Inspection on 11/08/08 for Myland House.

This inspection was carried out on 11th August 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Myland House. 12/10/07

Myland House. 27/09/06

Myland House. 08/02/06

Myland House. 17/08/05

Myland House. 29/03/05

Myland House. 11/01/05

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Myland House 81 Mile End Road Colchester Essex CO4 5BU Lead Inspector Deborah Kerr Unannounced Inspection 11th August 2008 09:35 Myland House DS0000017893.V370002.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 Myland House DS0000017893.V370002.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. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Myland House Address 81 Mile End Road Colchester Essex CO4 5BU 01206 853604 01206 853604 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) The Brain Injury Rehabilitation Trust Mrs Suzette Anne Doherty Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2007 Brief Description of the Service: Myland House is one of a number of homes owned and run by the Disabilities Trust. The Brain Injury Rehabilitation Trust (BIRT) are part of the Disabilities Trust and are the registered providers for Myland House. The service is registered to provide care to five people aged between 18-65, who all have an acquired brain injury. The home is a detached former family dwelling located in an established residential area of Colchester. It is situated within walking distance of all of Colchesters main shopping facilities. The accommodation is arranged on the ground floor and first floor of the premises. Furnishings throughout the home are in keeping with the needs of the people who live there. Fees for accommodation range from £906.60 to £1,237.20, an additional charge is made for one to one care hours, where required. Items not covered by the fees are personal items, such as clothing, toiletries, hairdressing and newspapers. This was the information provided at the time of key inspection, people considering moving to this home may wish to obtain more up to date information from the care home. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection, which focused on the core standards relating to adults, aged 18-65. The inspection was unannounced on a weekday, which lasted nine and a half hours. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from a relative and 2 staff ‘Have Your Say’ surveys and the Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI). This document gives providers the opportunity to inform the CSCI about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living at the home against the Key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with three people who live in the home and two members of staff. The manager was on annual leave on the day of the inspection, the deputy manager was present and fully contributed to the inspection process. What the service does well: The service provides the people who live there with a comfortable and homely environment, which is suited to their needs. The service offers a flexible structure to the day, people were observed moving freely around their home and told us they are happy living there and that they are supported to do what they want to do. This was supported in conversation with a relative visiting, who commented, “on the whole my relative gets on well with the staff, appears happy here and is well cared for”. Observation and discussion with staff reflects they have developed good relationships with the people living in the home. They support each individual to make decisions and take risks in their everyday lives, as part of developing an independent lifestyle, both in the home and the wider community. People are supported to have meaningful daytime work, educational opportunities and to take part in activities of their choice. People who use the service are provided with the information they need, which keeps them informed about things that happen in the home, their rights to be protected from harm and how to make a complaint. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Information about the service needs to updated to reflect the new contact details of The Commission via the Regional Contact Team (RCT), who are based in Cambridge. More could be done to monitor the health and well being of people using the service and where problems are identified these are dealt with at an early stage to ensure they maintain good health. This relates to ensuring peoples continence and nutritional needs are monitored and reviewed regularly, especially where there may be risk factors to sudden weight loss. Additionally, the current end of life plans need to be expanded to include information about people’s wishes at the time of death and dying, so that these will be carried out, with respect and as the individual would wish. To protect people using the service from the risk of financial abuse, systems need to change to ensure bankcards and pin numbers are kept separate. Additionally, to ensure people are able to access their money at all times, secured lockable storage should be provided in their own rooms. To ensure vulnerable people using the service are not at risk from unsuitable staff the recruitment process needs to be improved. A previous requirement was made to ensure all employment checks and documentation, required by regulation are obtained in respect of employees prior to them commencing work. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 7 Although, there had been some improvement in this area, none of the files seen, contained a recent photograph, as proof of the person’s identity. The start date of a member of staff reflected they had commenced employment before their Criminal Records Bureau (CRB) had been received, with no evidence that a Protection Of Vulnerable Adults (POVA) 1st having been received, as an interim precaution. Another staff file reflected a reference had not been obtained from their previous employer to explore the issues why the individual had left their employment. To ensure new employees are confident and competent to carry out their role and meet the specific needs of the people living in the home, the required support and tuition to help them complete their induction programme must be provided. To ensure the health, safety and welfare of people living in the home, the manager must make sure that arrangements for taking soiled linen to the laundry room, through the kitchen are reviewed, to minimise the risks of spreading infection. Uncovered radiators, which are a potential risk to people using the service, need to fully risk assessed and actions identified to minimise the risks. The hot water supply to showers and hand basins must be assessed to meet the needs and capabilities of people living in the home and monitored on a regular basis to ensure the water does not exceed the safe recommended temperature. 