Care Home: Magdalen Close

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What the care home does well Listens to people and helps them to do the things they want to do.Looks after people`s health and cares for them well.Helps people keep in touch with their families and friends.Helps people get out do lots of activities that they enjoy.People have comfortable bedrooms with their own things in them.The home has comfortable rooms to live in. What has improved since the last inspection? Some staff are doing different jobs to help the home run better.There has been some redecorating.There has been some new furniture.Some of the paperwork is better. What the care home could do better: Carry on making the decorating better. Key inspection report Care homes for adults (18-65 years) Name: Address: Magdalen Close 1-5 Magdalen Close Clacton on Sea Essex CO15 3LS The quality rating for this care home is: three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ray Finney Date: 2 9 1 0 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 38 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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. 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 Care Homes for Adults (18-65 years) Page 3 of 38 Information about the care home Name of care home: Address: Magdalen Close 1-5 Magdalen Close Clacton on Sea Essex CO15 3LS 01255432951 01255422784 dennis.bateman@essex.gov.uk www.essexcc.gov.uk Essex County Council care home 18 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 18 0 learning disability Additional conditions: Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 18 persons) Date of last inspection 2 6 1 0 2 0 0 6 Care Homes for Adults (18-65 years) Page 4 of 38 A bit about the care home Magdalen Close is a local authority residential home, which provides accommodation, personal care and support for people with a learning disability. The property is located in a residential area of Clactonon-Sea. The home is within walking distance to the post office, shops, pubs, GP surgeries, cinema, local theatre and the seaside. The home is made up of four separate houses, each with a kitchen, utility room, bathroom, lounge and dining area, individual bedrooms and a rear and front garden. Care Homes for Adults (18-65 years) Page 5 of 38 The home has a vehicle managed by Magdalen Close Motor Vehicle Trust Fund. People living in the home, including those who are there for short breaks, can pay a membership fee to use the vehicle. Alternatively people are supported to use other methods of transport, although the cost is the responsibility of the individual. Care Homes for Adults (18-65 years) Page 6 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 38 How we did our inspection: This is what the inspector did when they were at the care home We visited the home on 21st October 2009. We looked around the home. We looked at lots of different evidence for this report. Care Homes for Adults (18-65 years) Page 8 of 38 We looked at paperwork like care plans, staff files and menus. The manager sent us information called an Annual Quality Assurance Assessment or AQAA. This gave us information about how they run the home. We talked to people living in the home and staff. Care Homes for Adults (18-65 years) Page 9 of 38 We looked to see if people were happy with what goes on in the home. What the care home does well Listens to people and helps them to do the things they want to do. Care Homes for Adults (18-65 years) Page 10 of 38 Looks after peoples health and cares for them well. Helps people keep in touch with their families and friends. Helps people get out do lots of activities that they enjoy. People have comfortable bedrooms with their own things in them. Care Homes for Adults (18-65 years) Page 11 of 38 The home has comfortable rooms to live in. What has got better from the last inspection Some staff are doing different jobs to help the home run better. Care Homes for Adults (18-65 years) Page 12 of 38 There has been some redecorating. There has been some new furniture. Some of the paperwork is better. Care Homes for Adults (18-65 years) Page 13 of 38 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Ray Finney Care Homes for Adults (18-65 years) Page 14 of 38 CQC Eastern Citygate Gallowgate Newcastle-upon-Tyne NE1 4PA If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 15 of 38 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 16 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People choosing to use the service provided by Magdalen Close can be confident they understand what the home provides and that their needs will be met. Evidence: The manager told us in the AQAA, The home recognises that the fundamental choice of where to live is extremely important and therefore how we support individuals is the key to providing an appropriate placement. We work closely with the prospective service users ensuring they have all the necessary information about Magdalen Close, thus assisting them with making this choice of where to live. The home has produced a comprehensive Statement of Purpose and Service User Guide. The documents are produced to a high standard giving clear information about the service provided by the home. The Service User Guide is produced in an easy read format using clear, simple language, written in large print and supported by pictures. The guide provides people with a wide range of information covering areas such as the environment, staffing, what is included in the cost of living at the home and what additional personal items are not included, personal care, support with finances, activities and lifestyle, transport and making complaints. Care Homes for Adults (18-65 years) Page 17 of 38 Evidence: As at the last inspection, there is a comprehensive process in place for assessing the needs of people wishing to move in to Magdalen Close. Through discussions the manager was able to