Care Home: Maeres House

Similar services:

• Sunny Bank (P.R.S.) Ltd
• SignHealth
• Ruskin Lodge
• Ashwood Court Unit 1
• Dystlegh Grange
• Thornton Lodge
• The Good Companions
• Cuerden Grange Rest Home

What the care home does well Staff have been able to build up a good rapport and ability in getting to know each person and are knowledgeable in how they express their behaviours. Staff had been able to interpret some people`s needs, likes and dislikes and had documented this in their support plans. We had received 2 surveys from staff working at the service. One person made a comment and felt that they, "treat service users as individuals, always give them choice and independence." Records showed that before anyone is appointed to work at Meares House a series of checks are carried out. These checks help to make sure the people living there are safe and that staff are suitable to support them. We have received 3 surveys from people living at Maeres house which were mostly positive. Two people felt they "always" make decisions about what they want to do each day and felt they can "always" do what they wanted. The lounge and dining room were open plan in design and had been developed and built to achieve a bright and modern style of decor suitable for younger Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 adults taste. Each area had been decorated and furnished to a high standard with very good quality furniture seen throughout the service. There were various day areas including a quiet lounge, activity room and fully accessible landscaped gardens. What has improved since the last inspection? This service is very new and only been open for 6 months. However during our visit we found that the service was offering a good standard of care and support and had shown were they were meeting and sometimes already exceeding the standards necessary for a registered care home. The manager had already developed the service user guide further with the use of picture bank to help give easy read style documents for some people to use and understand. The service has developed very specific plans for the needs of young people with sensory and cognitive needs. Staff support people in various ways and have developed plans called, "goal assessment sheets." These assessments helped identify plans and support to help people for their future. Staff explained that although the service had only been open for 6 months that the company are already heavily investing into developing the environment further. They are in the process of adapting the activity room into a "teaching kitchen" which will provide easy access to everyone who wants support in developing their living skills. Upstairs the staff showed us were they use to have a sensory room which had been fully equipped. They now have plans in progress to develop this room further to offer a fully equipped gym. Staff also advised that they were due to develop the gardens further with plans to build raised beds so that everyone could get involved in the garden if they wished including anyone who used the facility of a wheelchair. These were examples of good practice regarding the company`s commitment to continually invest and offer a high standard of facility that would always meet the needs and requests of people living at Maeres House. We chatted generally to staff and we met everyone living at the service. Most comments made were quite positive. Some comments included, "all staff are ok here,,," "The staff have a good relationship with everyone here and get on very well."Maeres HouseDS0000072983.V375771.R01.S.docVersion 5.2Staff felt happy with the training they had received and felt much supported in developing their skills to meet the needs of people living there. Both people living at Maeres house and staff said in their comment cards and in discussions with us that they are aware of the action they need to take if anyone raises concerns regarding the service. What the care home could do better: We have made various requirements and recommendations at this first key visit. The statement of purpose would benefit from continued review and should include any changes and updates such as the services contact phone number, minibus costs and details of a holiday fund. This helps to make sure people have the right information accessible to them if they needed it in any way. The statement of purpose was clear in detailing they have 8 beds and are registered to support people with, "acquired brain injury and physical disability and mental disorder" however it did not mention that they have supported people with drugs and alcohol problems. This information must be considered and included in the statement of purpose if the company continue in offering services to people with drug and alcohol problems. Some support plans would benefit from being reviewed further to include the requests made by people during our visit about their long term goals and aspirations. Some plans need the clinical input and the medical care to be reviewed as soon as possible to make sure the right support and specialist input was given to offer continued psychological support. Each persons financial care plan should be clear what support and actions would be taken to support them in getting the best value for their money, including accessing the community and in making sure their benefit and mobility allowance is used in their best interest. Support plans would benefit from having a lot more information to explain clearly all parts of their financial management including any social services input, storage of their monies, names of appointees, ongoing costs and management and records of debiting and collection of receipts. Details about the costs incurred and the entitlement to holiday funds should be clearer and included in each person plans so they have specific details to enable them to make informed choices about holidays and using the minibus. Any continued change in the medications prescribed by a doctor should always be reviewed by the doctor to review any effects to the persons care and condition.Maeres HouseDS0000072983.V375771.R01.S.doc Version 5.2 Temperature records for the drugs fridge need consistent daily checks to help ensure that medications are always stored correctly and at the right temperature.To ensure all staff received training in safeguarding. This training is considered mandatory for all staff to enable them to be fully up to date in safeguarding and have the necessary information and skills to always safeguard the people they support. To ensure the service has access to its monthly reports carried out on a regular basis by a representative of the organisation. These visits form part of the quality assurance process and form an opinion on the standard of care and support provided. These visits are also a requirement of the care home regulations and a report has to be produced to show evidence of these checks. It is important that these checks are done to check the standard of care and management in the service. Key inspection report CARE HOME ADULTS 18-65 Maeres House 56 Blundell Road Hough Green Widnes Cheshire WA8 8SS Lead Inspector Diane Sharrock Key Unannounced Inspection 28th May 2009 10:30 Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 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. