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Inspection on 05/11/08 for The Malvern Nursing Home

Also see our care home review for The Malvern Nursing Home for more information

This inspection was carried out on 5th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

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

Following our last inspection the home has made some improvements and the registered manager has told us about other improvement they are planning to make. These improvements should make The Malvern a better and safer place for people to live. One relative told us how they could visit as often and when they wanted and how they were always made welcome and offered a cup of tea. Before a person moves into the Malvern, staff visit them and carry out an assessment of their needs. Following this they are encouraged to visit, this helps to make sure The Malvern is the right choice.

What has improved since the last inspection?

The home has updated its care records and risk assessments, so people are now safer, however further improvements should be made to make sure staff are aware of and following these plans. The home has recruited a activities organiser who has improved the number of social activities available to people. A better choice of food and drinks are available. This ensures that people receive a varied and nutritious diet. One person said the food had improved. Staff are now following the recommendations made by health professionals, which will help people stay healthy. The way that medication is checked is much better, this helps make sure the right medication is given to people. Peoples` complaints are now listened to and responded to, this helps the management to improve the service. Some staff have received training on how to protect people, this will help keep people safe. The cleaner is employed longer hours and some areas of the home have been refurbished this has made it a cleaner and more comfortable place to live. The registered manager has updated some of the policies and procedures this will help to make sure people receive a constant approach to their care.

What the care home could do better:

To help promote and maintain peoples independence, the care plans need to include more about peoples social and cultural needs and how the staff can support people to meet these needs.To make sure peoples rights are promoted, when a persons actions are restricted due to a possible risk staff should always make sure that people have agreed to the restrictions, or a mental capacity assessment has taken place and it is in the persons best interests. The way the registered manager makes sure the staff have the right qualities to work with people living in the home must be improved. To protect people from the effects of passive smoking advice must be sought from the environmental health department about the smoking room. Although some refurbishment has taken place, further work needs to be carried out to make it into a more comfortable place for people to live. To prevent the spread of infections the home should seek the advice of the infection control nurse and provide staff with training. To protect people Bradford Adult Protection Unit must be informed of safeguarding incidents and the rest of the staff should have completed their training by early next year. Also systems must be in place to identify any patterns in the incidents so that the appropriate people can be informed. Also all staff must have training on how to work with people who display challenging behaviour. To make sure the staff have the necessary skills to look after people properly they must all receive training in how to work with people with mental health problems and the mental capacity act and the nurses must up date their practices to be sure they are providing support staff with examples of good practice. To be sure only suitable people are employed two appropriate references must be obtained before staff start work To make sure care is provided in a consistent way supervisions should be carried out regularly.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Malvern Nursing Home 425 Toller Lane Heaton Bradford West Yorkshire BD9 5NN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Caroline Long     Date: 0 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: The Malvern Nursing Home 425 Toller Lane Heaton Bradford West Yorkshire BD9 5NN 01274492643 01274499557 rachel@malvernuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Rachel Halsall care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home The Malvern is a 28-bedded care home with nursing, specialising in the care of adults with mental illness. The home takes both males and females and was established 20 years ago. The house is a late 19th century detached residential building situated on a main road approximately 3 miles from the centre of Bradford, served by a good bus route. There is a parking area to the side of the building and a small patio area situated on the other side of the building. Access to the home is gained through the conservatory at the front and a ramp is provided for people with mobility difficulties. There are 16 single bedrooms and 6 double rooms on two floors, accessible for those with mobility difficulties by a stair lift to the first floor. The home is owned and managed by Mrs Rachel Halsall, RMN. 28 Over 65 28 Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Information provided by the assistant manager on indicated that the current weekly fee for the home is from 500 pounds per week, dependent upon peoples needs. Additional costs include the provision of extra support by staff, toiletries, hairdressing, holidays, leisure activities and clothes. This is what we used to write this report. We looked at information we have received about the home since the last key inspection. We asked for information to be sent to us before