demonstrate a good awareness of the importance of carrying out a thorough pre-admission assessment. A sample of three care plans examined all contained detailed assessments and the information recorded was of a high standard. Anyone choosing to move in to the home can be confident that their needs, wishes and aspirations will be assessed and the service will ensure they are able to meet these needs. We received positive responses about the quality of the service and one relative who completed a survey told us, The service is exceptionally good. Care Homes for Adults (18-65 years) Page 18 of 38 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that their needs will be met in ways that they want. Evidence: The manager told us in the AQAA, From the assessment information, a person centred care plan is developed that clearly demonstrates the individuals needs and aspirations and how these are going to be met. He also stated, Magdalen Close staff have worked extremely hard in redeveloping our care planning process. The result has been to provide, in working closely with the service user, very detailed comprehensive individual person centred care plans that clearly identify individuals needs, their aspirations and how these are to be met. These are written in easy to understand language and include personal, healthcare, emotional and social care needs. A sample of three individual care plans was examined on the day of the inspection. The care plans identify the area of need, specify the goal that they are aiming for with the individual and record in detail the plans or guidelines for staff on how they are going to support the person to achieve the goal. The documents are well laid out, written from the Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: individuals point of view and use very positive language. A relative who completed a survey told us that what the service does well is, it provides a friendly, caring home for small groups in a family atmosphere, The residents are treated as individuals. Through discussions with the management team it is evident that people living in the home are encouraged and supported to be involved in compiling their care plans. The section identifying the area of need contains pictures to assist the individual in understanding their care plan. The section recording the ‘plans to achieve the goal’ has an excellent level of detail to ensure staff are able to provide care and support consistently in ways that the person wishes. Records examined confirm that care plans are reviewed regularly, usually on a monthly basis, to ensure peoples changing needs are taken in to consideration. Throughout the inspection, staff spoken with were able to demonstrate a good awareness of peoples care plans. A member of staff who completed a survey told us, Service users are supported as individuals and are encouraged to meet their own individual goals in life and another said, the home does its best to meet the needs of each individual. The manager told us in the AQAA, The promotion and development of our inclusive communication processes further assist empowering individuals to make informed choices. A respectful approach by staff as well as ensuring service users have access to all their entitled benefits and individual bank accounts, all assist individuals with their self esteem and identity and To the best of our ability, we include service users in decisions about their lives and their home. There was ample evidence in records examined to confirm that people are encouraged and supported to make choices and decisions. Where people have difficulties with communication, the service uses a range of methods to ensure people are able to make their needs known, including Makaton signing and the use of pictures. The manager told us in the AQAA, Magdalen Close openly encourages family involvement as well as wherever necessary accessing the independent advocacy service to assist and support individuals. Throughout the course of the inspection we observed that staff consulted people and actively sought their opinions. There is also evidence that people are encouraged to use advocacy services where this type of support is wanted or needed. We received five surveys from people living in the home, all of which were completed with the support of an advocate. They all responded that carers always listen and act on what they say and staff always treat them well. Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: The manager stated in the AQAA, Integral to the individual care planning process is the development of ongoing risk assessment and risk management strategies. Again this takes into account an individuals aspirations and personal development. The home recognises the need to take risks in a carefully balanced way, thus ensuring we do not have a risk averse environment. There were comprehensive risk assessments in place in the sample of records examined. The risk or hazard is identified, who is at risk and how they are at risk is recorded, the risk is evaluated and actions are put in place to minimise the risk. The risk assessments are designed to enable the person rather than restricting them. One risk assessment in place focused around healthy eating for a person with limited understanding of the consequences of obesity. The risk assessment recognises the persons rights and wishes but supports them to understand the consequences and helps them to develop the knowledge to make healthier choices. Each person has a comprehensive range of risk assessments relating to their individual needs, including Mental Capacity Act (MCA) assessments for documenting the individuals ability to make decisions about various issues. Care Homes for Adults (18-65 years) Page 21 of 38 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Magdalen Close enjoy a lifestyle that meets their wishes as well as their needs. Evidence: The manager told us in the AQAA, In our opinion