Care Home: 32-33 Macarthur Road

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• 2 Perhaver Park
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What the care home does well Each person now has a range of up to date care plans that identify their needs and steps staff must take to meet them. This is a significant improvement since the previous inspection. All care plans are reviewed monthly. This is a significant improvement since the previous inspection. In each of the files we examined people had been asked to approve who had permission to look at the information. Each person had a document that identified "what made a good day" which showed what they liked to do. Staff complete a monthly summary of significant events and activities people take part in when completed thoroughly this provides good evidence enabling easy review.32-33 Macarthur RoadDS0000066773.V377823.R01.S.docVersion 5.3We saw a PCP supported with good evidence to support goals being achieved, or the progress towards achieving goals. In 1 person`s file staff had created guidelines in picture format to enable the person to understand them more easily. Both of the people whose care we were studying had a range risk assessments in place that are regularly reviewed and minimised potential risks to people. People living in the home lead active lifestyles with the appropriate support of staff as required. People`s health needs are met by the appropriately qualified professionals as required. Although the re-decoration of the properties was incomplete at our site visit when finished people will benefit from a bright and clean environment. Staff commented that they feel morale will be better as a result of the redecoration. This is a significant improvement since the previous inspection. When the last staff were recruited to the team a person living in the home was involved with the recruitment process. Staff recruitment processes are thorough and minimise the potential risks to people living in the home. Staff training records are well organised providing evidence of the training completed by staff and enable the manager to plan future training as required. This is a significant improvement since the previous inspection. What has improved since the last inspection? The deputy manager`s plan to change the way meals and food are chosen and prepared will promote greater independence for each person. Staff supervision meeting are more frequent than at the previous inspection but still fail to meet the minimum standard identified in these standards. When new staff start at the home they receive a thorough induction and this minimises potential risks to the people living in the home. What the care home could do better: The acting manager should ensure that wherever possible people are asked to sign their care plans if they agree with them.32-33 Macarthur RoadDS0000066773.V377823.R01.S.docVersion 5.3There must be evidence to show that people have been supported to achieve the goals identified in their PCPs. The acting manager must ensure that monthly summaries written by the staff are completed thoroughly showing the significant events of the past month. A quality assurance system that puts the opinion of people in the home as central must be introduced. Key inspection report CARE HOME ADULTS 18-65 32-33 Macarthur Road 32-33 Macarthur Road Northleach Cheltenham Gloucestershire GL54 3HS Lead Inspector Paul Chapman Key Unannounced Inspection 16th September 2009 09:00 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service 32-33 Macarthur Road Address 32-33 Macarthur Road Northleach Cheltenham Gloucestershire GL54 3HS 01451 860237 01451 860237 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.brandontrust.org The Brandon Trust Mr David Watson Care Home 7 Category(ies) of Learning disability (7) registration, with number of places 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only-Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability- Code LD The maximum number of service users who can be accommodated is 7. Date of last inspection Brief Description of the Service: Macarthur Road consists of two semi-detached houses connected to each other on the ground floor. The home is in the village of Northleach in the Cotswolds. Vehicles are provided to enable people to access different activities and there is some access to public transport. People using the service have single rooms either on the first or ground floor and also have access to a range of communal areas including two adjoining lounges. There is an enclosed back garden with outbuildings. Up to date information about fees was not obtained during this inspection. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was completed over a period of 6 hours in September 2009. The acting manager was present throughout the visit. On arrival at the service the door was answered by a person living there who invited us in. The acting manager was not there when we arrived and we spent time in the kitchen with a person eating their breakfast and a member of staff. Observations from this situation showed that the person had a good relationship with the member of staff, staff were respectful and supporting the person to do things for themselves. After the acting manager arrived we completed a tour of the premises with them while they explained the progress towards completing the decoration and re-styling of the home. We studied the care of 2 people in detail examining the assessments of their needs, care plans in place to meet those needs, their identified goals and the progress towards achieving them, health, risk assessments, activities, family and friends contact and other documentation relating to their finances and safeguarding. In addition to these documents we also looked at documents relating to staff recruitment, training, management and health and safety. The quality rating for this service is good. This judgement has been made using available evidence including a visit to this service. What the service does well: Each person now has a range of up to date care plans that identify their needs and steps staff must take to meet them. This is a significant improvement since the previous inspection. All care plans are reviewed monthly. This is a significant improvement since the previous inspection. In each of the files we examined people had been asked to approve who had permission to look at the information. Each person had a document that identified “what made a good day” which showed what they liked to do. Staff complete a monthly summary of significant events and activities people take part in when completed thoroughly this provides good evidence enabling easy review. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 6 We saw a PCP supported with good evidence to support goals being achieved, or the progress towards achieving goals. In 1 person’s file staff had created guidelines in picture format to enable the person to understand them more easily. Both of the people whose care we were studying had a range risk assessments in place that are regularly reviewed and minimised potential risks to people. People living in the home lead active lifestyles with the appropriate support of staff as required. People’s health needs are met by the appropriately qualified professionals as required. Although the re-decoration of the properties was incomplete at our site visit when finished people will benefit from a bright and clean environment. Staff commented that they feel morale will be better as a result of the redecoration. This is a significant improvement since the previous inspection. When the last staff were recruited to the team a person living in the home was involved with the recruitment process. Staff recruitment processes are thorough and minimise the potential risks to people living in the home. Staff training records are well organised providing evidence of the training completed by staff and enable the manager to plan future training as required. This is a significant improvement since the previous inspection. What has improved since the last inspection? What they could do better: The acting manager should ensure that wherever possible people are asked to sign their care plans if they agree with them. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 7 There must be evidence to show that people have been supported to achieve the goals identified in their PCPs. The acting manager must ensure that monthly summaries written by the staff are completed thoroughly showing the significant events of the past month. A quality assurance system that puts the opinion of people in the home as central must be introduced. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If the home admitted a person to the home there is an admissions policy that would minimise the risk of someone being admitted whose needs could not be met. EVIDENCE: Since the previous inspection no new people have been admitted to the service. The home has an admissions policy. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide the reader with an accurate description of the person’s needs and the action required to support that person consistently. The detail contained in people’s care plans will enable a regular assessment of the person’s needs. PCP’s are in place but progress towards achieving identified goals is not recorded consistently making it impossible to confirm that people’s goals are being achieved. People are able to make choices in their day to day lives and where appropriate staff support them with this. Risk assessments are in place that identify potential risks and provide guidance on minimising them. EVIDENCE: 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 11 A major shortfall identified at the previous inspection site visit was the quality of the care plans in place and that they had not been reviewed for long periods. As a result of those findings we made a requirement in the previous report that all care plans must be reviewed. Speaking with the acting and deputy managers (the management team) they explained they had re-organised people’s personal files making them easier for staff to use. At this site visit we examined the care of 2 people in depth. Both of the files we examined were well organised providing the reader with a range of information about the person. A minor shortfall we found was that sometimes different formats of documents were being used. An example of this was 1 person had a “Listen to me” workbook that provided a lot of information, and the other person had another format of this document. We feel it would be better if the documents used were the same (adapted to meet people’s communication needs where appropriate). Both files firstly contained a document signed by the person giving their permission to share information with others. This is good practice providing some evidence of people’s rights being respected. Both of the files we examined had documents that identified what the person thought was a good day, things they liked and disliked, what other people think of me and activities they I like to do. Both of the documents we read provided a good picture of the person and the things they liked and disliked and would hopefully enable the reader to quickly grasp some essential information about the person. Since the previous site visit people’s needs have been re-assessed and care plans have been developed to meet those needs. In the files we were examining we found care plans covering areas including completing laundry, communication, finances, activities, ironing, personal care, choking, maintaining a healthy weight, attending college, epilepsy and nail cutting. Reading these plans they provided a sufficient level of detail to enable the reader to understand the person’s needs and what support was required to meet them consistently. All of these plans had been reviewed monthly since they were created, and we were able to see evidence of changes made to plans as a result of review. One person had signed their care plans stating they agreed with them, these were also signed by staff. Unfortunately the other person had not signed their care plans and we brought this to the attention of the acting manager, it is recommended that wherever possible there should be evidence of the person agreeing to their plan of care. Staff are expected to sign a document in the file to confirm they have read and understood the care plans, some staff had signed this but it was only a small number. It is good practice to ask staff to sign confirming they understand documents and it is recommended that the acting manager continues this practice. A practice implemented since the previous inspection site visit is that staff complete a monthly summary for each person that identifies their activities 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 12 and social/family contact. In general the sample we examined provided a good source of evidence about the activities people had been completing. Unfortunately some of the recording was weak and did not provide a good level of information. This was brought to the