Care Home: 1 & 2 Markyes Close

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What the care home does well Markyes Close offers the people who live there a very homely, comfortable and safe home. Residents` relatives think the service is very good. One comments "The residents are treated as individuals but are also made to feel part of a family. The home is a "home". Another said that "X couldn`t have had better care anywhere. We`d always get a welcome whatever time we turned up". Every resident has a plan that shows their care needs, skills, likes and dislikes. Plans help staff know the support that each person needs and how to give it. Staff support residents to take part in many different activities and to go out to places they like. They also make sure they enjoy a variety of healthy meals. Residents receive good support with their personal and health care. Staff also make sure they have regular health checks and manage their medicines safely.Markyes Close is ordinary bungalows, which helps people living there fit in with the community. It is in a good place near shops and facilities in Ross-on-Wye. The home is kept in a good condition and clean. The bungalows are suitable for residents with mobility difficulties and aids and equipment help them to move around easier. Residents` bedrooms have been made nice and are personal. Staff receive good training, which helps them to understand and know how to meet the needs of people living at the home better and how to keep them safe. New staff are checked out to ensure they are suitable to work as carers. The home is well run and staff receive good support from the manager and owner. The staff team work well together and are committed to providing a good quality service. One care manager says "The staff give excellent client care. Management ask for advice when required and are open to new ideas". What has improved since the last inspection? Staff are assessing and recording possible risks more fully. This helps to keep residents safe, whilst also allowing them to be as independent as they can be. The home is setting up health action plans for all the residents. These plans will better ensure their good health and promote a healthier lifestyle. Work has been done in the garden and patio and new garden furniture bourght so residents have a nicer place to use. Some windows have also been replaced. More staff have achieved a care qualification. This should help them have the knowledge and skills to meet the needs of people living at the home better. CARE HOME ADULTS 18-65 Markyes Close 1 & 2 Edde Cross Street Ross-on-wye Herefordshire HR9 7BZ Lead Inspector Christina Lavelle DRAFT REPORT: Key Unannounced Inspection 12th&30thMay2008 12-5.30pm &10- Markyes Close 1 & 2 DS0000024681.V364146.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 Markyes Close 1 & 2 DS0000024681.V364146.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. Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Markyes Close 1 & 2 Address Edde Cross Street Ross-on-wye Herefordshire HR9 7BZ 01989 769034 01989 769034 markyes@aspirechoices.com www.aspirechoices.co.uk Aspire Living 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) Mrs Irena Victoria Bace Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8) of places Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users’ primary care needs on admission to the home must be within the following categories:• Learning disability - Code LD The maximum number of service users who can be accommodated is:• 8 5th January 2007 2. Date of last inspection Brief Description of the Service: Markyes Close was first registered as a care home in 1992. The provider Aspire Living is a voluntary organisation and a registered charity. It operates just in Herefordshire, running seven other care homes and a supported living scheme. Their head office is at the Fred Bulmer Centre, Wall Street, Hereford, HR4 9HP. The manager (Mrs Bace) was registered in respect of the home in August 2006. This home provides accommodation with personal care for eight adults. People living at the home must require care due to learning disabilities and may also have physical disabilities and/or a sensory impairment. Most people who live there have profound disabilities and may use behaviours that could challenge a care service. Two of the main stated aims of the home are to respect service users’ rights as individuals and to assist them to establish active, fulfilled lives. Markyes Close is in a convenient location in Ross-on-Wye a small market town. The home is within a short walking distance of the town centre and its shops, services and facilities. Suitable transport is also provided to enable people living there to go out in the community. The property is owned by the Primary Care Trust and is leased to Aspire. The home consists of two self-contained purpose-built bungalows next to each other that can both accommodate four people. Residents all have single bedrooms with a wash hand basin but that do not have en-suite facilities. Each bungalow has its own lounge, separate dining room, assisted shower and bathing facilities, kitchen and utility room for everyone to use. There is a small secure garden area behind the property. Information about the home is provided in a statement of purpose and service users’ guide, which are available from the home and Aspire Living’s office. The guide is also produced in a format that is more suitable for people who have learning disabilities. The weekly charge for the service in 2007 was £1331.57. Additional costs include such as newspapers, toiletries, dry cleaning, private dentist and chiropody, holidays, transport and the fees for specific activities. Markyes Close 1 & 2 DS0000024681.V364146.