Magdalen Close has a strong value base of promoting all of our service users right to live an ordinary and meaningful life. Accommodation is provided in small groups within individual houses and every effort is made to ensure they are as homely as possible. Each house is totally independent, which gives development opportunities to all service users according to their abilities to be included and participate in menu planning, shopping and meal preparation as well as other household tasks. Through discussion the management team and staff were able to demonstrate that Magdalen Close has a strong ethos of enabling people to have opportunities for personal development and supporting them to develop social and independent living skills. The homes layout of small, self-contained houses enables people to be supported in a homely Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: environment. Staff support individuals to learn skills such as going to the bank and doing their own personal shopping. People living in the home who completed surveys with the support of an advocate all confirmed that they can make decisions about what they do each day. The manager further told us, We support service users according to their assessed needs, wishes and aspirations to attend local work enterprise schemes, resource centres, colleges, sensory, hydro and music therapy sessions and access to their own bank. Diverse wishes and needs being met include the ever popular bar-b-cues, supporting attending a range of classes at colleges which include sensory, animals and birds, Tai Chi, healthy living, making snacks, drama, music, using symbols and signs, personal and independent living skills, travel and community awareness and Social and leisure activities are supported within the local community and include trips to local pubs, restaurants, theatres, cinemas, evening clubs and keep fit classes. To assist us in this, we have a Motor Vehicle Trust Fund which has a vehicle, which service users have the choice to become members and contribute a membership fee. As reported at the last inspection, people living at Magdalen Close continue to be supported to access a range of educational and learning opportunities such as college courses, resource centres and sensory facilities. Peoples individual care plans contain pictorial planners that document their individual programme of activities. A relative who completed a survey told us, Magdalen Close is an ideal environment for [our relative]. It provides a social, communal based living which is very suitable. [Our relative] has easy contact with others, is not isolated or restricted in any way and every facility that they need is available. A member of staff who completed a survey told us that what they do well is, support and enable the service users to enjoy as good a quality of life as possible. The manager told us, We are committed to service users family and friends visiting. We also strongly respect family involvement and inclusion in service users’ lives where this is agreed with the service user. This contact is maintained by regular visits, trips to the family home, letters and phone calls. We have provided a speaker phone for one individual who would have difficulty holding a receiver. Staff spoken with on the day of the inspection explained how families and friends continue to take an active part in peoples lives. They explained the importance of maintaining good family links and the ways that people are supported with this, including visits to the family home, telephone contact, holidays, relatives visiting and being invited to social activities. Records examined confirm that relatives are invited to and take part in reviews and care Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: plans have a section that clearly documents important people in my life. One person spoken with independently visits relatives locally on a daily basis. A relative who completed a survey told us, existing family ties are encouraged and supported and another relative told us, They inform me of any changes to [my relatives] needs. Another relative stated, I am always made welcome when myself or my family visit. On the day of the inspection we observed that people were encouraged to get involved with the day to day running of the home. The manager spent some time working in the garden and people joined in with the work, helping with the weeding and sweeping the paths. People are encouraged to get involved in planning menus, shopping and, where appropriate, preparing meals. Each house plans meals and mealtimes around the wishes and needs of the people living in the house, taking into account what activities they have planned for the day. The home makes good use of pictures for people with limited verbal communication, including pictorial menu choices and Makaton signs for food such as fruit and vegetables. Staff explained how they support and encourage people with healthy eating and some people are waiting to start a 12 week Healthy Eating and Lifestyle course that is run locally. Care Homes for Adults (18-65 years) Page 24 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Magdalen Close are confident they are supported as they would wish with their personal and healthcare needs. Evidence: The manager told us in the AQAA, Individual person centred care plans clearly detail service users personal, health and emotional needs and how the service user wishes these needs to be met. Implicit within the plans are our actions that respect the individual and of the need to have their support delivered in a dignified way that respects an individuals right to be treated sensitively and respects individuals privacy. Individual care plans contain information about what personal care the individual needs and the way they prefer to have personal support carried out. The level of detail in the care plans is excellent and daily records are completed to a high standard