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 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 Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maeres House Address 56 Blundell Road Hough Green Widnes Cheshire WA8 8SS 0151 424 0622 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) Voyagecare.com Voyage Limited Ms Kate Louise Openshaw Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8), Physical disability (8), Sensory of places impairment (8) Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only- Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia- Code MD Physical disability- Code PD Sensory Impairment- Code SI The maximum number of people who can be accommodated is: 8 Date of last inspection New service Brief Description of the Service: Maeres House provides support and accommodation for eight adults whose primary needs cover a range of needs such as, physical disabilities, sensory impairment and mental disorders. The home is run by Voyage Limited. They are a national organisation who provide a range of care services across the country. Staff is available twenty four hours a day to support the people who live at Maeres House. The house is a newly designed and new build detached property in a residential area of Widnes, close to local shops, transport and facilities. Accommodation is provided over two floors. Everyone living there has their own bedroom with a large ensuite walk in shower room, some bedrooms have their own ceiling track hoist. The service has been fully designed for the needs of the people admitted to the service with large open corridors and an extensive list of the latest up to date equipment such as electric profile beds. The service has been decorated and furnished to the highest standards offering very good quality furniture and furnishings throughout. There are various communal areas such as a modern comfortable lounge, a quiet room and an activities room. There is an open plan dining room with a fully equipped kitchen that looks out to the landscaped and fully accessible gardens. The registered manager is Lorraine Openshaw. The manager has developed a statement of purpose and service user guide that she makes accessible to anyone wanting to have information about the service. This is the services first inspection since opening 6 months ago and the Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 5 inspection report should also be accessible to people wanting to know about Maeres House. The fees are paid for by the placing authority with various amounts once calculated by the provider approximately £1817.24 per week Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use the service experience good quality outcomes. We gathered information for this inspection in a number of different ways. We carried out an unannounced site visit on 28th June 2009. This took place over 7.5 hours and included reading records, meeting people and looking at the building. We use a tool called “case tracking” which means, we spent time looking at the support the people living at Maeres House receive. This included looking at the support they get with their daily lives, care plans, medication, money, activities and environment. We met the four people who live at Maeres House and all the staff on duty including the deputy manager. We reviewed any information we had recently received about Meares House. The manager completed a detailed self assessment form called an (AQAA) which we sent to her before our visit. We used some of this information in this form and the other information we had to help plan our inspection and write this report. What the service does well: Staff have been able to build up a good rapport and ability in getting to know each person and are knowledgeable in how they express their behaviours. Staff had been able to interpret some people’s needs, likes and dislikes and had documented this in their support plans. We had received 2 surveys from staff working at the service. One person made a comment and felt that they, “treat service users as individuals, always give them choice and independence.” Records showed that before anyone is appointed to work at Meares House a series of checks are carried out. These checks help to make sure the people living there are safe and that staff are suitable to support them. We have received 3 surveys from people living at Maeres house which were mostly positive. Two people felt they “always” make decisions about what they want to do each day and felt they can “always” do what they wanted. The lounge and dining room were open plan in design and had been developed and built to achieve a bright and modern style of decor suitable for younger Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 7 adults taste. Each area had been decorated and furnished to a high standard with very good quality furniture seen throughout the service. There were various day areas including a quiet lounge, activity room and fully accessible landscaped gardens. What has improved since the last inspection? This service is very new and only been open for 6 months. However during our visit we found that the service was offering a good standard of care and support and had shown were they were meeting and sometimes already exceeding the standards necessary for a registered care home. The manager had already developed the service user guide further with the use of picture bank to help give easy read style documents for some people to use and understand. The service has developed very specific plans for the needs of young people with sensory and cognitive needs. Staff support people in various ways and