much as I used to. I think that they (staff) are doing their best for her”. As previously mentioned in the report the social activities for the service users had been assessed and tailored for the individual. Consequently they ranged from very simple board games to having trips out in the home’s transport. Many of the in-house activities were designed to improve the service users’ dexterity and their coordination. The records indicated that the service users led relatively active lifestyles. In general the service users only interacted with the staff and not each other. The most able service user preferred not to be in the company of the other two service users and this had been respected. The development of the meals provided for the service users had been based on the knowledge accrued by the staff over a considerable number of years. It was evident that the meals took into account the known preferences of the service users and provided a reasonably balanced and nutritional diet. The deputy manager provided examples of how the staff endeavoured to get the service users to choose what they wished to eat and how the staff verified that this was a considered decision and not an arbitrary one. The most able service user had chosen to have their meals in their room thereby promoting their independence. Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users’ personal and health care needs are met by the staff with good support being provided by health and social care professionals. This has consequently led to a good standard of inter-agency working. EVIDENCE: The service users’ care records indicated that they had received good standards of support from health and social care professionals and had good access to local health care facilities. The service users had been registered with the local medical practice and the staff had established a good working relationship with the practice to ensure that the service users are provided with good medical support. The staff were endeavouring to get a female service user to attend the ‘well woman’ clinic particularly for breast screening. At present the service user concerned was reluctant to do so. The service users’ care plans contained advice for staff on how, and when, a service user required specific care. They also incorporated information on the service users’ health care needs. The local Community Learning Disability Team provided good Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 16 support for the staff and had given specialist advice on the provision of the service users’ care. From discussions with the staff it was apparent that importance had been placed on maintaining the service users’ dignity, privacy and respect. For example, it was noted that the staff spoke to the service users in a calm and adult manner. They also endeavoured to get the service users to answer questions for themselves thereby promoting their individuality. The staff also promoted dignity by taking into account the gender of the service user and by enabling them to have time on their own in a bath. Considerable emphasis was placed on the need for the service users to maintain their personal hygiene standards. The service users had unrestricted use of their bedrooms and it was evident that they considered their rooms their ‘private space’. This was respected by the staff who, it was observed, either knocked and got the permission of the service user before entering a bedroom. On the day of the inspection visit the service users were dressed in clean and appropriate clothing. The staff stated that they endeavoured to get the service users to choose and buy their own clothing. The most able service user had a considerable amount of quality clothing and said that they enjoyed shopping for it. All of the service users had good quality toiletries and fragrances available in their rooms. The aforementioned points helped promote the service users’ independence. The home continued to use a monitored dosage system for administration of the service users’ medication. The medication was secured in a dedicated cabinet. Those staff responsible for the administration of the medication had been appropriately trained. A medication policy and procedure was in place. The procedure was displayed in several areas to ensure that the staff had good access to it. Two members of staff generally administered the medication with one acting as a witness. From a description of the medication process given by the deputy manager it was evident that action had been taken to reduce the possibility of error. Subsequent to the inspection visit, however, the Commission for Social Care Inspection was informed of an error in the administration of medication. At the time of this report the Wilf Ward Family Trust was investigating the incident. The care records provided confirmation that the service users’ medication had been regularly reviewed by a medical professional and in some cases had been reduced. A relative of a service user also confirmed this. Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An extensive network of internal and external support ensures the service users’ welfare and safety. EVIDENCE: The home had an appropriate complaints procedure in place and for the benefit of the service users it was also in a pictorial format. Due to their level of disability, however, it was doubtful that two of the service users could make a considered complaint even by using pictures. Consequently, as previous mentioned in this report, reliance was placed on the staff working in an advocacy role with the service users to identify any areas of concern. The manager provided examples of where this had taken place. The service users also had a good network of external support that should assist in safeguarding them. The relatives of two of the service users said that they were confident that they would notice if anything was wrong or the respective service user was not happy and that they would not hesitate raise their concerns with the home’s manager. The Trust had a comprehensive policy and procedure for the reporting of incidents of alleged abuse. The staff were aware of the procedure. They had received training on the subject of abuse either as a dedicated topic or as an integral part of their induction, LDAF (learning Disability Award Framework) and NVQ (National Vocational Qualification) training and consequently were Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 18 confident that they could recognise the signs of abuse. A visiting NVQ Assessor confirmed that the subject of Adult Protection was a training module of the NVQ. As previously stated in this report, physical restraint had been employed on the service users on several occasions since the last inspection. This, however, was well recorded and was based on the guidance of health and social care professionals. Due to the limited alternatives available, the registered manager and the locality manager acted as financial appointees on behalf of the service users. The service users’ finances were, however, the subject of regular external audits to minimise the possibility of errors or malpractice. The Responsible Individual or representative confirmed this in the reports following their monthly visits to the home. Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are provided with a homely and pleasant environment that currently meets their needs. EVIDENCE: The premises continued to be maintained and decorated to a good standard. They were clean and completely free from any offensive odours. The impression to the visitor was one of domesticity with good standards of furnishings. Externally there was nothing to identify the premises as a care home thereby reducing possibility of the service users being stigmatised. There was parking for several vehicles to the front of the property. The large rear garden was safe for use by the service users and provided reasonable privacy having a surrounding high fence. The garden had been landscaped with a Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 20 variety of shrubs and a large central lawn. There was also a green house, a gazebo and a range of outdoor equipment for use by the service users. Several improvements had been made to the premises since the previous inspection such a new lounge suite and carpets. The service users had their own bedrooms that were personalised having been furnished with their personal possessions. Even the most disabled service user was able to independently operate their television. The most able service use had for several years been accommodated in their own ‘flat’ located on the upper floor. This had a separate lounge, bedroom and bathroom. It did not present as being part of a traditional care home but was more in way of a supported living unit. The service user was relatively independent and was able to take some responsibility for their accommodation. It was evident from the way that this service user provided the inspector with a guided tour that they had considerable pride in their accommodation. As previously stated in this report, the service users had complex behavioural problems, which could manifest itself in bouts of aggressive behaviour including damage to the furniture and fittings of the premises. To the credit of the staff this had not led to a reduction in the physical standards of the home. They had, for example, partly overcome the problem by fixing pictures to the walls so that they could not be pulled off, using quick release strips on the curtains and by arranging the furniture so that the service users could not easily access the wiring behind the television. There was also a rigorous ongoing programme of maintenance so that any damage would be quickly rectified. The home did not have a passenger lift and therefore was only considered suitable for service users who were fully ambulant. The registered manager had submitted plans to the Trust for an additional bedroom to be built on the ground floor thereby providing some flexibility in the accommodation should the mobility of a service user deteriorate. The home had adequate numbers of toilets and bathrooms that provided the service users with reasonable privacy. Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are supported by an enthusiastic and competent staff team. Their support enables the service users to lead reasonably active and meaningful lives. EVIDENCE: The staff rota confirmed that the relatively high ratio of staff to service users continued to be in place. The overall staffing level had been reduced slightly whilst the total number of service users being accommodated was reduced to three but it continued to be sufficient to meet the complex needs of the service users. From discussions with the staff it became apparent that they understood the aims of the home and how their roles assisted in achieving those aims. They demonstrated a sound understanding of the needs of the service users and of those elements of care, such as independence and choice, which go to provide them with a good quality of life. The staff had been provided with Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 22 clear job descriptions and contracts of employment. Documentary evidence confirmed that they had been provided with regular supervision and appraisals. It was the stated aim of the manager to encourage the staff to undertake career development within the Trust if possible. The staff presented as being enthusiastic particularly with regard to training. One member of staff confirmed that the atmosphere in the home had improved since the current manager came into post approximately two years ago. The staff had been provided with the opportunity to participate in a range of training courses on both statutory and professional subjects. Over 50 had obtained a National Vocational Qualification at level 2 or above. The staff recruitment and selection process was undertaken by the manager in conjunction with the Trust’s Human Resource section based in Pickering, which is approximately 20 miles from Filey. The Commission for Social Care Inspection had previously assessed the staff selection and recruitment procedure. It had been concluded that the process was reasonably rigorous to ensure that all prospective staff are fully vetted and assessed thereby safeguarding the service users. The registered manager of Muston Road was directly involved in the staff recruitment process particularly during the interview phase. Comments from the staff included: “I’ve (deputy manager) got my NVQ 3 and I’m intending to take the Registered Manager’s Award. I’ve been given good support and encouragement. I’ve been enabled to be involved in management task to increase my knowledge and experience. I think we’ve moved things on with regard to the service users” and “ We (staff) get a lot of training including handling challenging behaviour and adult protection procedures. I’ve been trained on the use of restraint but would only use it as a last resort. I prefer using encouragement and persuasion. We’re aware of the signs of behavioural problems and try to take action before they happen. Our aim is to give the service users a good quality of life and provide them with the opportunity to act independently”. Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 and 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed thereby ensuring good support for the staff and the provision of a safe environment for the service users. EVIDENCE: The registered manager had considerable experience in the provision of care for service users who had complex needs. He was fully qualified having obtained a National Vocational Qualification at level 4 and the Registered Manager’s Award. Since his arrival approximately two years ago he had made a number of changes in both terms of staffing and the general lifestyles of the service users. His stated approach was that “we need to have a positive attitude to the provision of care and concentrate on what the Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 24 service users can do and not on what they can’t do”. He had endeavoured to make the staff more responsible for their actions by the delegation of appropriate tasks and encouraged them to share ideas on how the lives of the service users could be improved. The manager presented as having a balanced and consistent managerial approach and provided good leadership for the staff. The Trust had a sound quality assurance process in place that entailed actively seeking the views of the service users’ relatives and health and social care professionals directly involved in the care and welfare of the service users. The home was subjected to regular external audits that covered all aspects of the care provided. Those records examined were well maintained, up to date and readily available. The staff records confirmed that they had received training on health and safety subjects including manual handling, first aid and fire procedures. From an inspection of the premises and an examination of the safety reports, it was apparent that the manager had taken appropriate action to ensure a safe environment for the service users and the staff. Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 25 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 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 4 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 4 3 X 3 3 3 Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Muston Road (70) DS0000007840.V309137.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 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. 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