the inspection, this is called an annual Care Homes for Adults (18-65 years) Page 5 of 31 quality assessment questionnaire. We sent surveys to people living in the home. Two inspectors visited the home unannounced. This visit lasted two days and included talking to the staff and the assistant manager and the registered manager about their work and the training they have completed, and checking some of the records, policies and procedures the home has to keep. We spent time talking with people who live in the home and a relative and two health professionals who were visiting. We looked at five peoples care records to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. We focused on the key standards and what the outcomes are for people living in the home, as well as matters, which were raised at the last inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: To help promote and maintain peoples independence, the care plans need to include more about peoples social and cultural needs and how the staff can support people to meet these needs. Care Homes for Adults (18-65 years) Page 7 of 31 To make sure peoples rights are promoted, when a persons actions are restricted due to a possible risk staff should always make sure that people have agreed to the restrictions, or a mental capacity assessment has taken place and it is in the persons best interests. The way the registered manager makes sure the staff have the right qualities to work with people living in the home must be improved. To protect people from the effects of passive smoking advice must be sought from the environmental health department about the smoking room. Although some refurbishment has taken place, further work needs to be carried out to make it into a more comfortable place for people to live. To prevent the spread of infections the home should seek the advice of the infection control nurse and provide staff with training. To protect people Bradford Adult Protection Unit must be informed of safeguarding incidents and the rest of the staff should have completed their training by early next year. Also systems must be in place to identify any patterns in the incidents so that the appropriate people can be informed. Also all staff must have training on how to work with people who display challenging behaviour. To make sure the staff have the necessary skills to look after people properly they must all receive training in how to work with people with mental health problems and the mental capacity act and the nurses must up date their practices to be sure they are providing support staff with examples of good practice. To be sure only suitable people are employed two appropriate references must be obtained before staff start work To make sure care is provided in a consistent way supervisions should be carried out regularly. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before admission to The Malvern however insufficient training means peoples needs are not always met. Evidence: The registered manager and the nurse in charge told us a nurse will usually visit people before they move in to complete an assessment to make sure the Malvern will be able to provide a service that will meet the persons needs and aspirations. As part of this process the staff will also gather information from any other agencies involved. Following this people are encouraged to visit before they make a decision to move in. The assessment and the visit help to make sure The Malvern has the equipment and staff necessary to care for people properly and any new people are compatible with the other people living at the home. We looked at one assessment and it contained enough information to enable the staff to make a decision about whether or not they would have the necessary skills and equipment to provide the person with the support they need. Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: However three people who returned their surveys told us they were not asked if they wanted to move into the home and did not receive enough information about The Malvern before they moved in so they could decide if it was the right place for them. Also staff told us and the records showed they had not received the necessary training in mental health, to enable them to look after people properly, such as mental health. When accepting a new admission to the home the registered manager must make sure have the staff have sufficient specialist training to be able to care for people properly. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvements need to be made to be sure people are involved with and making as many decisions about their lives as possible. Evidence: Five peoples case records were looked at in order to check that a plan had been formulated which would help staff provide support to people according to their needs and wishes. At the previous inspection we asked for everyones care plan and risk assessments to be reviewed as their needs changed and to include all their personal and health care needs and their goals and aspirations. We found overall the information in the care plans was person centred and quite detailed with peoples personal preferences and choices. These had been updated as peoples needs changed. Also where risks were identified, risk assessments were carried out which provided staff with the actions they needed to take to minimise any risks. In some instances guidance was available to Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: manage specific behaviours such as verbal and physical prompts. However there was still limited information about peoples social and cultural needs, and financial choices. Allthough there is some good information on how to approach people and gain their co operation we saw staff were not always following these good practices. People told us they can make some basic choices about their daily routine such as when to get up and when to go