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 the service at Markyes Close is 2 Star. This means people using this service experience good quality outcomes. This is a key inspection of Markyes Close. This means all the Standards that can be most important to adults living in care homes are assessed. This visit to the home was made without telling staff or the people living there beforehand. The second visit was arranged at Aspire Living’s office to look at staff records. Time was spent in both bungalows with the residents. It is not possible to ask most of them directly what they think of the home because of their learning disabilities and communication difficulties. The way the service is run and any changes since the last inspection were discussed with the deputy manager. Two care staff were spoken with about their role, training and support and the lifestyle of residents. Surveys were sent to the home for some staff, residents’ relatives and advocates and care professionals involved with the home and seven surveys were returned. All the feedback is referred to in this report. An annual quality assurance assessment (AQAA) was completed as part of this key inspection, as is now required. This asks managers to say what they think their home does well, could do better, what has improved in the last year and their plans to improve it. It also has information about the people living there, staff and other aspects of the service. Various records kept by the home were checked and the accommodation looked around. All other information received by the Commission about the home since the last inspection is also considered. What the service does well: Markyes Close offers the people who live there a very homely, comfortable and safe home. Residents’ relatives think the service is very good. One comments “The residents are treated as individuals but are also made to feel part of a family. The home is a “home”. Another said that “X couldn’t have had better care anywhere. We’d always get a welcome whatever time we turned up”. Every resident has a plan that shows their care needs, skills, likes and dislikes. Plans help staff know the support that each person needs and how to give it. Staff support residents to take part in many different activities and to go out to places they like. They also make sure they enjoy a variety of healthy meals. Residents receive good support with their personal and health care. Staff also make sure they have regular health checks and manage their medicines safely. Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 6 Markyes Close is ordinary bungalows, which helps people living there fit in with the community. It is in a good place near shops and facilities in Ross-on-Wye. The home is kept in a good condition and clean. The bungalows are suitable for residents with mobility difficulties and aids and equipment help them to move around easier. Residents’ bedrooms have been made nice and are personal. Staff receive good training, which helps them to understand and know how to meet the needs of people living at the home better and how to keep them safe. New staff are checked out to ensure they are suitable to work as carers. The home is well run and staff receive good support from the manager and owner. The staff team work well together and are committed to providing a good quality service. One care manager says “The staff give excellent client care. Management ask for advice when required and are open to new ideas”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Markyes Close 1 & 2 DS0000024681.V364146.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 Markyes Close 1 & 2 DS0000024681.V364146.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. 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 this visit to the service. Good assessment and admission procedures are in place to help to ensure the home could appropriately meet the needs and wishes of prospective residents. EVIDENCE: There had not been any new residents at Markyes Close since February 2006. It was confirmed in the previous inspection however (and the home’s AQAA reaffirms) that Aspire Living provides thorough written referral and admission procedures for any prospective service users. These procedures were followed when the home’s newest resident moved into the home. This person’s care needs were fully assessed and information obtained about them by the home from their family and social worker. There is also suitable written information about the service provided at Markyes Close, including a service users’ guide. It is also confirmed that whenever feasible introductory visits to the home and a trial stay would be arranged for possible residents. A review meeting would then be held following their trial period with all relevant people involved, before a decision is made about the suitability of the placement. It is good the home has refused to admit some prospective service users when the manager has considered their complex needs could adversely affect existing residents. Markyes Close 1 & 2 DS0000024681.V364146.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. 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 this visit to the service. People living at the home all have a plan showing their needs and preferences and how staff should support them. Residents are enabled to make choices in their daily lives and routines. Their individuality and independence are also promoted, whilst any possible risks are assessed to help to keep them safe. EVIDENCE: Each person living at the home has a care plan, and several plans were looked at in their care files that are kept by the home. Care records include important background information about them and the plans identify their care needs with any support needed to meet them. The home’s approach to care planning is appropriately person centred (PC) in that the plans focus on the preferences, skills and goals of each person. One care manager says that the home has “Good care plans that are normally adhered to”. Staff involve residents (to the extent they are capable) in setting up their own plans and in 6 monthly care reviews when their families and/or advocates are also invited to participate. The manager and deputy manager have attended PC planning training and the home plans for all staff to complete this training during the next year. Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 10 Particular care staff are allocated to every resident as their keyworker and they take specific responsibility for aspects of their care. They can provide some 1 to 1 support and have a role in drawing up and reviewing their plans. This offers residents some individual attention and means keyworkers get to know them, their needs, likes and dislikes and so can advocate for them better. Relevant risk assessments are carried out to promote each resident’s safety. Risk assessments seen in care records sampled had been recorded in a new format that is more personalised and comprehensive. When necessary specific plans had also been put in place to manage particular behaviours in the best way and to keep that resident and other people as safe as possible, whilst promoting their independence. Any limitations to an individual’s freedom and choice are agreed and recorded e.g. using bed rails. Advice and input had also been sought from other health and social care professionals, when appropriate. Residents are encouraged to make daily life decisions, although for some this can be limited due to their disabilities. Staff were seen to show a high level of understanding and to try to offer them choices. The manager plans to monitor how staff promote choice making through their individual supervision. The staff team have received training in total communication to facilitate residents choosing such as what they would they like to eat and do. One person’s care records contain pictures and photos of items that are relevant to them (e.g. the minibus) and a care worker confirmed these are being used and he enjoys looking at them. Aspire’s communication facilitator is currently setting up a talking photograph album for another person to use as a communication aide. It is evident that issues of equality and diversity are being considered. For example one resident now has a male keyworker, as he clearly relates better to same gender carers. The manager and deputy attended relevant training and passed the information they obtained to the staff team. This included the implications of the new Mental Capacity Act and it is good plans will include information about each resident’s mental capacity and home’s management will go through this legislation as part of the induction programme for new staff. The home recently arranged a “best interest” meeting when a resident had serious health problems. This had involved the manager, their next of kin, social worker and Consultant Psychiatrist in making the decision about their treatment on their behalf as they were unable to make an informed choice. Markyes Close 1 & 2 DS0000024681.V364146.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. 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 this visit to the service. People living at the home are enabled to take part in activities they enjoy and go out in the wider community if they wish. Their daily choices and individual rights are respected and contact with their families is supported. Staff ensure that residents are offered a variety of healthy and suitable meals they like. EVIDENCE: Residents’ plans include an activities programme and daily reports show what each person has actually taken part in and where they have been. Activities include some people attending day services on varying weekdays, but they are mostly arranged to meet individuals needs, choices and capabilities. The home ensures there is time available for staff to support residents flexibly with their activities and outings they enjoy. It was nice they had taken the opportunity today to all go out on a picnic, as the weather was lovely. The home and residents benefit from two activities co-ordinators who are deployed solely to provide support for activities within the home as well as the wider community. Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 12 Whilst none of the residents are able to have a work placement or attend life skill development courses at colleges (because of their behaviours, disability and/or age) activities they currently take part in include music therapy, horse riding, using sensory facilities and a pool. Keyworkers have a role in activity planning and enabling residents to go out on outings, walks into town to visits shops, pubs and cafes etc. and on weekends away or holidays, as appropriate. The home has two vehicles with suitable adaptations to provide transport. In relation to household tasks there are limitations to the extent that residents are able to be involved. However staff encourage them to do so as much as possible, even if this is just being with them and observing and the home plans to try and promote their daily living skills more actively. They do involve them in choosing décor etc in their bungalow and bedrooms and some people are helping to grow plants for the home. There is clearly an emphasis on making sure daily routines, meal times and activities are flexible and take into account residents moods and behaviours at any time. One resident was observed to return from an outing and was initially guided by staff into the sitting room. They then went into their bedroom to put a CD player on and were in and out of the bedroom several times, with staff clearly letting them do as they wished. The