have developed plans called, “goal assessment sheets.” These assessments helped identify plans and support to help people for their future. Staff explained that although the service had only been open for 6 months that the company are already heavily investing into developing the environment further. They are in the process of adapting the activity room into a “teaching kitchen” which will provide easy access to everyone who wants support in developing their living skills. Upstairs the staff showed us were they use to have a sensory room which had been fully equipped. They now have plans in progress to develop this room further to offer a fully equipped gym. Staff also advised that they were due to develop the gardens further with plans to build raised beds so that everyone could get involved in the garden if they wished including anyone who used the facility of a wheelchair. These were examples of good practice regarding the company’s commitment to continually invest and offer a high standard of facility that would always meet the needs and requests of people living at Maeres House. We chatted generally to staff and we met everyone living at the service. Most comments made were quite positive. Some comments included, all staff are ok here,,, The staff have a good relationship with everyone here and get on very well. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 8 Staff felt happy with the training they had received and felt much supported in developing their skills to meet the needs of people living there. Both people living at Maeres house and staff said in their comment cards and in discussions with us that they are aware of the action they need to take if anyone raises concerns regarding the service. What they could do better: We have made various requirements and recommendations at this first key visit. The statement of purpose would benefit from continued review and should include any changes and updates such as the services contact phone number, minibus costs and details of a holiday fund. This helps to make sure people have the right information accessible to them if they needed it in any way. The statement of purpose was clear in detailing they have 8 beds and are registered to support people with, “acquired brain injury and physical disability and mental disorder” however it did not mention that they have supported people with drugs and alcohol problems. This information must be considered and included in the statement of purpose if the company continue in offering services to people with drug and alcohol problems. Some support plans would benefit from being reviewed further to include the requests made by people during our visit about their long term goals and aspirations. Some plans need the clinical input and the medical care to be reviewed as soon as possible to make sure the right support and specialist input was given to offer continued psychological support. Each persons financial care plan should be clear what support and actions would be taken to support them in getting the best value for their money, including accessing the community and in making sure their benefit and mobility allowance is used in their best interest. Support plans would benefit from having a lot more information to explain clearly all parts of their financial management including any social services input, storage of their monies, names of appointees, ongoing costs and management and records of debiting and collection of receipts. Details about the costs incurred and the entitlement to holiday funds should be clearer and included in each person plans so they have specific details to enable them to make informed choices about holidays and using the minibus. Any continued change in the medications prescribed by a doctor should always be reviewed by the doctor to review any effects to the persons care and condition. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 9 Temperature records for the drugs fridge need consistent daily checks to help ensure that medications are always stored correctly and at the right temperature. To ensure all staff received training in safeguarding. This training is considered mandatory for all staff to enable them to be fully up to date in safeguarding and have the necessary information and skills to always safeguard the people they support. To ensure the service has access to its monthly reports carried out on a regular basis by a representative of the organisation. These visits form part of the quality assurance process and form an opinion on the standard of care and support provided. These visits are also a requirement of the care home regulations and a report has to be produced to show evidence of these checks. It is important that these checks are done to check the standard of care and management in the service. 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. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 10 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 Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 11 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): 1,2,4. 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 have good information explaining about life at Maeres house which helps people to make decisions about the service. EVIDENCE: The service’s aqaa gave us a lot of information before we visited the service and it told us that they, “…….Identify the needs of the individual from the pre-admission assessment/review of needs and ensure this is reviewed at least yearly or as required, include family with service users agreement in this process. New service users are offered introductory visits to the service, structured and appropriate transition plans, service users are involved in and agree to their individual plan…… All individuals have a service user guide and residency contract. All individuals have regular reviews of their care packages, the first usually being after 1 month, then 3 months, and then 6 months after this. Individuals are encouraged to personalise their bedrooms and the home in general, by bringing in personal items, decorating their rooms as they wish.” Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 12 The above information was well evidenced during our visit and staff were busy preparing a bedroom for one person due to move in very soon. They felt they can offer people a lot of choice in picking their own room and they are still adapting and investing into the building to meet the ongoing needs and requests of the people living at Maeres House. Each person has the comfort and privacy of their own large bedroom with an ensuite large walk in shower room. Some of the rooms have ceiling track hoists depending on the needs of the person moving in and the manager organises for specialist equipment to be installed before someone arrives. During our visit staff were busy installing an electric profile bed for a new person so their room was prepared and ready for them to use. Staff had already carried out visits and assessments to any prospective new person going to live at the service. This helped them identify if they can support people with their needs and helps them to prepare for any new person going to live at Maeres House to help them settle in and be comfortable in their new home. We looked at the service user guide and the statement of purpose provided at Maeres House. These documents are necessary records to help give accurate and accessible information about living at Meares House and should help people make judgements and decisions about the service. These records should also help to make sure the rights of people who live at the service are fully promoted. The manager had already developed the service user guide further with the use of picture bank to help give easy read style documents for some people to use and understand. Some minor updates were needed, e.g., including the change from our departments name and address and the service needs to have its phone number accessible as they still had head office contact phone number. The statement of purpose was clear in detailing they have 8 beds and are registered to support people with, “acquired brain injury and physical disability and mental disorder” however it did not mention that they have supported people with drugs and alcohol problems. The staff were able to explain various issues about this being reviewed and felt the statement of purpose would eventually be accurate to reflect the support to people with predominate needs as stated in the services registration. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 13 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. People’s needs are identified and included in their support plans keeping everyone informed about the support they can expect to receive EVIDENCE: The service’s aqaa gave us a lot of information before we visited the service and it told us, “All individuals have their own individualised planned package of care, all personalised to their own needs and requirements. We source support for those individuals as required, from specialist provisions, eg; Dietician, Speech and Language, Drug and Alcohol…… We ensure that all staff are trained in all areas, updates are provided and training records maintained, “ Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 14 They aqaa also told us they plan to, “We aim to develop further the format of the individual support plans in a format that is appropriate to each individuals needs and provide each service user with their own copy.” The above information was well evidenced during our visit. The service operates a key worker system and each person who uses the service had several care plans and support plans. Each key worker also used an easy read format for regular meetings that they had with the people they supported. These records helped make clear the discussions they had and helped people to understand what was said. We looked at 2 plans during our visit and we met the people living at the service. These documents offered good detail and information to help staff support people in the right way and in the way they chose to be supported. They gave individualised information on each person’s likes and dislikes. One plan that we looked at was very individualised and specific to what the person wanted to do each day such as being very detailed in what time they wanted to get up. The service has also developed very specific plans for the needs of young people with sensory and cognitive needs. Staff explained that to support people further in various ways they had developed plans called, “goal assessment sheets.” These assessments helped identify plans and support to help people for their future. They are in the process of adapting the activity room into a “teaching kitchen” which will provide easy access to everyone who wants support in developing their living skills. This is an example of good practice regarding the investment by the company to continually adapt and finance any type of development that was considered beneficial to people living at Maeres House. When we spoke to staff they could clearly discuss the needs of the people they helped support and had built up a good rapport to know them very well. It was evident during our visit and in speaking to some of the people living at the service that the staff team had built up a good relationship and respect with the people living there and were able to interpret their needs and requests. A daily record is made of the well being of the people who live at Maeres House and how they have spent their time during the day. Some people told us about what they would like for their future and identified their own long term goals yet their plans had no details of how they would be supported with theses particular requests and aspirations. Some plans would Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 15 benefit from further review with the people living at the service, to show how they can expect support to be provided with requests and long term goals. The manager had developed risk assessments and updated them with actions to be taken to reduce any identified risks to help keep people safe including topics such as, e.g., smoking moving and handling, scalding and the use of bed rails. We have received 3 surveys from people living at Maeres house which were mostly positive. Two people felt they “always” make decisions about what they want to do each day and felt they can “always” do what they wanted. One person gave a suggestion that staff should, “listen better” but felt that staff, “treat well”. We met a mixture of people during our visit some had been supported to go out in the day and some chose to stay in and liked their own company in their own rooms. People seemed to get on well with the staff. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 16 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: 12,13,15,16,17. 