to bed. We saw some people sleeping late in the morning and moving around the home as they choose. Also leaving the home to go to the local shops, having a key to their rooms and smoking as many cigarettes as they wanted. Staff told us some people due to the risks they may encounter were restricted in certain ways, such as when they smoked, or the amount of money they could have each day or whether they could leave the home alone. However we found there was no information to show what assessments had been carried out about peoples mental capacity to make decisions and some of the care records did not tell us about the restrictions. We talked with the registered manager and the nurse who explained that they were in the process of updating all the records to make sure they reflected why people were restricted and whether they had agreed to these restrictions. Three people who returned their surveys when asked do you make decisions about what you do each day stated sometimes. There is a daily records book in the office, which contains a summary of the care plan for some people, the nurse told us this is for people who are more challenging and is to provide a quick reference for staff, and copies of the summaries are also put inside wardrobe doors in these peoples room. When we looked around the home we saw these records in peoples rooms, we found they were brief and did not contain peoples personal preferences in detail. We discussed with the registered manager and the nurse the risk of having two sets of documentation in use, as staff may rely on the summary and will not refer to more detailed care plans, which could mean important information is being overlooked. The nurse explained people living in the home do have regular meetings where staff encourage them to voice their views about the home, however the last minutes we could find were for July 08. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The support people receive to maintain and develop independent living and social skills is limited. People are receiving a choice of nutritious meals. Evidence: At our last visit we asked for people to be provided with a choice of and be supported in accessing activities in the community. During this visit we found there was some evidence people were now being offered more opportunities to go out and a member of staff has been allocated to carry out activities. There was a list of activities which should be available in the home daily. There was evidence some people were accessing day centres and going out to the local shops and people had been taken to Blackpool and to a bonfire. We also saw two people were involved in watching videos, one person was being encouraged to use a colouring book and two others were helped with their make up. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: However peoples care records did not reflect their social preferences and we saw the activities within the home remained very limited and consisted of people generally wandering around home aimlessly or sitting in the lounge or the dining area smoking. Although the TV was constantly on not many paid attention to it. One person who could go to the local shops also told us they would like to go further a field to buy other items but were restricted from doing so because staff were unavailable to go with them. We also saw although there were enough staff available to provide people with one to one activities which would maintain or improve their daily life skill, this was not happening and staff were not trying to occupy peoples time with meaningfully activities. Staff were generally just watching people and only talking to people when a task needed completing and this mainly consisted of telling or asking people to do something. Staff need to be aware that in order to help maintain peoples independence they need to be provided with activities which will help them maintain their daily life and social skills. Also a member of staff told us peoples cultural needs were not being addressed they said special occasions like Eid are not celebrated and they are treated differently. Although some peoples rooms were locked because of a possible risk of fire should they smoke in their bedrooms, this was reflected in peoples care plans and other people either had a key or were able to tell us how they had made a choice about not having a key to their room. The annual quality assessment questionnaire also told us that more people now have keys to their rooms. One relative told us how they could visit as often and when they wanted and how they were always made welcome and offered a cup of tea. At our last inspection we asked for people to have a choice of meals in comfortable surroundings, we found people are now offered a choice of meal the day before and improvements have been made to the dining area and the registered manager told us further improvements are to be made. We saw the cook baking scones for tea, and she told us she does a lot of baking, biscuits and uses sugar substitutes so that people with diabetes can have cakes and biscuits. Many people told us they enjoyed the food and it was good, also staff told us there had been improvements in recent months. However there was still evidence of institutional routines such as tea trolleys. To help people maintain their daily life skills the registered manager could look at ways of enabling people to make their own tea and coffee when they want it. Care Homes for Adults (18-65 years) Page 15 of 31 Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident they will be provided with the support they need to access health care, however more should be done to help people with their personal care and mental health needs. Evidence: During our last visit we found that although people were regularly referred to health professionals their advice was not always taken, so we asked staff to make sure any recommendations