by staff. Staff spoken with demonstrated an excellent level of knowledge about peoples needs, likes and dislikes around personal and health care. Throughout the course of the inspection we observed good interactions between staff and people living in Magdalen Close. Relationships were observed to be respectful, supportive and friendly and communication was good. Healthcare professionals who completed surveys responded positively to all the questions Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: asked in our survey, including whether peoples privacy and dignity is respected, are peoples individual and diverse needs met, whether the service seeks advice and acts upon it to meet peoples health care needs and whether peoples health care needs are properly monitored, reviewed and met. Records examined also contained good evidence of how people are supported with their healthcare needs. Each individual has a personal health profile. This is recorded on a personal profile sheet devised by Essex Rivers NHS Trust and contains all the information that would be needed in the event of an emergency hospital admission. Individual files record evidence of input from a range of health care professionals relevant to the persons needs, including doctor, dentist and optician. Staff spoken with were able to demonstrate a sound knowledge of healthy living initiatives and explained how they encourage people to make healthy choices around eating and exercise. A health care professional who completed a survey told us, Magdalen Close has always looked after the residents in a very commendable manner. The manager told us in the AQAA, All appropriate staff have been trained in administering medication. Magdalen Close has a clear administration of medicines policy regarding the ordering, receipt, recording, storage and handling of medication and At the present time we do not have any service users who self medicate, although this has in the past and I am sure in the future will be a development and independence goal, although this will be within a risk assessed and managed process and We have introduced a my medication format with pictures, which hopefully enables individual to have a better understanding of why their medication is prescribed as well as clear information of side effects for staff to monitor the ongoing wellbeing of individuals. Magdalen Close has a robust system in place to support people with their prescribed medication. Records examined confirm that each person has a medication care plan with supporting pictures of the medication, the reasons for taking the medication and possible side effects. The storage and recording of medication were examined and found to be well managed and accurate. Training records examined confirm that staff have completed training workbooks that assess their personal competence in administering and recording medication. In addition, all the management team have additional training around medication and the deputy manager has a system for auditing medication procedures. Care Homes for Adults (18-65 years) Page 26 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are confident that any concerns they may have are listened to and acted upon. Evidence: The manager told us in the AQAA, All service users and their families are given a how to complain document. This has been produced as a pictorial document and explained to our service users. We have also developed positive links with our local advocacy service to assist our service users and All complaints/compliments are logged and responded to within the timescales within our policy. We strive to achieve a positive outcome to all concerns and complaints, although recognise and will support individuals to further their complaint if dissatisfied with our response. As at the last inspection, Magdalen Close continues to have a comprehensive complaints procedure in place. Records examined confirm that people living in the home have been provided with a guide to making a complaint. This is clearly written using simple language and large print and supported by pictures to help people understand the process. The complaints log was examined and contained evidence that even minor concerns are taken seriously and the process for dealing with concerns and complaints is followed. A relative who completed a survey told us, If there are any problems they inform me straight away and another person said, I am always able to talk to anybody if I have any concerns. Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: Surveys received from people living in the home which were completed with the support of an advocate confirmed that people know who to speak to if they are not happy. The manager further told us, The home has a robust safeguarding of vulnerable adult policy, which has been distributed to all individual staff and All 35 staff have now attended a two day course on Risk and Conflict, which assists staffs understanding of challenging behaviour and safe procedures in diffusion and post incident support. Magdalen Close has appropriate policies and procedures in place around adult safeguarding. Staff spoken with were able to demonstrate a good awareness of their responsibilities around keeping people safe, recognising abuse or poor practice and understand what they should do. Personnel records examined confirm that there is a robust recruitment process in place that includes ensuring staff undergo relevant CRB (Criminal Record Bureau) checks. Training records confirm that staff have received training around safeguarding. Care Homes for Adults (18-65 years) Page 28 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy living in a homely environment that meets their needs. Evidence: The manager told us in the AQAA that some of the improvements to the environment in the last year include, changed one of the baths to reflect the changing needs of individuals, decoration of 3 bedrooms, ongoing timely