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. The people living at Maeres House are supported with a lifestyle of their choice. EVIDENCE: The service’s aqaa gave us a lot of information before we visited the service and it told us, “Individuals are encouraged to partake in the local community, accessing local facilities, community environments, etc. The service has a vehicle to enable individuals to explore the wider community when and where they wish, staff support all activities ensuring individuals are able to undertake activities of their choice. The team also provide inhouse activities for all individuals, which can often be incorporated into their required therapy regimes. All staff receive training on delivering therapies as required. Individuals are encouraged to increase their independent living skills through Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 17 taking part in the day to day running of the environment, they are encouraged to partake in cleaning, laundry, cooking, etc. The staff team aim to provide all individuals with a full and varied life, opening up new experiences and opportunities, and maximising independence…… they also have the opportunity to manage their own budget and cook their own meals, and have support from occupational therapy and support staff for this.” The above information was well evidenced during our visit. We watched staff supporting people in the afternoon getting ready for their lunch. They provided assistance and encouragement in a respectful way. Records of meals served in the service showed that a variety of meals are served in order to offer people as much choice as possible. Staff had also helped develop a visual menu were people were encouraged to collect pictures of meals and menus they liked. The visual pictures of food helped some people to plan their menus and make shopping lists. We looked at activity records for 2 people. Each person has a weekly structured activity plan which can include a variety of support with activities such as, shopping, cigarettes/baking/painting/jewellery/pampering/painting. Some people have had support in developing “prompter boards” which helps keep them orientated to what they are doing each day, details of the menus and food offered and other day to day details that staff help keep up to date. Key worker records and minutes of meetings of people living at Maeres house told us that people want more trips out. One person explained they are trying to support people with holidays and are looking into organising trips out to various places. Staff advised that a communal minibus is available for use and each person will eventually be charged a weekly amount for the costs of managing and maintaining this vehicle. The staff confirmed that they still only had 2 staff who could actually drive the communal bus. The services statement of purpose told us that the company will contribute to an annual holiday; however it didn’t give a specified amount. It advised that they had a shared vehicle were they are asked to contribute from their mobility benefits to the ongoing running costs depending on what level of benefit they receive. The guide also advised people that if they mainly used public transport they could opt to just pay per mile for when they occasionally used the minibus. Details about the costs incurred and the entitlement to holiday funds should be clearer and included in each person plans so they have specific details to enable them to make informed choices about holidays and using the minibus. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 18 Each persons care plan should be clear what support and actions would be taken to support them in getting the best value for their money They should include how they would access the community and make sure their benefit and mobility allowance is used in their best interest. The lounge and dining room were open plan in design and had been developed and built to achieve a bright and modern style of decor suitable for younger adults taste. Each area had been decorated and furnished to a high standard with very good quality furniture seen throughout the service. There were various day areas including a quiet lounge, activity room and fully accessible landscaped gardens. Staff explained that although the service had only been open for 6 months that the company are already heavily investing into developing the environment further. The activity room already has a range of kitchen units waiting to be installed to offer everyone the use of a “training kitchen.” One person was really looking forward to this and said they would use it a lot. Upstairs the staff showed us were they use to have a sensory room which had been fully equipped. Now they had plans in progress to develop this room further to offer a fully equipped gym. People had already indicated to staff they were looking forward to using this including new people coming to Maeres house. Staff also advised that they were due to develop the gardens further with plans to build raised beds so that everyone could get involved in the garden if they wished including anyone who used the facility of a wheelchair. These were examples of good practice regarding the company’s commitment to continually invest and offer a high standard of facility that would always meet the needs and requests of people living at Maeres House. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 19 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 are treated well and their personal and healthcare needs are maintained. EVIDENCE: The service’s aqaa gave us a lot of information before we visited the service and it told us, “Where possible and it is deemed safe, we support service users to selfmedicate and control their medication, eg. ordering, stock control,… Equipment is purchased inline with individual needs to ensure all aspects of care can be appropriately delivered and supported. Named keyworkers are chosen or allocated for individuals to ensure that they are provided with a point of contact whom will promote their thoughts and feelings and act in their best interest on their behalf. Staff are provided with training to ensure that they are able and competent to deliver care to all individuals as prescribed and inline with policies and procedures.” The aqaa also gave us details about their plans for the future such as, Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 20 “Implement a Health Action Plan in conjunction with GP, District Nurse, other health professionals, Ensure