attention of the management team. There was an expectation that all staff should read each of the monthly summaries every month and we posed the question as to whether this was achievable? We suggested that maybe a way to ensure that all staff are informed of the information contained in the monthly summary was to discuss them at the monthly staff meetings? Each person whose care documents we were examining had a PCP (Person Centred Plan). One was dated December 2008 and we were unable to see the progress towards meeting any of the goals they wished to achieve. I brought this to the attention of the acting manager. They explained that there is an expectation on staff to complete a monthly update on progress towards meeting goals, but unfortunately the person’s key worker had left and this had been missed. The deputy manager showed us the other person’s PCP. A lot of work had been completed by staff and provided an excellent source of evidence to show that the goals had been either achieved, or the progress towards achieving them. It is important that the management team ensure that records are available in this level of detail for each person. This becomes a recommendation of this inspection report. Both people had documents relating to their communication needs. One had been completed while the other had not. Speaking with the acting manager they stated that they were aware of this and planned to use another format that they felt was better. It is important that people’s communication needs are assessed and plans are in place to address them. The management team showed a good awareness of this and we are confident that each person will have a plan to address these needs in the future. We saw a good example of a person’s “morning and evening routine” being supported by pictures to enable the person to understand it more easily. As part of this site visit we were able to spend time speaking to a person living in the home and 3 members of staff. We also had the opportunity to watch interactions between staff and people, these were positive, respectful and people were seen being given choices about the activities they wished to complete and the food they wished to eat. Speaking to a person living in the home they gave us a number of examples about different activities they take part in. From speaking with staff and examining monthly summaries we found more examples of people being given choices. The previous inspection report made a requirement for all risk assessments to be reviewed regularly and updates made as required. We examined a range of risk assessments covering topics including; personal care, community 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 13 activities, sleep in staff, use of vehicles, safety on the stairs, and fire safety. All of the assessments we saw had been reviewed monthly. It is clear that a significant amount of progress has been made by the management team to address the shortfalls of the previous inspection report. We discussed the progress to date with them and it was agreed that the work completed to date has enabled people’s needs to be identified, and staff to meet those needs, but there remain some shortfalls that will be addressed in the coming months. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 14 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): This is what people staying in this care home experience: 12, 13, 14, 15, 16, 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead active lifestyles and there is now a real focus on making people more independent and enabling them to take part in a range of new experiences. EVIDENCE: As identified earlier in this report staff complete a monthly summary for each person that records what activities they have completed and contact with family and friends. From examining these documents, talking to staff and people at home when we were there the following activities have taken place: 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 15 Trips to the shopping centre at Gloucester docks, Bourton on the water, Weston Super Mare, Longleat, Birdland and Cirencester. Other activities that happen regularly include attending the Everyman club (social club that people attend weekly), walking (with a rambling club and staff), accessing the local college and day services, Martial Arts, shopping, attending church regularly (if a people wish to), visiting cafés/restaurants/pubs and local towns and cities. In house people enjoy using a foot spa, cookery, watching TV/DVDs, listening to music and after recently purchasing a Karaoke machine, singing. 1 person told staff that they wanted to go to see the Strictly Come Dancing live show and staff supported them to go to Birmingham and watch it. Holidays have been booked for all of the people in the home. People are going to Euro Disney and cottages in the Cotswolds and Dunster. Holidays will mainly be individual and no more than 2 people together. When speaking to the management team we suggested that as well as keeping a record of the activities that people complete they should also record when people are offered activities but refuse them. 2 people are seeking employment in the local community. 1 person has been supported by the deputy manager to create a picture CV showing what they are able to do and has successfully got some work experience cleaning locally. This is another good example of a goal in a person’s PCP being achieved. Another person is being supported by a local employment service to get a job and it is expected they will start in supported employment in the future. Records showed that people have regular contact with their family who can visit them at MacArthur Road, or people will go to their home. At present people choose the meals and food as a group each week. The deputy manager has a plan to make cooking and shopping a much more individual activity. The first steps to achieving this have already been agreed with staff to bring in their own food in future. Each person will then be supported to choose what they would like to eat, go into the local community and shop for it and then staff will support them to cook it. We asked how staff are going to support people to make choices about what they would like to eat to include new foods that they may not be aware of, as there is risk of people eating the same meals day in/day out. After discussion with the management team we suggested that the staff could organise “tasting sessions” where they would support people to taste different meals/foods to enable them to increase their range of choices. It is good practice empowering people to have a greater choice of food/meals and support them to be more independent. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s personal care needs are identified in care plans and these provide the reader with detailed instructions to enable them to meet people’s needs consistently. People’s health needs are being addressed by appropriately trained professionals. Medication administration is well managed and this minimises potential risks to people. EVIDENCE: From examining people’s care files we saw plans were in place that identified people’s personal care needs and provided staff with detailed instruction to meet the person’s needs consistently. Each person now has a health file (created since the previous inspection). All documents relating to people’s health needs are now contained in these files. Examining 2 of these files showed that each person had a health action plan, 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 17 and that there were a range of notes and correspondence relating to appointments with other health professionals. The service’s medication policy has been revised since the previous inspection and part of a recent team day was spent examining the new policy. At the previous inspection we saw that the medication was being managed appropriately. The deputy manager is a trained nurse and has responsibility for overseeing the medication. All staff will be completing refresher training in medication administration over the next few months. The previous inspection found no shortfalls with medication administration/practices. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure produced in an easy read format to enable people to use it more easily. It is good practice that the complaints procedure is explained to people at regular intervals to ensure they understand how to make a complaint if the are unhappy. The staff team are in the process of completing training in safeguarding adults which will further minimise potential risks to people in the home. EVIDENCE: The home has a complaints procedure produced in an easy read format and we saw a copy of it available in the communal area. Speaking with the deputy manager they said that in a recent house meeting they had explained the complaints procedure to people. This was confirmed by the staff who attended the meeting. At the previous inspection we spoke to staff about the steps they would take if a complaint was made to them. This confirmed that they would ensure any complaint would be taken seriously and people would be protected appropriately. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 19 At the previous inspection we made a requirement for all staff to complete safeguarding adults training. Records showed that 7 staff have now completed the training and the rest of the team are booked to complete the training in the near future. None of the people living in the home manage their own finances and the staff team are responsible for doing this. At the previous inspection site visit we examined the records of people’s income and expenditure which provided evidence of good recording. At shift handover staff check all of the monies to ensure there are no discrepancies. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Once the redecoration of the houses has been completed it should provide people with a comfortable, clean and well-decorated environment that meets their needs. EVIDENCE: This service is part of the Brandon Trusts estates strategy with plans that it may be relocated to Cirencester. At the previous inspection site visit we found that the decoration across both houses was only “adequate” with both properties looking very “tired”. As a result of our findings the previous inspection report made 2 requirements in this outcome area. The first was for both houses to be decorated and the second was the carpet in lounge of 32 must be replaced. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 21 At this site visit we completed a tour of the premises with the acting manager. Both of the houses were in the process of being decorated and 2 of the people we spoke to confirmed they had been asked what colours they would like the communal areas painted. The acting manager explained that once the decorating has been finished they were going to organise a shopping trip for people to choose new curtains, pictures and other items. In addition to the communal areas being painted bathrooms, toilets and bedrooms will also be redecorated. It is aimed that the programme of decoration will be completed by October 2009. As identified previously this service is 2 houses and therefore people have access to 2 lounges, dining rooms, kitchens, etc. At the previous inspection site visit the 2nd house had limited use, but since then people have started making greater use of the lounge and dining areas. The acting manager stated with the plan to support people in cooking individual meals access to a 2nd kitchen will be invaluable. At present the 2nd kitchen is not useable but this will be addressed in the near future. The carpet has been replaced in the lounge and hallway of house 32. Generally both houses were clean and tidy. The only shortfalls we found were in 2 people’s bedrooms. In 1 person’s bedroom their appeared to be faeces on their bedding and we brought this to the attention of the acting manager. The 2nd bedroom belongs to a person who is within the autistic spectrum and their patterns of behaviour mean that their bedroom can become a little dirty. The acting manager said they had been working to address these issues and the environment had improved. Strategies for maintaining a good level of cleanliness (and minimising potential health and safety risks) should be recorded; this becomes a requirement of this report. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff training programme should ensure that people living in the service are not put at risk due to staff not having the skills to meet their needs. Staff training records are now comprehensive and provide evidence of the training completed by each person. Staff supervision meetings are being held more frequently but still fall short of the number required by these standards. EVIDENCE: As part of the previous inspection site visit we examined a range of documentation relating to the staffing of the service. We found shortfalls in the following areas; there was no training plan for the staff team, the records of staff training were poor and staff were not receiving regular formal supervision from the manager. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 23 Since the previous inspection 2 staff have been employed. The acting manager explained that 1 of the people living in the home had been involved in the recruitment process. This is good practice. We examined the employment records for the 2 new staff which showed that all of the information required by these regulations was present. At the previous site visit we examined the induction programme for new staff and found major shortfalls. On this occasion we were able to examine the induction for 1 new staff member; we were able to see they had completed a “local” induction in the home and were booked to complete the “corporate” element (including skills for care) at the Brandon Trust offices. We examined training records for staff. These have now been reviewed and provide an accurate record of what training staff have completed and what training they need to complete. Since the previous inspection site visit the training certificates have been collated to provide a good record of the training completed. There is training programme planned for the coming months that includes staff attending courses in fire safety, first aid, manual handling, equality and diversity, food hygiene, mental capacity, infection control and makaton. When speaking to a member of the team they explained that since the previous inspection they had completed refresher training in all of the mandatory areas and were due to complete makaton training. They stated, “I am looking forward to completing makaton training as I feel it is important to use it in the house and I want to support other staff to use it.” Staff supervision meetings are held more frequently and records of the meetings were being kept by the acting manager. Examining the frequency of when these meetings are held they are still not as frequent as they should be and it becomes a requirement that staff receive supervision meetings within the suggested timescales in these minimum standards. The acting manager stated that they were about to start staff appraisals. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been significant improvements to the outcomes for people living in this service due to the hard work of the staff team and the leadership of the acting manager. The quality of the service provided is improving and the introduction of a quality assurance procedure in the service will enable the manager to measure improvements and identify weaknesses. Health and safety procedures and regular checks under taken by staff minimise potential risks to people in the home. EVIDENCE: 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 25 After the previous inspection was completed the registered manager moved from this service to another within the organisation. As a result there has been an acting manager in post (the acting manager is a registered manager of another service rated as excellent). This action was taken in agreement with the CQC. It is clear from the information gathered as part of this site visit that the acting manager and staff team have worked hard to address the shortfalls of the previous inspection report. We also recognise that it is the acting manager’s leadership and management skills that have lead this team and service to improve outcomes for people living in the service. From speaking to staff and questionnaires we received, staff made the following comments, “Over the last 6 months there has been more structure”, “our philosophy is very person centred”, “people are respected more”, “I feel supported and excited about my job”, “It is very important that people are being prompted to do things for themselves”, “Everything at MacArthur Road has improved 100 , I enjoy working there”, “It is a good cohesive staff team that work well together under pressure and stress”, “redecoration of the home will be a real morale booster”. Under Regulation 26 as the provider is not in day to day charge of the service they are expected to complete monthly unannounced visits where they examine a range of documents and speak to people in the home and staff. These visits are being completed each month and reports were available in the service for us to examine. Speaking with the acting manager they stated that they plan to have formalised a quality assurance process by October, and that it will be implemented by December. It was clear from speaking to the acting manager they believe this process should be lead by the opinions of people living in the home. There are a number of procedures in place to minimise potential risks to people living in the home. In addition to these procedures staff and qualified engineers also complete a range of checks. The only shortfall we identified was that when fire equipment had been checked by a qualified engineer they had missed an extinguisher which was now overdue maintenance. We brought this to the attention of the acting manager and shortly after the site visit the acting manager confirmed that this had been addressed. 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 2 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Version 5.3 Page 27 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA30 Regulation 13(4), 23(2)b Requirement Strategies must be developed and recorded to ensure that the cleanliness of this bedroom is maintained and does not put the person at risk. Staff must receive formal supervision regularly. Requirement from the previous inspection report not achieved (03/04/09). 3. YA39 24 A quality assurance procedure must be implemented that puts the opinions of the people living in the home at the centre of the process. 27/11/09 Timescale for action 13/11/09 2. YA36 18 (2) 30/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Wherever possible the people should be asked to sign their DS0000066773.V377823.R01.S.doc Version 5.3 Page 28 32-33 Macarthur Road care documents confirming they agree with it. 2. YA6 It is good practice to ask staff to read and sign documents confirming they understand them. This practice should be continued. Records should be available to support the progress or successful achievement of people’s goals. In addition to recording the activities people take part in the staff should also record what activities are offered and refused. 3. 4. YA6 YA12 32-33 Macarthur Road DS0000066773.V377823.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission South West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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