manager in the AQAA and other staff confirm the home welcomes visitors warmly and keyworkers support family and friends contact. The three relatives who returned surveys are positive about the service and feel they always receive enough information and are kept updated about important matters by staff. One relative comments “ They are all so approachable and keep me informed”. Another person’s family said that “X couldn’t have had better care anywhere. We’d always get a welcome whatever time we turned up”. Regarding food provided by the home menus seen for the last 4 weeks showed a good variety of nutritious meals. They including a snack midday lunch such as omelettes, sandwiches, baked potatoes and a cooked meal in the evening e.g. cottage pie and vegetables, lasagne, roasts, sweet and sour and quiche with salad. Fruit and vegetables were used in most meals and stocks were seen to include plenty of fresh food, which was being prepared and stored in a suitably safe and hygienic way. Staff spoken with have a good understanding of the importance of a balanced diet. One resident needs a special diet and staff make them their own jellies and cakes etc. Staff closely monitor this person’s condition as well as the weight and appetites of frailer residents and the home liaises with the Dietician and Speech Therapist when necessary. Mealtimes are flexible and relaxed to suit residents and staff encourage them to choose meals and if not they know their preferences and dietary needs well. Markyes Close 1 & 2 DS0000024681.V364146.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. 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 this visit to the service. Residents’ personal and health care needs are identified, monitored and being suitably met. Their medicines are managed safely by the home on their behalf. EVIDENCE: Care plans detail the support that each resident needs with their personal care and to maintain good hygiene. Individual preferences about such as gender of carer, who cuts their hair and how they like their personal care to be given, are clearly indicated. Records are kept of all the support they receive from staff. Residents were seen to be well presented and appropriately clothed in relation to their age, disability and the weather. Keyworkers help choose and shop for clothes for their allocated residents, if they are not able do so for themselves. Care records provide information about residents’ medical history, conditions and any current health issues showing how they should be monitored and dealt with and by whom. Staff receive moving and handling training and plans with risk assessments regarding residents’ mobility are in place, as well as a range of aids, hoists, and equipment provided. Physical care checks are also carried out to promote good health e.g. weight, with records kept and for seizures. Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 14 Records are also kept of routine and specialist health care appointments, which keyworkers arrange and support residents to attend. Detailed accounts are made of all health care input, with the outcomes, and there was evidence that medical help and advice is sought promptly whenever needed. It is good that specialist training had been arranged for the staff team in respect of the needs of one resident with particular health problems to enable staff to manage their physical and emotional needs better. One other positive development is that full health assessments are now being carried out and it is planned that individual health action plans (HAP) will be set up for all the residents. One HAP that had been completed was looked at and was in a suitable format with pictures. It has detailed information about this person’s current medication and health and appropriately includes their behaviours, emotional needs, communication, support required from health care professionals and how to monitor and identify when they may be in pain. Other relevant factors such as consent, lifestyle, diet, hygiene and health checks are also considered. Regarding management of residents’ medicines no one living there currently is able to self-administer and so staff take full responsibility. Each resident has a detailed list of their medication (that is reviewed regularly) and the records of medicines kept and administered were being maintained appropriately. There is suitably safe storage of medicines in the home and for controlled drugs that could be prescribed. There are good procedures in place for taking medicines out of the home and for when a medication can be given as and when required to control behaviours or anxiety etc. There is then a plan showing behaviours that could result in the particular medication needing to be given with good recording of behaviours to clearly show why it was administered. Staff are fully trained in safe handling of medicines and the home has a comprehensive policy and procedures. A Pharmacist regularly inspects the medication system. Markyes Close 1 & 2 DS0000024681.V364146.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. 