plans for ageing and death are developed for all individuals prior to their need, not as a direct result of deterioration in health. Continue to review and evaluate all aspects of individuals care packages.” Individual support plans were available for each person; we looked at two of them. Most parts of the plans had been updated and revised and gave information to show how their personal care and support would be met. Some parts of the plan provided staff with guidance and were appropriate instructions as to the support each person needed and requested. The service had also developed “acquired brain injury” assessments which staff had used to help them develop each persons individual care plan. Staff explained that they had a good relationship with the local district nurses and they continued with their visits each day to offer support with various nursing needs of some people living at the service. Care records showed that staff support people with various health care checks such as appointments with the doctor, the optician, dentists ect which helped to show how people are supported to stay healthy. We discussed one plan that had various sections that had not yet been completed and noticed basic details to help support the person. We advised that specialist input should be reviewed to see if their needs and care plan could be developed further to enhance their condition generally including their psychological needs. We looked at a sample of pre admission assessments that told us that people are offered the right facilities when they come to live at Maeres house. E.g. if a persons assessment identifies they need specialised equipment then staff arrange for this to be in place to help them to live comfortably at the service. Some people have a ceiling track hoist in their own bedroom and some people have been provided with specialised electric beds and pressure relieving mattresses. The service also has a large communal bathroom with a ceiling track hoist and electric adapted chair which helps give further choices to people in how they choose to be supported with their personal care. We chatted generally to staff and we met everyone living at the service. Most comments made were quite positive. Some comments included, all staff are ok here,,, The staff have a good relationship with everyone here and get on very well. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 21 We looked at the storage and procedures of managing medications at the service and found them to be stored safely and well managed. We looked at a sample of medication records and noticed that one person was regularly not wishing to take their prescribed medication. Any continued change in the medications prescribed should always be reviewed by the doctor to review any effects to the persons care and condition. Some temperature records for the drugs fridge had not been recorded daily. Consistent regular checks would help ensure that medications are always stored correctly and at the right temperature. The systems in place for dealing with medication, along with staff training, help to reduce the risk of mistakes occurring that could impact on people’s health. People were found to be up to date with medication training. Staff advised that the company were arranging for another room to be developed in the service to provide a larger area for the storage and management of medications. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 22 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. Good systems are in place within the service for dealing with any concerns or complaints that arise which aim to protect people. EVIDENCE: The service’s aqaa gave us a lot of information before we visited the service and it told us, “The Monthly Service Review is completed by the Operations Manager, during which finances are checked closely. All individuals and families are provided with the letting us know what you think policy, help cards are made available to all individuals. This supported by a copy of the POVA policy and confidentiality policy, which are also included in the service user guide. Staff recieve knowledge of these subjects as part of their induction. Individuals families and staff are encouraged to express any concerns through a variety of forums, be it individually, group - house meetings, coffee mornings, staff meetings, supervisions…” Staff said in their comment cards and in discussions with us that they are aware of the action they need to take if anyone raises concerns regarding the service. Some of the staff we chatted to described various training that they had attended including, safeguarding and abuse awareness. Some staff records Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 23 indicated they may not have received their training yet in safeguarding. This training is considered mandatory for all staff to enable them to be fully up to date in safeguarding and have the necessary information and skills to always safeguard the people they support. We have received 3 surveys from people living at Maeres house which were mostly positive. Three people said they knew who to speak to if they wasn’t happy. Information about how to raise a concern or complaint was made available to the people living at Maeres House within the service user guide and statement of purpose. They also have an easy read summary of what to do, “if not happy about something” which was very personalised to the service. This is good practice as it helps to increase the opportunities for people using the service now and in the future to have a better understanding of the ways in which they can raise concerns. We looked at the services complaints records and noted they have received no complaints since opening 6 months previously. We looked at a sample of finance records managed on behalf of various people at the service. Some people are supported in managing their own finances which is an example of good practice in continuing and developing a person’s independence. One person had a support plan with brief details regarding their finances. We discussed this plan and noted it would benefit from having a lot more information to explain clearly all parts of their financial management including social services input, storage of their monies, names of appointees, ongoing costs and management and records of debiting and collection of receipts. One handwritten receipt was undated and unsigned although we saw other records with up to date details. Updated clear financial records and processes are necessary to help show how people are safeguarded. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Maeres House provides a safe, modern and comfortable environment that is highly maintained for people to live in. EVIDENCE: The service’s aqaa gave us a lot of information before we visited the service and it told us, “The service is new and purpose built, and very specifically meets the needs of those who have physical disabilities….. Further development which highlights the needs of the service user group has been identified and developed, eg. downstairs blinds for privacy, drop kurb for wheelchair users.” The aqaa also told us about their plans for the future such as, “The development of training kitchen and gym. Annual service review will be carried out in October 2009 and this will identify a maintenance programme for the following 12 months.” Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 25 The above information was well evidenced during our visit. Meares House offers a purpose built home which has been newly built in a residential area. The service is situated close to shops, pubs and other community facilities including public transport and a local park. Shared space consists of a high quality domestic style kitchen, open plan dining room looking onto attractive landscaped gardens. The service had numerous day space including a lounge, a quiet room and an activities room which were all decorated and maintained to a very high standard with a modern décor throughout. Everyone had a single bedroom and ensuite walk in shower room. We saw a sample of the bedrooms, which were personalised, and maintained to a very high standard with good quality furnishings and matching bedroom furniture, linen and curtains offering a modern and bright home to live in. Externally the gardens have been landscaped to very high standard, with very good quality wooden tables and chairs, all wheelchair accessible and fenced right around the building. Staff felt they were going to have raised beds installed to enable people to do a bit of gardening if they wished. A lot of thought and specialised input has been given to the design of the building which is fully accessible to people who use a wheelchair with extra wide corridors and doors throughout the building. A sample of maintenance certificates and environmental risk assessments were seen. These records gave up to date checks which helped show what actions were taken to keep Maeres House safe and well maintained. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 26 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. 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 are supported and protected by the services safe recruitment and selection procedures EVIDENCE: The service’s aqaa gave us a lot of information before we visited the service and it told us, “All staff employed have under gone a strict recruitment procedure. All staff are provided with regular supervisions and annual appraisals…… All staff receive training which is monitored closely…. Opportunitiy is taken to develop the staff team through sharing of knowledge and information, courses specialist to the meeting of individual needs, such as makaton, etc. Discussion takes places with the regional training manager to source any specialist training required within the service.” Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 27 The above information was well evidenced during our visit. We looked at a sample of staff files. The records showed that before anyone is appointed to work at Maeres House a series of checks are carried out. These included obtaining written references and checking with the criminal records bureau (CRB). These checks help to make sure the people living there are safe and that staff are suitable to support them. We met all the staff on duty and looked at a sample of 2 staff training records which showed what training had been provided. There were 3 support staff and the deputy manager on duty during our visit. Most of the staff were up to date with mandatory training with a vast amount of very specialised training such as, Sex and sexuality, understanding brain injury, (which covers common effects of brain injury), the carers perspective, model of awareness and acceptance, philosophy of care, values and goals, epilepsy, equality and diversity, moving and handling, report writing, communication, risk assessment, person centred planning and medication assessments. We met the staff and they felt happy with the training they had received and felt very supported in developing their skills to meet the needs of people living there. The staff on duty were really happy working for the company and felt it was the best place they had ever worked for, they felt the training was excellent and that the building was fantastic. The staff told us that they felt they had good staffing levels and good support and they explained the staffing levels were due to change due to the changing needs of people going to live at the service. We have received 2 staff surveys which were overall positive, one person felt they, “always” have enough staff and one person felt they, “usually” had enough staff. One person made a comment and felt that they, “treat service users as individuals, always give them choice and independence.” We looked at a sample of staff minutes of recent meetings organised at the service. They showed that staff were included in the developments of the service and were encouraged to raise their own comments and suggestions about Maeres House. Staff told us they can bring anything up at meetings and they received regular supervision were they could also discuss any issues. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 28 Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 29 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. The service is well managed for the benefit of the people living there and the staff. EVIDENCE: The service’s aqaa gave us a lot of information before we visited the service and it told us, “The home manager has 6years residential care management experience, NVQ 4 Management qualification and has nearly completed NVQ 4 Care. She has also recently completed a management development programme. We also provide deputy managers in the absence of the manager in order to provide a point of contact. …” We met the deputy manager during our key visit. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 30 Staff told us that the service is visited on a regular basis by a representative of the organisation. These visits form part of the quality assurance process and form an opinion on the standard of care and support provided. These visits are also a requirement of the care home regulations and a report has to be produced to show evidence of these checks. It is important that these checks are done to check the standard of care and management in the service. We could not access or find these monthly reports but the staff advised that they had been carried out for the last 6 months since the service had been opened. We looked at a sample of records and certificates which showed that regular checks are carried out on the building and equipment. This includes checking fire appliances and electrical installation. These checks help to make sure that the environment is well managed and is a safe place to live and work in. The manager organises regular staff meetings. These meetings make sure that staff have a regular forum to discus issues that may affect the service provided to people. We looked at copies of recent staff meetings which showed details of various topics about the service including, records and each of the people living at Maeres House. The staff on duty were really happy working for the company and they were really complementary about the manager and deputy and said the management were really good and very supportive. It was obvious during our visit that within just 6 months the staff team had become very close and respectful of each other. They were all very motivated and enthusiastic in their work. There seemed to be a good moral were people enjoyed their work. Staff were continually developing the service and looking forward to eventually having 8 people living at Maeres House. We also looked at a sample of minutes from meetings with people living at the service. The manager has developed the minutes to include easy read formats using pictures from the picture bank which helps some people to understand the information in a better way for them. People were encouraged to give their opinions about the service to see what else could be done to enhance their lives at Maeres house. Some people had commented on the need for the kerb to be dropped outside the building to help with better access for people using wheelchairs. The company then went on to look at trying to take this suggestion forward so they could eventually drop the kerb to give better access. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 31 Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 32 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 2 2 3 3 x 4 4 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 4 25 4 26 3 27 4 28 4 29 4 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 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 X 15 3 16 2 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 2 3 x 3 x 3 x x 3 x Version 5.2 Page 33 Maeres House DS0000072983.V375771.R01.S.doc N/A 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 YA19 Regulation 15 Requirement One persons plan needed to be reviewed as a matter of priority. The clinical input and the medical care needed to be reviewed as soon as possible to make sure the right support and specialist input was given to offer continued psychological support. Timescale for action 06/08/09 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 YA1 Good Practice Recommendations The statement of purpose and the service user guide, must all be accurate and up to date to give people the right information to help them make decisions about their service. The plans would benefit on being reviewed to make them clear and accurate, to reflect staff explanations of how they support the people living at Meares house and include DS0000072983.V375771.R01.S.doc Version 5.2 Page 34 2 YA2 Maeres House the requests made by people during our visit about their long term goals and aspirations. 3 YA23 Each persons financial care plan should be clear what support and actions would be taken to support them in getting the best value for their money, including accessing the community and in making sure their benefit and mobility allowance is used in their best interest. Support plans would benefit from having a lot more information to explain clearly all parts of their financial management including any social services input, storage of their monies, names of appointees, ongoing costs and management and records of debiting and collection of receipts. Details about the costs incurred and the entitlement to holiday funds should be clearer and included in each person plans so they have specific details to enable them to make informed choices about holidays and using the minibus. While the service continues to endorse the use and funding of a communal minibus by the people living at Meares House, then more staff must be assisted in being trained to drive the bus to enable people to have more choice and accessibility. Any continued change in the medications prescribed by a doctor should always be reviewed by the doctor to review any effects to the persons care and condition. Temperature records for the drugs fridge need consistent daily checks to help ensure that medications are always stored correctly and at the right temperature. All staff must have updated training in safeguarding so they have the right skills and training to meet the needs of the people living at the service and so they can safely support people at all times. To ensure the service has access to its monthly reports carried out by a representative of the organisation. These visits form part of the quality assurance process and form an opinion on the standard of care and support provided. These visits are also a requirement of the care home regulations and a report has to be produced to show evidence of these checks. It is important that these checks are done to check the standard of care and management in the service. 4 YA13 5 YA20 6 YA23 7 YA39 Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 35 Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 36 Care Quality Commission North West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northwest@cqc.org.uk Web: www.cqc.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) 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. Maeres House DS0000072983.V375771.R01.S.doc Version 5.2 Page 37 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!