replacement of equipment as required, new three piece suite purchased for house 5, new fire retardant net curtains for the home costing in excess of £1100, replacement carpets/flooring to house 5 bathroom and bedroom, lounge in house 4 and hallway in house 2. He further told us, We include to the best of our ability service users in choosing both decor to communal areas and personalising their bedrooms and, if they wish, participate in actually decorating. The manager also told us, I would like to mention the commitment of staff members who undertake decorating, invariably in their own time, to improve the quality and appearance of our home. The environment at Magdalen Close is homely and is pleasantly decorated and well maintained. Peoples individual rooms are decorated to a high standard and contain ample evidence of personal possessions and items that reflect their individual tastes and interests. Peoples bedrooms are their own private area and other residents are encouraged to respect this privacy. Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: The manager told us in the AQAA, Service users have the opportunity to have keys to their personal bedrooms or support from staff to respect their privacy when out of the home. During a tour of the premises we observed that all the bedrooms have locks and some people choose to keep their rooms locked. One person was pleased to show us their room and said they liked living there. The kitchens and laundry areas in each house are domestic in nature and people are encouraged to be involved in the day to day domestic tasks to help develop skills around daily living. We also observed that it was evident that staff support people to maintain a good standard of cleanliness throughout the home and there were no unpleasant odours. The manager stated in the AQAA, The home has a range of specialist equipment to meet the needs of individual service users, these include Parker baths with riser chairs and hoists, which are all maintained and serviced regularly by approved contractors. We observed that the range of adaptations and specialist equipment available were of a good standard and it was evident that peoples individual needs were catered for. Care Homes for Adults (18-65 years) Page 30 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Magdalen Close are confident that staff support them as they would wish by meeting their needs and keeping them safe. Evidence: The AQAA dataset stated that 50 of permanent care staff had achieved a NVQ [National Vocational Qualification] and through discussions the manager and staff demonstrated that other staff were in the process of completing the award. Staff spoken with were enthusiastic about completing NVQ courses. The manager stated, All new staff will have access to induction which includes completing the LDC [Learning Disabilities Qualification] award as appropriate. A further three staff are currently undertaking their NVQ level 3. The registered manager has now completed his NVQ assessor award, which with the new deputy manager will ensure the home has 2 NVQ assessors on site to assist other staff members achieve their award. Through discussions the management team demonstrated a commitment to encouraging staff to complete NVQ awards. On the day of the inspection an NVQ assessor was in the home assessing the progress of two members of staff who are currently working towards the award. Staff spoken with were positive about the support they get to gain NVQ qualifications. The manager explained that they have not recently needed to employ any new members Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: of staff. The current staff team is well established and work well together. Relatives who completed surveys made positive comments about how staff support people living in the home. One person told us, The staff provide a continuity of care which is exactly what [our relative] wants and needs and another said, I am very pleased with the service [my relative] receives, the staff are very good. Other people told us, the staff are obviously dedicated to the job and residents and I think the staff do a first class job and could not fault their dedication to caring for all the clients in their care. A member of staff who completed a survey told us, Magdalen Close has a very close knit feel to it. Most of the staff can debate and come to team decisions and always put the service users first. The manager told us in the AQAA, The home has a robust recruitment process that ensures completion and receipt of a CRB [Criminal Record Bureau] check, any gaps in employment are checked and matching skills and experience to the job description and specification are all carried out before a prospective member of staff can commence working at Magdalen Close and the home has successfully managed to recruit and retain staff and continues to have a very low turnover, which all aid with continuity and development of the service. Service users supported by our local advocacy service are involved in the selection process. Records examined confirmed that Magdalen Close has a robust process in place for recruiting staff. A sample of three personnel files examined contained all the documentation as required in the regulations. These include a photograph of the member of staff, relevant proofs of identity, references and Criminal Record Bureau (CRB) enhanced disclosures. The personnel records are maintained to a high standard and are well organised. The manager told us in the AQAA, All staff have received training in manual handling and receive regular refresher training. The home has invested in supporting a manager to become a manual handling instructor which assists with training as well as manual handling risk assessment and Magdalen Close has developed positive links with our health colleagues in our local Primary Health Care Trust and have accessed training according to individuals needs in