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 this visit to the service. Residents and/or their representatives can express their views about the home and feel confident that any concerns would be dealt with appropriately. Staff understand their responsibility to promote residents’ welfare and protect them. EVIDENCE: The home has a complaints procedure also available in a format that should be easier for people with learning disabilities to understand. Whilst most residents are not able to express their views and concerns directly their relatives have previously confirmed they feel they could do so (and know how). One relative comments in their survey about staff that “They are all so approachable and keep me informed”. The manager and other staff confirmed that although only two current residents would be able to discuss their concerns verbally they are fully aware of the importance of monitoring any signs of distress. They would all actively advocate for residents if there were such indicators and would also take up worries expressed by the two people who could express them verbally. The home or Commission had received no complaints about the service, nor were any referrals made about matters that could affect the safety and welfare of the vulnerable adults living at the home since the last inspection. Required policies and procedures are provided to promote residents’ welfare and protect them, which include multi-agency procedures for the protection of vulnerable adults (POVA), recognising abuse and whistle blowing. Staff are expected to read all these documents and to sign a checklist confirming they have done so and that they understand and will adhere to them in their working practices. Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 16 The manager, deputy manager and most of the staff team have also received training on POVA procedures and those spoken with are clear about their role and responsibility for safeguarding the vulnerable adults who live at the home. Relevant instruction is also part of the home’s induction programme and the accredited training course for staff working with people who have learning disabilities (LDAF), which all new staff are expected to complete. Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 17 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at Markyes Close benefit from accommodation that suitably meets their needs and offers them a very comfortable and safe home. Arrangements are made to keep the home well maintained and furnished; clean and tidy. EVIDENCE: Markyes House is in a good location, within walking distance of the shops and other facilities in Ross-on-Wye town centre. The bungalows were purpose built for people with profound physical disabilities and so are accessible with wide doorways, ramps and other adaptations. Specialist equipment is also provided such as hoists, there is an emergency call bell system and the environment is safe and suitably secure for people who may also have challenging behaviours. The accomodation comprises of two self-contained bungalows next to each. The impression obtained of them is homely and comfortable and that they are maintained, furnished and decorated to a good standard. One relative says “The home is a home”. Since the last inspection new garden furniture has been Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 18 bourght and some trees cut down and windows replaced. It is planned to redecorate some rooms and repair the slabbed area at the entrance to the home this year. Residents bedrooms are well personalised to reflect their individual interests and needs including such as specialist beds, sensory lights and other items and music systems. Bedrooms are decorated to their taste and their family choose the décor when they are unable to. For example one keyworker said that one resident whose birthday was coming up was going to have her bedroom repainted and her family had chosen a pale yellow colour. Both bungalows were found to be clean, tidy, warm, fresh and airy. One care manager comments “The homes are clean and tidy”. Whilst residents are not able to take an active part in household tasks staff clearly make sure that cleanliness and good hygiene are promoted and take pride in the bungalows. Aspire Living provide relevant policies and procedures in relation to infection control, general health and safety and Legionella. There is a seperate laundry room and suitable arrangements are made for disposal of soiled waste. The home also provides staff with disposable gloves and aprons and paper towels. Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 19 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, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. Residents are supported by sufficient staff who are well motivated, trained and supported. Thorough recruitment procedures help to ensure that only suitable staff are employed to support people living at the home, for their protection. EVIDENCE: There are always two support staff rostered to work in each bungalow during the daytime and evenings plus the two part time activity co-ordinators. The manager and deputy also work weekdays, with the manager having four days for the management task and the deputy two or three days. Two waking staff work during the night. It is confirmed by staff and this inspection that staffing levels are appropriate to meet the personal and social needs of residents. It is also good for consistency of care that staff turnover is relatively low and leave can almost always be covered by contracted and/or the home’s relief staff. It is confirmed Aspire Living now take up all necessary checks on prospective care staff including police (CRB) and POVA checks and two written references obtained. When appointed all staff are given a job description that defines their Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 20 role and responsibilities and a Terms and Conditions of employment. Each new staff member has then to undertake a 6-month probationary period before their employment is confirmed and they sign a contract. The induction of new staff includes them going through all the home’s policies and procedures, shadow shifts and learning about residents’ individual needs and preferences. An induction checklist is completed and they also have to undertake LDAF (Learning Disability Accredited Framework) training, which is specifically for staff working in care with people who have learning disabilities. Staff interviewed clearly understand their role