were followed. We found that people are referred when necessary to the health professionals and their records showed us some people have regular appointments with their psychiatrist, where their medications are reviewed and with the speech therapist, optician and physiotherapist. We were able to see that recommendations had been carried out for example one person was recommended a type of diet and to be weighed two weekly, this was documented in their care plan. The speech therapist was able to confirm that recommendations were normally followed. We visited on two consecutive days and staff told us people are encouraged to and Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: supported to wash regularly, however we found some people were wearing the same clothes on both days and other records also showed us that some people sleep in their clothes. Also many ladies hair appeared uncombed and people clothes looked mismatched and old. There was also a rail of communal coats in the laundry and there was a distinct lack of people personal toiletries in peoples rooms. We discussed with the registered manager how more could be done by staff to promote respect and dignity by encouraging people to take more pride in their appearance. Also how alternative funds could be sought to provide people with new clothing of their own. Most of the people who live at the Malvern have a mental health issue and would therefore benefit from talking to the staff about how this affects them. However we saw although there were staff standing around they were not generally interacting with people in a therapeutic or positive way but were just directing them to the next task. We found that staff have not had infection control training and there was no soap or paper towels in some of the bedrooms to enable the staff to wash their hands following helping a person with their personal care. The registered manager explained staff always wear gloves and use the sink in the nursing office. However to prevent the spread of infections the staff need to seek the advice of the infection control nurse about how to improve their practices. A relative told us the staff are kind and respectful and another person told us the staff were alright. However one person told us the staff are not kind or respectful not interested just bothered about themselves but they liked the assistant manager and the registered manager. At a random inspection we looked at the medication in detail and asked the home to make sure all medication was administered correctly and a system be in place to check medication is always in date. When we visited we found the system for the administration of medication had been reviewed and the samples of medication we checked were generally correct and the storage of medication had improved. However the medication policy was in the process of being reviewed and there was a store of old controlled drugs which needed to be destroyed and one bottle of medication which was out of date. The registered manager agreed to forward a copy of the medication policy following its review and to make sure the controlled drugs and out of date medication were dealt with. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further work needs to be carried out to make sure people are properly safeguarded. Evidence: At our last visit we asked for the home to make sure people could be confident that their concerns will be taken seriously and acted on, we found this had been carried out and the complaints procedure was in the hallway. Two people told us they would complain if needed and a health professional also confirmed people were able to make their views known. We also saw people approach the nurse to voice their concerns. However three people who returned their surveys stated they did not know how to complain or who to speak to if they are not happy. Since the last inspection the home has received three complaints two which have been referred to them from Bradford Adult Protection Team. One of these had been investigated by the home and responded to, and lessons had been learned from it, a second was being investigated. The third complaint by a person living at The Malvern was investigated by the assistant manager but this complaint contained an incident which should have been referred to adult protection. At our last visit we asked for people from the home to have a up to date policy and procedure for the staff to follow about the protection of vulnerable adults. The home has sent us a copy of their new procedure and some of the staff have attended adult Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: protection training in October and more training is planned for the near future. The registered manager and deputy manager are booked to attend the manager course for adult protection in November. However we did find incidents which should have been referred to the adult protection team which we discussed with the registered manager, assistant manager and the nurse explaining that all safeguarding incidents must be reported to adult protection or a protocol agreed with Bradford Adult Protection about keeping them informed. When we looked at the incidents, although staff were recording them there was not a overall analysis being carried out, which would identify any patterns of behaviour. This analysis would help the staff to reduce the number of person to person incidents in the home. At the last inspection we asked for the home to be sure staff are following the good practice guidelines when they are using any type of restraint, the registered manager told us in the improvement plan that all staff have been made aware of the guidelines and she will monitor the quality of the record keeping. We found no incidents in the sample of records we looked at where physical restraint had been used. However the training matrix shows us that only six staff have had training in how