Care Home: Magnolia House

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What the care home does well Admissions to the home are well managed and arranged in a planned way so that people’s needs are fully assessed, whilst ensuring that the home is suitable for them. Detailed care plans and supporting documentation give a full picture of each person`s preferences and particular needs, and give staff clear guidance on how these should be met. They also promote delivery of consistent person centred care. The two people who use the service appeared happy and comfortable around their carers. Ongoing training opportunities direct and guide staff practice so that they can meet people’s individual and collective needs. When a person`s needs change, the home is good at making sure the appropriate action is taken. This includes consultation with other relevant healthcare professionals and making any necessary adjustments to their care and support plans.People take part in leisure activities which are meaningful to them and take account of their social interests, choices and personal capabilities. The home is kept clean, safe and decorated to a very good standard meaning that people live in comfortable and homely surroundings. The manager communicates a clear sense of direction and Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 leadership that meets the aims and purpose of the service. The home provides useful information in ways that help people understand what services they can expect to receive. What has improved since the last inspection? The two areas that needed attention from the last inspection in October 2008 have been addressed. People now have a more detailed risk assessment on issues around vulnerability. This further ensures that best actions to minimise each identified risk are in place and followed. The staff recruitment process has been strengthened to ensure that the people who live in the home are safeguarded from possible harm and poor practice. Other improvements have included further training for staff to keep their knowledge and skills up to date in meeting the needs of people using the service. In addition the manager and small staff team have completed training on mental health awareness to prepare them for supporting people who have such needs. In support of the home’s application to vary its registration category, the owners have moved out of the property and the home now offers a fourth bedroom and separate smoking room on the first floor. What the care home could do better: There are no legal requirements made following this inspection and the home continues to work well to ensure excellent outcomes for people who use the service. As this is still a new service, the home cannot achieve an excellent rating as it would need to demonstrate a consistent track record over time. We have repeated our two previous recommendations. It would be better if the induction process for staff was based upon the Skills for Care standards. These are designed for new staff entering into the care industry to undergo a minimum level of initial training. Additional training on visual impairment and diabetes should be undertaken as two people using the service have such specific needs. Key inspection report CARE HOME ADULTS 18-65 Magnolia House Magnolia House 19 Fairholme Road Cheam Surrey SM1 2EE Lead Inspector Claire Taylor Unannounced Inspection 12th May 2009 10:00 Magnolia House DS0000072954.V375110.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. Magnolia House DS0000072954.V375110.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 Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Magnolia House Address Magnolia House 19 Fairholme Road Cheam Surrey SM1 2EE 020 8642 6722 020 8642 6722 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) New Life Care Ltd Maria Louisa McDonald Care Home 3 Category(ies) of Learning disability (0) registration, with number of places Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 3 30th October 2008 Date of last inspection Brief Description of the Service: Magnolia House was first registered as a service for people with learning disabilities in April 2008. In November 2008, the owners Mr & Mrs McDonald changed the company name to New Life Care Ltd. In March 2009, they then made an application to vary the service category to include “mental disorder” and increase the number of beds from 3 to 4. At the time of this visit, the application was still being processed. The home is a very large detached property situated in a residential area of Cheam in Surrey. The home is close to shops, community facilities and there are public transport links nearby. Both the owner and manager, Mr and Mrs. McDonald provide most of the care and support with three other part time staff. There are two comfortable lounge areas with one providing rear access to a large and well maintained garden. The kitchen, as well as the utility room is in keeping with a family home and there is a very small but secure staff office. On the first floor there is a main shower/bathroom, two single bedrooms with en-suite facilities, a smoking room and a staff sleep-in room. These rooms were not in use at the time of our visit due to the pending approval to vary the home’s registration. There is no lift access and these rooms would therefore not be suitable for people with physical disabilities. Two of the bedrooms are on the ground floor and were occupied at the time of this visit. Fees ranged from £850.00 up to £1500 and were correct at the time of this inspection. Additional charges are payable for holidays, hairdressing, toiletries, newspapers, clothing and some activities such as Aromatherapy. Any extras would be discussed prior to admission. Copies of the Statement of Purpose and Service Users Guide can be obtained directly Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 5 from the home. Magnolia House DS0000072954.V375110.