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. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5. People who use the service experience good quality outcomes in this area. People considering moving into Myland House will be provided with information, which clearly tells them about the service, so that they and their representatives have the information they need to choose if the home will meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of the statement of purpose and service users guide were provided at the inspection. Both had the required details about the home, the aims and objectives of the organisation and the services provided, however both documents need to be amended to reflect the new contact details of The Commission via the Regional Contact Team (RCT), who are based in Cambridge. The Disabilities Trust has also produced a DVD called ‘A Service for Everyone’, which tells people about the organisation and what they do. The home is registered to provide care for up to five people. One person has recently moved to an alternative placement within the same organisation. There have been no new admissions to the home, however information provided in AQAA and the homes policies and procedures reflects the home has a clear and robust admissions procedure in place. Prospectivie clients are invited to look around the home and stay for lunch, (if they wish to) and would be invited to stay for a weekend. A six week assessment review is held with Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 10 the individual and their family and funding authority. A further six month review is held to ensure all of the persons needs are being meet. An individual and their relative confirmed they had been able to look around the home. The person who moved into the home said they had been able to choose, which room they wanted. People also told us about their different experiences about living at Myland House and told us they are happy living there and that they are supported to do what they want to do. Information provided in the AQAA reflects the manager and a clinical psychologist complete a full assessment of prospective clients needs prior to them moving into the home. This process ensures the manager has all the information they need to ensure the service will be able to meet the individual’s specific needs. The files of two people looked at as part of the inspection process contained the required assessments providing a comprehensive overview of their health, personal and social care needs. People living in the home have been provided with a copy of terms and conditions of residence (contract), which had been agreed, signed and dated. Contracts included information about additional charges made to people living in the home. These included details relating to the contribution for the television licence. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. People who use the service experience good quality outcomes in this area. People using this service know they will have their needs and personal goals reflected in their individual plans and will be supported to make decisions and to take risks in their everyday lives, as part of developing an independent lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of two people living in the home were examined as part of the inspection process. These are well organised, covering all aspects of the individuals health, personal and social care needs. Both contained information about the individuals past, health, personality and issues, which could lead to inappropriate behaviours and how these should be managed. Support plans have been developed using the information obtained through the pre admission assessment process and input from the clinical psychologist, where required. The plans contain good information of the actions staff need to take to support individuals, to be as self managing as possible. These are supported by risk assessments, which address safety issues, whilst aiming for Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 12 positive outcomes and ensuring the individual is supported to maximise their independence, whilst completing daily living tasks. A previous requirement was made for people’s care plans to be kept under regular review, and that they are consulted on all aspects of their care. Information seen in care plans confirmed people living in the home are involved in monthly reviews and annual reviews held with a representative from the funding authority. The previous requirement also related to concerns about a programme of care for an individual, to help manage continence issues. The plan was previously viewed to be bordering on a reward and punishment programme. The organisations clinical psychologist, and other senior members of the team had agreed the programme, in consultation with the individual. The registered manager was previously advised that the programme needed to be reviewed to ensure that it provided a clear rationale for its use, and that it should be subjected to regular review. Information obtained at this inspection, confirmed this plan is no longer being used. The individual concerned has decided not to follow the agreed action plan and their decision has been respected. This was confirmed by entries in their care plan and through discussion with the deputy manager and the individual themselves. Information provided in the AQAA and verified at the inspection confirmed people using the service are provided with information and assistance to make decisions about their lifestyle and quality of life. Each person has been provided with their own folder, which they keep in their room containing a copy of their agreed weekly programmes, care plans and risk assessments, copy of service user meetings and information about their rights and how to complain. The deputy manager explained the process in place for supporting people using the service to manage their finances. The Brain Injury Rehabilitaion Trust (BIRT) holds bank accounts for people using the service, their allowances are paid directly into their individual account. To obtain spending money, individuals have their own bank cards. These are held by the manager with the individuals pin number, in a locked cash tin, with their money. The deputy manager was advised the pin number and cash card need to be kept separate to protect the individual from possible finacial abuse. Additionally, only the manager and deputy have access to the keys, to the safe and each persons tin. If neither person is in the home, people are unable to access their money. This was discussed with the deputy manager who was advised the National Minimum Standards (NMS) state people using services, should be provided with secured lockable storage space in their own rooms. A separate ledger is kept for each person’s expenditure, these were checked for the two people being tracked as part of the inspection. They showed a clear audit trail of all financial transactions and monies checked against the balance sheets and were found to be accurate. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17. People who use the service experience adequate quality outcomes in this area. People using this service are supported to take part in meaningful activities, however more could be done to ensure peoples nutritional needs are monitored and reviewed to investigate, risks such as weight loss. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed people using the service are supported to acheive their specified goals, in the form of age appropriate activities, within the community. This includes an individual who has a voluntary job at a local country park, one day a week, gardening. Individual weekly activity charts confirm people living in the home have access to adult education classess at local colleges and reflect their chosen leisure time activities, these include regular visits to the pub, cinema, Gateway club, church and personal shopping trips. The weekly activity plans also show people living in the home are encouraged to take responsibility for house keeping tasks, which include a weekly grocery shop at a local supermarket. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 14 Staff confirmed their shift times have recently changed, they are now working long days, instead of early and late shifts, which means they have been able to facilitate more social activities, during the daytime for the people using the service. Most recently, two people confirmed they were supported to spend the day out in town, having lunch and going to the cinema in the afternoon. The service offers a flexible structure to the day, with no rules other than those required for safety. People have unrestricted access around the home, with the exception of other people’s rooms. People confirmed they are able to spend time on their own in their room, if they chose to do so, and that staff respect their privacy. Staff were observed knocking before entering people’s rooms. The interaction between people living in the home and staff was friendly and appropriate, chatting about day-to-day events and interests. People were seen moving freely around their environment, relaxing, eating their meals and getting ready to go on holiday. An individual spoken with confirmed they help to weed, cut the grass and water the garden. They also help to take care of the fishpond in the garden and feed the fish and birds. Information provided in the AQAA and verified at the inspection confirmed people are supported to maintain contact with families and friends. An individual was observed getting ready to go on a week’s vacation with their relatives, who arrived during the inspection. People are able to choose when they eat their meals. There are no routine meal times, as people living in the home have day time activities, which vary. The home has a menu, which people living in the home have had a say in what their prefrences are. None of the the people living at the home require a special diet and the menu seen provided a range of varied, balanced and nutrious meals. Additionally, people are able to access the kitchen to make drinks and snacks, as they wish, although staff are on hand to provide support, if required. The menu and food was discussed with two people living in the home, with conflicting views. One was very happy with the food they received, where as the other individual was concerned they did not have enough to eat. A food diary was not consistently being completed and therefore did not accurately reflect, what each person, had eaten each day and the amount. This was discussed with the deputy manager, who was advised to ensure these were being kept and monitored, especially in the case of the individual who told us they were not having enough food and whose care plan reflects they have lost weight over the last three months. Myland House DS0000017893.V370002.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21. People who use the service experience adequate quality outcomes in this area. The health and personal care that people receive is based on their individual needs, however where peoples health needs change, more could be done to seek advice to ensure problems are dealt with at an early stage. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans contained clear information of people’s health needs and how these were to be met. Their support plans described the level of guidance and support, each individual required to manage their own personal hygiene. These were varied and reflected the individual’s needs and preferences. These plans were supported through discussion with staff who were able to provide a verbal account of each person’s health and well-being and by a relative who commented, “on the whole my relative gets on well with the staff, appears happy here and is well cared for”. Information in the care plans confirmed that people living in the home have access to health care services in the local community. These include the General Practitioner (GP), the nurse for routine health checks, dentists and other specialist services, such as occupational therapists (OT). An individual, with impaired mobility has recently been assessed by the OT and provided with appropriate aids to maximise their independence and protect them from harm, should they fall. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 16 The Disabilities Trust employs their own psychologist who is involved in the assessment process and who helps to identify the specific health and behavioural needs of people using the service. The care plan of an individual showed they previously had a plan in place, developed by the psychologist, management team and agreed by the individual to help them manage their continence. However, the individual has decided they no longer wish to continue with this plan. Although, some concerns were raised at the previous inspection about the content of the plan, records showed that there had been a significant decrease in occasions of incontinence. The records show where the individual is no longer sticking to the plan, these incidents have increased and are susceptible to deterioration in their skin integrity and discomfort through their own poor hygiene. This was discussed with the deputy manager who was advised they should contact the continence team to reassess the individual’s needs. Records in people’s care plans confirmed that their weight is being monitored, however one individual was noted to have lost 8lbs over a four-month period. The individual spoken with was concerned about their weight loss, this needs to be monitored and followed up with the GP to ensure potential complications are dealt with at an early stage. The home has a comprehensive medication policy and procedure in place for ordering, storing, and administering medicines. Medication is locked in a storage cupboard to which only seniors hold the key. During our visit we looked at Medication Administration Records (MAR) charts and blister packed medication belonging to people living in the home. MAR charts inspected were found to be completed correctly, with no gaps. The deputy manager completes an audit of medication weekly to ensure there is no mishandling of medication. The practice of administering medication is generally safe and well managed, however the deputy was advised to avoid mistakes with people’s identity, it is recommended practice that each persons MAR chart has a front page with their name and photograph. No person living in the home is currently prescribed controlled drugs. However, should controlled drugs be prescribed for one or more persons the deputy manager was advised it is a legal requirement that the home has a separate metal cupboard of specified gauge with a double locking mechanism, which is fixed to a solid wall, with either rawl or rag bolts. Care plans contained critical illness plans, which had been discussed and agreed with the individual. These reflected the arrangements following their death. The Disability Trust has a policy and procedure, which states the arrangements for end of life plans should be discussed and completed, which reflect people’s wishes in the event of terminal illness, ageing and death. These would include the arrangements to ensure the individual chooses where they die, in dignity and free from pain. The current plans need to be expanded to include this information so that people’s wishes at the time of death and dying will be carried out, with respect and as the individual would wish. Myland House DS0000017893.V370002.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. People who use the service experience good quality outcomes in this area. People who use this service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has clear policies and procedures in place providing guidance to people using the service, their relatives and staff to make complaints and to respond to suspicions or allegations of abuse, including whistle blowing procedures. The adult safeguarding policy provides clear guidance of the procedures staff must take to report such allegations. The home has a copy of the Essex County Council safeguarding adults training pack, booklets and a DVD. Training records confirmed staff have received up to date training to protect vulnerable adults. This was supported in discussion with staff who are aware of peoples rights and about their duty of care and what they would do if they had concerns about the welfare of an individual living in the home. People living in the home have been provided with their own file, which contains a copy of the complaints procedure and information about their right to be protected from abuse. Say ‘NO’ to abuse procedures have been produced in conjunction with Voice UK. These provide information about the types of abuse, who might abuse them and what they can do and how to complain. This information has been produced in large easy read and pictorial format. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 18 The complaints book confirmed that neither the Commission (CSCI) or the home have received any formal complaints or adult safeguarding referrals in relation to this service, since the last inspection. Myland House DS0000017893.V370002.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 30. People who use the service experience adequate quality outcomes in this area. People who use this service are provided with homely and comfortable accommodation, however, there are potential risks to their safety with regards to uncovered radiators and spread of infection due to the current laundry arrangements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Myland House is a two storey home located in an established residential area of Colchester. The house is in keeping with others in the local community, nicely decorated throughout and is appropriate for the needs of the people living there. Communal rooms consist of a kitchen, a dining room, conservatory and a lounge. These are well furnished with modern equipment and domestic style furniture, carpets and curtains. The premises are bright, cheerful, clean, airy and free from any unpleasant odours. The home has five bedrooms, each with en-suite toilet and shower facilities, one of which has been made into a wet room. Four bedrooms are on the first floor, the fifth bedroom is on the ground floor providing accommodation to an individual with impaired mobility. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 20 People’s rooms are nicely decorated and furnished in the colour schemes of their choice. All rooms have appropriate lighting and personal effects, which reflect the individual’s hobbies and interests. All bedrooms doors have locks for privacy and the occupants have the choice to hold their own key. Staff can override these in an emergency. The deputy manager advised there is a programme of redecoration in place, which includes making improvements to the ground floor bedroom. The room smelt ‘musty’, which is due to the use of the wet room and water seeping out into the individuals bedroom carpet. There are plans to refurbish the wetroom and bedroom and replace the carpet with wooden effect floor covering. Domestic style radiators are situated throughout the home. There was evidence to show that an individual with unsteady mobility had been assessed as needing staff support at all times, when using the shower due the likelihood of slips and falls and injury against the radiator. Where radiators