to manage challenging behaviour in the last two years. To be able to keep people safe all the staff must have training in how to manage and care for people who have challenging behaviour. The registered manager explained some people look after their own finances, and for some the Council act as the appointee however for eight people the home is the appointee. All the money is paid into one bank account, which is not interest bearing. The registered manager has an accounting system where the money is individually allocated. People agree to receive their money either daily or weekly, which ever meets their needs. She told us where people do not go to the shops the home will buy the cigarettes for them. Also she explained although they have peoples consent they have not written this information in their care plans however the nurses are working on this at the moment. We talked to people who told us they had agreed to the staff managing their money but often objected to the amount they received. Staff also confirmed they only hold cigarettes for people if there is a risk. Care Homes for Adults (18-65 years) Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to make The Malvern a cleaner and more comfortable place to live. Evidence: At the previous inspection we asked for the home to be kept clean and free from offensive odours. As part of the improvement plan the provider told us they were going to increase the number of hours for the cleaner and they would monitor the standard of cleanliness daily. We found the home was much cleaner and the number of hours the cleaner was employed had been increased. Also staff told us the home was now generally much cleaner and no longer had offensive odours. Also at the previous inspection many areas were in need of refurbishment so we asked the provider to provide us with a plan of maintenance and refurbishment for the home. The provider sent us a plan which told us they sawaiting planning permission to carry out an extensive reorganisation of the ground floor, which would improve the dining area and one of the lounges. However whilst waiting they were going to improve the areas we had identified in our report. We found various improvements had been made to the environment, examples of these were hand dryers had been put in the communal toilets, two bedrooms and a shower room had been refurbished fully, others Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: had new carpets or new lino in the toilet area. The registered manager also told us about further work which is being carried such as the bedrooms and bathrooms which were due to be refurbished and how all the windows were awaiting replacement blinds. Peoples bedrooms had some of their possessions, which reflected their personal interests and tastes. Also both of the lounges had large flat screen TVs that would have been easily visible by everyone using these rooms. However one of the sharing bedrooms did not have any screens in. The registered manager agreed to look at this and replace the screens. The main area for people to smoke is the dining area. This area is not ventilated and the smoke drifts into one of the lounges. To make sure this room meets the required standards for a smoking room in a care home, the registered manager must contact the environmental health department nd seek advice about the room and carry out any recommendations they make. We spent sometime in the laundry and found there was a good system in place to make sure peoples cloths are washed regularly however some of the sheets and towels were very old and in need of replacing. We discussed with the registered manager a system for making sure old towels and sheets are replaced regularly. When we carried out our tour of the home we found a lack of soap and places for staff to wash there hands. The registered manager told us staff used gloves whilst carrying out any personal care and would wash their hands when they returned to the office. To help stop the spread of infections and to improve practice we recommended that advice should be sought from the infection control nurse and staff must have training in infection control. Care Homes for Adults (18-65 years) Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not provided with enough training to enable them to fully support the needs of everyone living in the home. Evidence: We were told there are normally five support workers and one nurse on duty during the day. These are supported by a cook, cleaner, laundry person and activities organiser. We looked at two staff files to make sure only suitable people are being employed. We found for two people who had recently started working in the home both had the necessary police checks carried out before they started work, however one person did not have any references on their file and there were no job descriptions. Before anyone starts work appropriate references must always be obtained to make sure they are suitable for the job. Staff told us and the training records confirmed that the training is not always updated, and is insufficient. We saw examples of how the staff were not provided with enough training to help them to meet people needs. For instance staff did appear to be confident talking to people but watched them from a distance and followed poor Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: infection control practices. To make sure the staff have the necessary skills to look after people properly they must all receive training in how to work with people with mental health problems and the mental capacity act. Nurses must up date their practices to be sure they are providing support staff with examples of best practice. The assistant manager told us that supervisions and appraisals were not carried out regularly, however staff told us they do have regular staff meetings. Supervisions must be carried out regularly these are an opportunity for the