and responsibility as keyworkers and/or senior staff. They appear committed to Markyes Close and to ensuring that residents receive individualised support and have a good quality of life. Staff complete all core health and safety topics and relevant specialist training e.g. epilepsy, autism and for positive management of challenging behaviours. Some of this training needs refreshing, which is one of the manager’s plans for the next year. One staff member says training is always arranged on request when they feel it is needed to help them understand and know how to deal with specific issues. Three relatives’ surveys indicate staff have the right skills, training and experience to look after people properly. One care manager says “The manager is not afraid to ask for help and training and any training offered is usually accepted and well received”. Over half the staff team have achieved an NVQ (National Vocational Qualification) and three more are currently working on it, helped by the manager and deputy who are NVQ assessors. All staff receive regular individual supervision and have an annual appraisal. A fairly new staff member feels well supported by senior staff and management. It is also confirmed that staff meetings are held regularly. Records are kept of all issues discussed in supervisions and meetings, with agendas and minutes taken. Staff clearly work together well as a team and there are good and open communication channels within the home and with Aspire Living. Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. The home is well run by a competent manager and the management approach ensures that people living at the home receive a good individualised service. The quality of the service is monitored and plans made for it to continue to develop and improve to benefit people living at the home. Policies, procedures and practices help to promote safety in the home and so protect the residents. EVIDENCE: The manager (Mrs Vicki Bace) has many years experience in the care of people with learning disabilities, latterly as a senior and deputy manager before being appointed as manager at Markyes Close. Mrs Bace has achieved a qualification in care and management (NVQ 4) and the Registered Manager’s Award (RMA), and attended much other relevant training. The management task is shared witha deputy manager who is also experienced and working towards NVQ/RMA. Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 22 Staff and relatives of residents feel the home is being well run. One relative says “I have always felt Markyes Close has been well managed and the clients appear happy and well cared for”. This key inspection confirms there is also an appropriately person centred approach to care, which results in good outcomes and individualised support for the people living at the home. There is clearly an open and positive management approach and a committed staff team who work well together. Staff say they can always approach the manager to discuss issues and there is good team work and morale. One care manager comments “Management ask for advice when required and are open to new ideas”. The home’s AQAA (annual quality assurance assessment) completed by Mrs Bace shows she understands the aims and ethos of the service and she was able to provide plenty of evidence about what the home does well and how this benefits residents. Mrs Bace outlined some areas that have improved and need to be developed, although needs to focus more on these areas. Aspire Living have introduced an effective quality assurance and monitoring system, which includes the monthly visits by their representatives to check the conduct of the home and regular health and safety audits. They are currently reviewing and updating all the relevant policies and procedures corporately, which will be cascaded to home managers and support staff and should help ensure working practices meet current legislation and accepted guidelines. The home’s plan to seek feedback on the quality of the service directly from residents and their representatives should be implemented so it influences service developments. Regarding health and safety in the home there is a comprehensive policy and procedures and staff receive training to help them put them into practice. Risk assessments are also carried out in relation to individual residents and the environment including for hazardous substances (COSHH). The AQAA confirms all necessary checks and servicing are being carried out by staff and/or approved contractors including the fire safety system and equipment, electrical appliances, heating, hoists and other equipment. Accident and incident records are kept and notified appropriately to the Commission and relevant other agencies. There were no safely hazards observed in the home during this visit. Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 23 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 3 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 Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NA STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered persons meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. No. 1 Refer to Standard YA35 Good Practice Recommendations Staff should receive regular refresher training in all the mandatory health and safety topics and in respect of procedures such as Safeguarding. This is to ensure that they are all clear about the procedures they should follow and know and understand the currently accepted practice guidelines in areas that promote the safety and protection of people living at the home. Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Markyes Close 1 & 2 DS0000024681.V364146.R01.S.doc Version 5.2 Page 26 - 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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