Inspection on 14/09/06 for Mythe End House

This inspection was carried out on 14th September 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mythe End House 17/01/06

Mythe End House 17/06/05

Mythe End House 31/01/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Mythe End House Mythe Road Tewkesbury Gloucestershire GL20 6ED Lead Inspector Mr Simon Massey Key Unannounced Inspection 14 & 19th September 2006 10:00 th Mythe End House DS0000061857.V304627.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 Mythe End House DS0000061857.V304627.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. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mythe End House Address Mythe Road Tewkesbury Gloucestershire GL20 6ED 01684 299272 F/P 01684 299272 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) Kentwood Ltd Mrs Jennifer Jillian Harvey Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the two bedrooms on the upstairs floor with their own staircase are only accommodated by service users that have been risk assessed as being able to safely access this accommodation. 17th January 2006 Date of last inspection Brief Description of the Service: Mythe End House is a care home for seven adults with learning disabilities that have complex needs. The home is set in large grounds approximately a mile from the town of Tewksbury. The accommodation is spacious and is spread over three floors. The home is annexed to another registered home that is run by the same organisation, Kentwood Care. Both have their own grounds and entrance. Information for prospective service users is available in the home’s Statement of Purpose and Service User Guide. The current scale of charges were not available at the time of this inspection. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This unannounced inspection took place over two days and lasted approximately 10 hours. The inspector met with the Registered Manager, care staff and service users. Records relating to care planning, health and safety, medication, staff recruitment and training were examined. An inspection of the environment was also carried out. What the service does well: What has improved since the last inspection? What they could do better: The home could incorporate a more person centred approach to the reviewing of care plans and the establishing of goals and objectives. The home needs to ensure that the recruitment procedures are followed and that staff do not commence employment until the correct checks have been completed. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 6 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. Mythe End House DS0000061857.V304627.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 Mythe End House DS0000061857.V304627.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 the service. The home’s Statement of Purpose provides the required information for perspective users of the service. The home’s admissions policy should ensure that only people whose needs can be met are admitted to the home. EVIDENCE: There have been no admissions to the home since the previous inspection and there are currently no vacancies. The home has an admission policy that complies with the regulations. All new service users would have an assessment of needs completed before their admission and would be provided with the opportunity of informal visits and a trial stay at the home. The manager stated that the Statement of Purpose and Service User Guide were being reviewed and updated at the time of the inspection. Copies will be supplied to the Commission when this process is completed. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 9 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, & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Detailed care plans ensure that the service user’s needs are documented and guidance is available to staff. The home takes action to encourage service users to make choices and supports them to take appropriate risks. EVIDENCE: All service users have detailed care plans in place that cover a full range of needs and are based on comprehensive assessments that have been completed. These are reviewed on a regular basis. The records show that medical and health issues are monitored and outside professional help and guidance sought where necessary. Where appropriate there are behavioural monitoring charts in place and records kept of any injuries or bruises that are observed by staff. Each files also contains a monthly summary of activities that have been undertaken. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 10 The files contain detailed daily recording that is of a good standard. This provides information about responses to activities, interaction with staff and with other service users. Whilst the care plans are detailed and cover a range of emotional, physical and behavioural needs there is scope for the development of a more person centred approach to the reviewing process. This could provide the opportunity for the service users to be more involved in the process. This would help identify more specific goals and objectives and identify the staff responsible for progressing them. Due to the needs of the service users, all of whom have an autistic spectrum disorder, their involvement, interest and understanding of care planning can be limited, but a more person centred approach may help facilitate more of their input. Service users are encouraged to make choices but are also supported to follow their routines as far as events and activities are planned. Staff recognise the importance of structure and routines for the service users and efforts are made to ensure that activities, trips out or visits from relatives, take place when they are scheduled to. People are supported to make choices about their clothes, food, bedtimes and activities in the weekends and evenings. Certain limitations are in place for some service users and these are recorded and risk assessed where appropriate. A sample of risk assessments were examined and these were up to date and had been regularly reviewed. There was evidence that these are used to encourage activities and independence. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 11 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): 12,13,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are supported to make choice and decisions about their daily routines and activities. People are supported to engage in a variety of leisure activities in the community and in the home. EVIDENCE: All service users have some form of daily and weekly routine that they are supported to follow. There is a system in place for planning the daily care and ensuring that the correct staffing levels are on duty and that people know who they are supporting and when. Efforts are made to access new activities or outings that can be undertaken and service users appeared positive about all the activities that were being organised during this inspection. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 12 People have large bedrooms, which accommodate enough room for people to follow their own interests in private if they wish. The home also has two large communal rooms as well as a sensory room that service users can use. One service user, after a lengthy period of declining to venture into the community, has now started undertaking short visits outside the home. This is seen as a very positive development by the staff team who consider this change has had great benefits to the service user concerned. Good staff planning and monitoring has achieved this. Records show regular contact with families and visits to the home. Responses from the key stakeholder survey carried out show that relatives were positive about the care and support the staff team provided and of their understanding of the needs of the service users. The kitchen was well stocked with fresh and frozen produce at the time of the inspection and all food was correctly labelled and stored. Information is provided on individual diets and preferences. Service users are supervised in the kitchen at all times due to the risks involved, but some do have some involvement in food preparation and planning, though this is limited due to the needs of the service users. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 13 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,& 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has systems in place for monitoring health needs that are effective and meet the needs of the service users. The home provides a good standard of personal care and support. There is an effective administration system for the storing and administering of medicines, and staff receive the appropriate training. EVIDENCE: The home and healthcare professionals have been considering the possibility of hospital treatment for one service user, who would be unable to give informed consent. A best interest meeting was convened which has agreed that this would not be the best way forward at present. This was all correctly documented, and the manager and care staff commented that they considered the right course of action had been taken as some progress was being made in the managing of the condition. The personal files contain details of health appointments and any outcomes or changes to the care that result from these. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 14 The records show people are having regular check ups and that their physical health needs are being monitored by the staff team. The medication storage and administration was examined and found to be in order with items being correctly stored and labelled. Advice was offered on the stock recording of some medicines. Staff are required to be inducted and complete medication training before they are deemed competent to administer. They also have an observed competency assessment completed by the management. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 15 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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service The home provides a safe environment for service users in which they are respected and treated with dignity. The home has satisfactory arrangements and procedures in place for the protection of service users. EVIDENCE: The recording relating to a complaint the home had received was examined. The home had responded appropriately and dealt with the issues that had arisen. Part of the incident related to staff smoking whilst on duty and the home have now provided clear guidelines about the smoking policy, and ensured that staff are aware of this. The manager has completed a training course in Adult Protection and also 12 staff have undertaken the training that is provided by the local Adult Protection team. Staff spoken to were able to demonstrate a good understanding of the practice issues, and their importance to the safety and protection of the service users. The home provides all staff with accredited training in the managing of challenging behaviours. All staff were up to date with this training. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 16 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home provides spacious and comfortable accommodation in a secure setting that is well maintained. EVIDENCE: The home was clean and hygienic throughout and in a good state of repair. The window in one service user’s room needs repairing, as the catch was broken preventing the window from closing. Service users rooms reflected their personal tastes and preferences, and were decorated and furnished according to their assessed needs. The outside of the property is well maintained and the gardens provide an attractive and large secure area for the service users. An intercom has now been installed at the main entrance, which has improved access to the building for visitors and callers to the home. Two of the bedrooms have locks, one service user has a key to their room and another is kept locked to prevent other service users accessing it. This is done in agreement with the service user, who, whilst not able to take responsibility Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 17 for the key, needs the assurance that their property and belongings are secure. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 18 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): 32,34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service user needs are met by a motivated and effective staff team. The safety of service user’s may be compromised by the failure to follow the required recruitment procedures. Regular training for staff helps ensure they have the necessary skills and knowledge to meet the needs of the service users. EVIDENCE: The Provider is in the process of opening another registered home and certain staff will be moving to the new unit. This has caused some problems for service users who have built up relationships with these staff. However the home has spent time discussing the changes with the service users and have taken steps to try and make the transition with as little anxiety to the service users as is possible. Staff were observed relating professionally with service users and meeting their needs. A fire evacuation was held during this inspection and the staff were observed dealing with this in a calm and professional manner, ensuring that the anxiety of the service users was minimised. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 19 Staff have been receiving regular recorded supervision and there was evidence that this is used to address issues around practice, as well as providing support and development. Staff files contained all the required information but the records show that not all required checks are completed before staff commence employment. The home appears to have a policy that allows staff to start before CRB checks have been completed. Staff are not permitted to undertake personal care or work unsupervised until these clearances are obtained. However this should only be done when there is a risk to services if new staff are not appointed. The situation should be risk assessed and the Commission informed, as this is not the default procedure for recruitment. Normally staff should not commence working in the home until CRB checks have been satisfactorily completed. The staff team have a full staff meeting every two months and these are recorded and minutes kept. These show a discussion of a range of issues and of staff being provided with guidance and advice, as well as having an opportunity to discuss any issue that have arisen. The organisation employs a training manager who is based at the head office. This person takes responsibilities for ensuring staff are up to date with the required statutory training as well as the ongoing behavioural management training. Staff receive annual updates on this accredited training, which focuses on the techniques required to mange service users who may have challenging behaviours Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 20 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, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is being run and managed in a professional and competent manner and is meeting the needs of the service users. Quality assurance systems ensure that the home is monitored and audited thoroughly by the organisation. EVIDENCE: The organisation employs a Quality Assurance manager who completes regular audits of all their services. A copy of the most recent audit was supplied to the Commission. The audit covers a wide range from care plans to the physical environment. The audit was very positive and provided good feedback to the manager and care staff. The home has had an audit completed by an outside firm in relation to Health and Safety. Staff also complete a monthly audit of the areas that are required to be monitored for any health and safety issue that may arise. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 21 The home has completed a “Key Stakeholder” survey or questionnaire as part of quality assurance. The recording from this showed that the home had responded positively to issues that had arisen. The home undertakes monthly management reviews, which are completed by a senior member of staff. This provides an audit of key tasks that should be completed. The home also has Regulation 26 visits completed, either by the Quality Assurance Manager or the Responsible Individual. All health and safety checks were being completed and recorded and all fire safety maintenance and training was up to date and correctly recorded. Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 22 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 x 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 x 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 X Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 23 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation Requirement Timescale for action 30/10/06 19(1)(b)(i) The home must ensure that staff do not commence their employment until the required checks have been completed 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 YA6 Good Practice Recommendations The home could develop more person centred systems for the reviewing of the care plans Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. Extracts may not be used or reproduced without the express permission of CSCI Mythe End House DS0000061857.V304627.R01.S.doc Version 5.2 Page 25 - 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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