management to make sure staff training is updated and to make their views known. The assistant manager told us that over half of the staff have completed their national vocational qualification in care at level two or above. Care Homes for Adults (18-65 years) Page 24 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvements need to be made to make sure the home is operating in the best interests of people who live there. Evidence: The registered manager is the owner of The Malvern she is a registered mental health nurse, with vast experience of caring for people with enduring mental health illness. She explained the assistant manager did not have any previous experience of working in a care setting and was initially recruited to provide business support only. But over the years his role has changed and he is now involved in all aspects of running the home, for which he had not received the necessary training. However to make sure the home is managed in the best interests of the people who live there she is now looking at ways of resolving this issue. We discussed with the assistant manager how if he was to continue in this role he would need to make sure he received all the appropriate training to care for people properly for example care, safeguarding, and mental health. Following our last inspection the management provided us with an improvement plan Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: which told us how and when they were going to improve. We found they have made improvements in many areas, however further issues still need to be addressed to enable the home to provide people with good outcomes. The annual quality assurance questionnaire contains relevant information and lets us know about changes they have made and where they still need to make improvements. The assistant manager told us they have not carried out a annual quality assurance survey this year for people in the home to complete, however they do have regular house meetings. At the previous inspection we asked for the policies and procedures to be reviewed and up dated to make sure staff are working in a consistent and safe manner. We found some had been reviewed such as the protection of vulnerable adults. In the improvement plan the registered manager told us they would continue to review all their policies. The annual quality assessment questionnaire states the maintenance and service records are in order. However the staff told us they had not all received regular fire training. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 16 16 People must be provided with opportunities and encouraged to carry out skills which will help maintain their daily life and social skills. This will help promote and maintain their independence. 01/01/2009 2 23 13 All staff must receive training on how to manage people who display challenging behaviour. This is to keep everyone in the home safe. 30/01/2009 3 23 13 You must agree with 15/12/2008 Bradford Adult Protection Unit a strategy for informing them of any safeguarding issues, and all staff must be aware of and follow this procedure. This procedure must also be reflected in the homes policy. Care Homes for Adults (18-65 years) Page 28 of 31 This is to help make sure people are protected from harm. 4 24 23 You must seek advice from the environmental health officer and following their recommendations about the smoking room and inform the Commission when this had been carried out. This is to protect people from the effects of passive smoking. To prevent the spread of infections the home must seek the advice of the infection control nurse and provide staff with training. This is to prevent the spread of infections. 6 33 18 You must make sure all staff 02/02/2009 are provided with training to enable them to work with people with mental health problems. This training must include the mental capacity act. Also the nurses must up date their practices to be sure they are providing support staff with examples of good practice. This is to make sure the staff have the necessary skills to look after people properly. 7 34 19 You must obtain two appropriate references before staff start work. 18/12/2008 06/01/2009 5 30 13 06/01/2009 Care Homes for Adults (18-65 years) Page 29 of 31 This is to be sure only suitable people are employed Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The care plans need to include more about peoples social and cultural needs and how the staff can support people to meet these needs. The home should always make sure when a persons actions are restricted due to a possible risk that people have agreed to the restriction, or a mental capacity assessment has taken place and it is in the persons best interests. Further work needs to be carried out on the dining area to make it a more comfortable place for people to eat. Staff should help people to maintain their dignity and self respect by encouraging them to take pride in their appearance. There needs to be a system in place to make sure sheets and towels are still in a use able condition. To help promote peoples privacy and dignity, where people are sharing a room screens need to be provided. Where training is provided by a member of the staff team, the registered manager should be sure they have the necessary upto date qualifications to carry out the training. To make sure care is provided in a consistent way supervisions should be carried out six times a year. The assistant manager should be provided with appropriate training for the work he is carrying out. The registered manager should seek the views of people with an interest in the service annually to make sure the service is managed and run in peoples best interests. To keep people safe all staff should attend regular fire training. 2 9 3 4 15 19 5 6 7 24 24 35 8 9 10 36 37 39 11 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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