diabetes awareness, epilepsy awareness, dementia awareness and promoting continence. We examined the homes training and personal development plan. Staff are provided with a good range of training and personnel records examined confirm that staff training includes a medication workbook update, a two day fire safety, infection control, clinical waste and health and safety risk assessment course, food hygiene, risk and conflict management, enablement and empowerment, first aid, manual handling refresher courses, mental capacity awareness, person centred active support. There have also been Care Homes for Adults (18-65 years) Page 32 of 38 Evidence: team away days including my performance/supervision, regulation standards awareness, time management, SOVA (Safeguarding of Vulnerable Adults), and financial regulations. Personnel records also confirm that there is a robust system in place for the supervision of staff that includes monthly supervisions and bi-monthly house meetings. The minutes of house meetings were examined and show that staff discuss issues relevant to people living in the home including care planning, medication and menu planning. Staff spoken with on the day of the inspection felt well supported by the management team. A member of staff who completed a survey told us, Staff are trained in areas required for their job role, sometimes involving specialised training to support individual service users and another said what the home does well is, provide training relevant to the job role. Care Homes for Adults (18-65 years) Page 33 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Magdalen Close are confident that the service is managed in their best interests. Evidence: The manager told us in the AQAA, The managers style is that of being open and supportive, whilst giving clear direction of the need to improve our service utilising person centred approaches. The manager, in conjunction with staff and service users, have not been averse to looking critically at our service and them making the necessary or required improvements. The registered manager holds the RMA (Registered Managers Award) and NVQ level 4 in care. Through discussion he explained that he has 23 years experience of working with adults with a learning disability. He also demonstrated a commitment to updating and developing his skills and knowledge. The homes AQAA was completed to a very high standard and contained ample, good quality information that gave us a good understanding of the service provided at Magdalen Close. Evidence examined throughout the inspection process confirmed that the Care Homes for Adults (18-65 years) Page 34 of 38 Evidence: information provided in the AQAA was accurate and gave a true picture of the home. On the day of the inspection the manager explained about the new management structure that was introduced earlier in the year which consists of the Manager, the Deputy Manager and a Team Co-ordinator in each house. Throughout the course of the inspection we had discussions with staff and the management team. Everyone spoken with was helpful and supportive during the inspection. The management team demonstrated an excellent awareness of ensuring systems work to provide an excellent service for the people living at Magdalen Close. The manager told us in the AQAA, We have just finished developing a pictorial quality assurance questionnaire for our staff to undertake with individuals who use our service to assist us further with listening to individuals comments and Magdalen Close views its complaints/compliments policy as an integral part of its quality monitoring of the service we provide. Our policy actively encourages individuals to contact us at any time to discuss their concerns and wherever possible their compliments, as this will give us indicators as to where we need to improve or indeed maintain the things we do well. We had extensive discussions throughout the day about how they monitor the quality of the service provided. It is evident that the culture of the service is one of listening to people and supporting them to make choices and decisions. It was also evident that the involvement of relatives is important and their knowledge and input is valued and respected. We observed excellent interactions between staff and people living in the home. A member of staff who completed a survey told us, If things need to be changed to provide a better service for service users this is implemented, whilst also recognising the need to work within our resources available and budgets. The manager told us in the AQAA, The home keeps accurate records relating to electrical testing, gas appliances, thermostatic control valves, fire/nurse call systems, fire appliances, legionnella controls, environmental health inspections, COSHH [Control of substances hazardous to health] and other risk assessments as required by Health and Safety legislation, which all contribute to the safe living and work environment. A sample of health and safety documentation examined was found to be in order, including certificates relating to electrical installation, gas and fire equipment. There was also a comprehensive range of risk assessments including slips, trips and falls, hot water and surfaces, vehicles, infection control and lone working. The risk assessments identify the hazard, the likelihood of the event happening, who could be harmed, existing measures in place to reduce the risk and any additional measures required. Records examined confirm that risk assessments are reviewed regularly. Care Homes for Adults (18-65 years) Page 35 of 38 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 36 of 38 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 or Email: enquiries@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. Care Homes for Adults (18-65 years) Page 38 of 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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