remain uncovered throught the home, these also need to be assessed to ensure people using the service, who are vulnearable due to the change in their mental capacity, are not at risk of receiving burns and/or scolds. A plumber had been called out to the home during the inspection to look at problems, occurring with the boiler. Random testing of showers, found the temperature of the hot water supply to the shower in bedroom 3, to be in excess of 56.6 degrees centigrade. This is above the recommended safe temperature of 41 degrees centigrade, for showers, which puts the individual occupying this room at risk of scolding themselves. An immediate requirement was left about the action that needed to be taken to ensure the safety of the person, occupying the room. A second random visit to the home on the 15th August 2008 identified that the hot water to the shower in room 3 was 57.1 degrees centigrade. A further immediate requirement was made and the shower was taken out of action. Following the inspection the divisional manager and service director of the Brain Injury Rehabilitation Trust (BIRT) have informed us (The Commission) of the action taken to address the issues around hot water temperatures. A second plumber was called to the home on the 15th August who found the cold water supply had been turned off to the shower. A record of weekly, hot water checks provided to us, showed prior to the first plumbers visit temperatures had not exceeded 40 degrees. The shower units in each en-suite have now been replaced, with built in thermostatic mixer valves. The utility room was clean and tidy with appropriate equipment to launder clothing and bedding, however it does not have a sluice cycle. The deputy confirmed they use dissolvable red laundry bags and separate out the soiled linen, which is washed separately in the washing machine above the recommended temperature of 65 degrees. The utility room is situated at the side of the property, which means staff are taking dirty and soiled laundry Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 21 through the kitchen area, which increases the risk of spreading infection and does not comply with the Department of Health Guidelines (DOH). Appropriate hand-washing facilities of liquid soap and paper towels are situated in all bathroom facilities, where staff may be required to provide personal care. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. People who use the service experience poor quality outcomes in this area. Staff in the home are trained, skilled and in appropriate numbers to support the people who live there, however to ensure the safety of people living in the home all documents required by regulation, must be obtained before appointing a member of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Twenty-four hour care is provided to the people living in the home. Staff confirmed there is two staff on duty during waking hours, with one sleeping in staff at night. Staff ‘Have Your Say’ surveys commented, “unfortunately we are understaffed and mostly rely on agency to fill the gaps”. However, staff spoken with felt staffing levels were sufficient to meet the needs of the four people currently living in the home, but acknowledged when there are five people, they could do with an extra member of staff. As previously mentioned in the lifestyle section of this report, staff shift patterns have recently changed. Long days have been introduced, instead of early and late shifts, which means staff are available thoughout the day to support people to engage in day time activities with out restrictions to fit in with staff’s working hours. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 23 Staff ‘Have Your Say’ Surveys, received, confirmed they have access to training, which is relevant to their job and helps them to understand and meet the needs of the people using the service. Most recent training has included, care of medicines, fire safety, safeguarding adults, epilepsy awareness, back care associated with moving and handling and food safety. Training more specific to meet the needs of people living in the home have included basic brain injury and ‘Who Cares’ training provided by the Disability Trust. The training records of five staff confirmed they had completed a National Vocational Qualifications (NVQ) level 2 and above. A previous requirement was made for the registered manager to ensure that people using the service are adequately protected by the homes recruitment procedures. This included obtaining all documentary as defined under Schedule 2 of the Care Homes Regulations 2001. Examination of three staff files confirmed there had been some improvement in this area, however, none of the files contained a recent photograph, as proof of the persons identity. Additionally, the start date of a member of staff reflected they had commenced employment before their Criminal Records Bureau (CRB) had been received. There was no evidence that a Protection Of Vulnerable Adults (POVA) 1st had been received, as an interim precaution to protect the people using the service. A staff members application form contained the details of their previous employeer and made reference to the reason they left their previous employment was due to health and safety issues. The references obtained for the individual did not include the previous employer and therefore these issues have not been explored, to ensure the prospective employee is suitable to work with vulnerable adults. Staff ‘Have Your Say’ surveys confirmed they received supervision and support to do their jobs. There was evidence on the three staff files seen that supervision had taken place on a regular basis. The Brain Injury Trust (BIRT) provides new employees with their own induction training programme, in the form of a booklet, which refers to the former TOPPS induction and foundation training, which complied with the National Training Organisations (NTO) specifications. The booklet has five sections covering the principles of care, the organistaion and role of the worker, experiences and needs of the service user group, safety at work and the influences and requirements of the service setting. Each section has a definition, outcome and study text. The induction programme relies on the completion of a workbook with regular support and input from a supervisor, however there was a lack of evidence to show that a recently recruited member of staff had received the required support and tuition. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. People who use the service experience adequate quality outcomes in this area. To ensure the safety and welfare of people living in the home, the manager needs to be more proactive with regards to administration of the home, such as recruitment issues, staff induction and monitoring of hot water temperatures need to be improved, This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has the required qualifications and experience for their role. They have completed National Vocational Qualifications (NVQ) level 4 in management and care services, NVQ 3 in care and the NVQ assessor’s award. They have approximately sixteen years experience of working with people with learning disabilities, challenging behaviour and brain injury. The manager partially completed the AQAA, when we asked for it, however this did not provide us (The Commission) with all the information we asked for. It has been explained that the AQAA was sent to us whilst the manager was on sickness absence, having been partially completed. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 25 The home’s quality assurance process is managed corporately and is addressed through the use of questionnaires, which seek the views of people using the service, their family and other people important to them. These questionnaires are collated centrally and a report on the outcome is published. The deputy manager advised they were aware that new questionaires are being developed, but was unable to locate the latest quality assurance report and agreed to forward a copy to us (The Commission). Maintainence records confirmed the required five-year, electrical safety certificate was still in date, which expires in July 2009 and Portable Appliances Testing (PAT) had been carried out in July 2008. A previous requirement had been made for the certificates relating to the safe running of the home are available and current. This related to the home’s gas safety certificate, which was out of date and there was no evidence that this utility had been recently checked. A gas safety inspection certificate was seen on the maintainence file to reflect that work had been undertaken to service the boiler, however a copy of the landlords certificate had not been obtained. The deputy manger contacted the company, who service and maintain the gas utilities, during the inspection, who agreed to forward the certificate to the home. The deputy manager agreed to forward a copy of this to us (The Commission) for confirmation. The fire logbook confirmed the home has an up to date fire risk assessment, completed by the Disabilities Trust, which reflects the fire safety precautions thoughout the home and means of escape in the event of the fire alarm being raised. The log book confirmed the fire alarm is being tested weekly using different zones and regular fire training and drills take place, with a record of the staff in attendance and outcomes of the drill recorded. The Fire and Rescue Service visited the home in February 2008 and found the premises to be satisfactory. As previously mentioned in the environmental section of this report peoples safety is at risk due to uncovered radiators throughout the home and hot water supply to a persons en-suite shower, exceeding the safe recommended ttemperature. The manager contacted us (The Commission) following the inspection to inform us that the temperature to the shower had been rectified and that they are planning to replace and upgrade all of the showers. Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 2 1 X 2 X X 1 X Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 YA19 Regulation 12 (1) (a) (b) Requirement The health and well being of people using the service must be monitored and where health and well fair needs are identified these must be dealt with at an early stage. This will ensure people maintain good health and well being. Arrangements for taking soiled linen to the laundry room through the kitchen must be reviewed to ensure practice minimises the risks for the spread of infection in the home. People working in the home must have all the required employment checks and documentation specified in paragraphs 1-7 of schedule 2 have been obtained in respect of that person. This will ensure that vulnerable people using the service are not at risk from unsuitable staff. This is a repeat requirement from 12/10/07. Timescale for action 29/08/08 2. YA30 13 (3) 05/09/08 3. YA34 19 (Schedule 2) 11/08/08 Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 28 4. YA35 18 (1) (c) (i) New employees must receive the required support and tuition to help them complete their induction programme. This will ensure they receive the training appropriate to the work they are to perform, fulfil the aims of the home and meet the specific needs of the people who use the service. Where radiators throughout the home are uncovered and could be a potential source of risk for people using the service, risk assessments should be completed based on their capabilities and needs, especially people with poor or unsteady mobility. Action must be taken to address any areas of medium or high risk to ensure peoples well being is properly safeguarded. The hot water supply to bathrooms, showers and hand basins must be assessed to meet the needs and capabilities of service users. Where thermostats have been fitted these must be monitored on a regular basis to ensure the water does not exceed the recommended temperature. This will ensure the health and safety of people living in the home. 05/09/08 5. YA42 YA24 13 (4) (a) 13 (4) (c) 05/09/08 6. YA42 YA24 13 (4) (a) 13 (4) (c) 11/08/08 Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The statement of purpose and service users guide need to be amended to reflect the new contact details of The Commission via the Regional Contact Team (RCT), who are based in Cambridge. Secured lockable storage should be provided in peoples own rooms and systems implemented to ensure people using the service have access to their money at all times and are protected from the risk of financial abuse. The nutritional needs of service users should be monitored and reviewed regularly, especially where there may be risk factors to sudden weight loss. The current end of life plans need to be expanded to include information so that people’s wishes at the time of death and dying will be carried out, with respect and as the individual would wish. 2. YA7 3. YA17 4. YA21 Myland House DS0000017893.V370002.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Myland House DS0000017893.V370002.R01.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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