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 2 stars. This means the people who use this service experience good quality outcomes. The reader should note that this home has only been registered since April 2008 and had its first full key inspection in October 2008. This second key inspection was undertaken because the owners changed their company name. The management arrangements remain the same, the same two people were living in the home and there are therefore similarities in this inspection report as there are for the previous one. As we only visited the home within the last six months, the focus of this inspection was to look at the required improvements since our last inspection and to check developments concerning the owners’ recent application to vary the service registration category. The home has applied to register an additional fourth bedroom and to also include a second category of mental health. At the time of this visit, the application was still being processed. We met with both Mr. & Mrs. McDonald who assisted us with this inspection. We looked at various records in relation to peoples care, staffing and the way the home was being run. We also looked around the building and checked to see that the environment was safe. The manager returned a revised AQAA to us when we asked for it. This gave a realistic overview of the home, any improvements and any planned developments. We did not send out any surveys on this occasion but did receive positive comments as part of our last inspection in October 2008. The reader may also wish to refer to this report for further information. All those who took part in this inspection are thanked for their time and contribution. What the service does well: Admissions to the home are well managed and arranged in a planned way so that people’s needs are fully assessed, whilst ensuring that the home is suitable for them. Detailed care plans and supporting documentation give a full picture of each persons preferences and particular needs, and give staff clear guidance on how these should be met. They also promote delivery of consistent person centred care. The two people who use the service appeared happy and comfortable around their carers. Ongoing training opportunities direct and guide staff practice so that they can meet people’s individual and collective needs. When a persons needs change, the home is good at making sure the appropriate action is taken. This includes consultation with other relevant healthcare professionals and making any necessary adjustments to their care and support plans.People take part in leisure activities which are meaningful to them and take account of their social interests, choices and personal capabilities. The home is kept clean, safe and decorated to a very good standard meaning that people live in comfortable and homely surroundings. The manager communicates a clear sense of direction and Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 7 leadership that meets the aims and purpose of the service. The home provides useful information in ways that help people understand what services they can expect to receive. What has improved since the last inspection? What they could do better: 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. Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 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. The home provides good information about the services offered and introduction opportunities so that people can decide whether the care home can meet their support and accommodation needs. People have an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. EVIDENCE: As highlighted in the summary of this report, the owners made an application to vary their registration category in March of this year. The Statement of Purpose had just been amended and updated as part of the home’s application to vary its registration category. The manager provided us with the most recent copy by email. It clearly informs any potential users of the service about the admission criteria and any exclusion. The statement of purpose stated, “We have the capacity and experience to work with service users who have a diagnosis of mental illness. The home can only accommodate service users who are stable within the community and have comprehensive support systems and packages in place, including risk assessments and detailed assessment of needs. The home does not provide psychiatric nursing and is Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 10 not able to admit any service user who has been diagnosed with the following: Drug dependency, Alcohol dependency, Other substance abuse, Psychopath, Sociopath, Personality disorder, Eating disorder, Self harm, Acute bipolar disorder.” This shows that the owners are clear about their limitations and capacity to meet individual needs. They have also considered the implications of providing care and support to people with different needs associated with learning disabilities and mental health. The Statement of Purpose includes all other required information to ensure that people or their relatives know about the service and facilities available to them. Large print and photos had been added to make the information more accessible. The same two people were living in Magnolia House and we saw that both needs assessments were up to date and reflected any changed needs. The assessment covers all aspects of a persons life, including their strengths, hobbies, social needs, dietary preferences, health and personal care needs and ability to take positive risks. Some equality and diversity issues are also explored through assessment which included details about the persons age, ethnicity, preferred faith and culture. Each person also had an assessment of needs undertaken through their placing local authority. The manager was in consultation with a local authority to offer a placement to a person with diagnosed mental health needs. Mrs. McDonald had carried out a full needs assessment with the person in their current placement. She was aware of her responsibility not to start the admission process until we have approved the variation application. The manager had also discussed the proposed changes to the service with the two existing people living in the home, their relatives and care managers. We saw in the other two people’s records that individuals are introduced into the home at a level and pace appropriate to them, through visits, meals and an overnight stay. There is a six week settling in period which allows time for the individual and the home to determine if the service is suitable to meet their needs, wishes and aspirations. A full review meeting is then held to confirm any long term placement. Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 11 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 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are highly person centered so that staff know how to support each person’s unique needs in a way they prefer. Risk management has improved so that each person’s independence is promoted as well as their safety from harm. EVIDENCE: We saw a range of records that look at all areas of each individuals life in a person centred way. The owners had taken steps to obtain lots of useful information about both people so that they would know what support they require. We saw up to date person centred plans that included good information about goals and aspirations, personal skills and abilities, peoples social lives and preferred lifestyles. All about me profiles enable staff who are not familiar with the person to deliver consistent person centred care. Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 12 There are good systems in place that will ensure that the placement and the care plans are reviewed regularly. These also involve people’s care managers, family and other representatives as necessary. Care records showed that each person has a named ‘key worker’ staff and meetings are held every two or three months to monitor progress, look at what has worked for the person and identify where changes are needed. There are advocacy arrangements, as well as family input, to represent people’s interests. Individual diaries are used daily and records seen were thorough, relevant, and also gave a sense of that person’s experience of their day. Discussion with the manager showed that they clearly know each persons unique needs, likes and dislikes. As requested by us, the manager had revised each person’s risk plan on issues concerning vulnerability. Each assessed risk was recorded separately and stated the best actions needed to safeguard the person whilst maintaining their rights and independence. This means that people are more fully protected from potential harm and exploitation. Other examples included managing risks associated with use of the kitchen, travelling in the community, mobility and eating and drinking. The risk assessments also inform staff how to make sure that each person is kept safe from anything that might harm them. Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 13 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 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can take part in activities that are appropriate to their age and culture and are part of their local community. The home supports people to follow their personal interests and activities and relationships with family and friends are well supported. Dietary needs and preferences are well catered for ensuring the people who use the service are provided with daily variation, choice, and nutritionally well balanced meals. EVIDENCE: Preferred interests, hobbies and likes are identified as part of the personal care planning process. We saw that care plans had good information about what activities each person likes to take part in and how staff should support them. Due to the two people’s limited communication skills, staff tend to organise activities based upon each individual’s assessed needs and knowledge of their Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 14 preferences. Care records showed that both people are provided with regular opportunities to experience their local community and are supported to follow their chosen interests and hobbies. These ranged from social clubs, shopping, lunches out, visits to places of interest and art and music activities for one person who also regularly attends a day centre on a sessional basis. An indoor and outdoor activity record is used so that staff can monitor what social activities people take part in and whether they meet their needs and personal interests. Plans included details about each persons social network and who is important in their lives. Families are involved and the staff support people to keep contact with those that are close to them. One person is assisted to write regularly to their relative. Records showed that family, friends and guests are welcome at the home and that the manager maintains good communication links with peoples respective families or representatives. The menus reflected a healthy and varied diet that took into account each persons preferences and dietary needs. Since our last inspection, the home has created a menu file which included photographs of the meals provided. There were also pictures of both people taking part in food preparation activities such as helping to prepare breakfast and making a cake. We saw that daily records are kept of what is eaten so that the staff can monitor each persons food intake and ensure a nutritional diet. This was particularly important for one individual due to their older age and needs. For how the home has improved, the AQAA said, “We have booked a weeks holiday in Devon for September 2009. Developed individual activities plan.” Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 15 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): 19 and 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. Heath care needs are well met and closely monitored. This ensures that people receive health services efficiently when required and promotes their quality of life. Positive arrangements for the safe administration of medicines are followed to ensure people’s health and well being. EVIDENCE: We saw that each person has their own health action plan that outlines the support they may need for check-ups and health screening. For example, one person has a renal condition and guidance was available for staff to support their needs. This person has other complex healthcare needs and the staff team work in close partnership with other agencies to ensure that these needs are met. The person is fully supported to access relevant specialist services on a routine basis. Individual records show involvement with a number of healthcare professionals including, GP, Consultant, optician, chiropodist and dentist. Staff keep a detailed record of all appointments, outcomes and any follow up action required. One person had a specific care plan related to their Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 16 older age and associated needs. The other person had previous involvement with Psychology due to showing some behaviours that may challenge the services they require. Records showed that the persons anxiety had significantly reduced since moving to Magnolia House. Outcomes also showed a further positive effect on their well being and that they no longer required a prescribed medication. Records therefore showed us that staff closely monitor the health and wellbeing of the people living in the home and take appropriate action to meet their needs. People who live in the home need full support to take their own medication and this was reflected in their care plans. The home has a detailed policy on the management of medication. In response to our last inspection, we saw that all staff had now received medication training through an external company. The remaining member of staff attended training in November 2008. At the time of our visit, the home was about to change pharmacy and there were plans for all staff to attend further training from the new pharmacist. Records were accurate for the receipt and disposal of medication and sampled administration charts were signed and accounted for. All medicines were stored appropriately in a locked cabinet. An appropriate healthcare professional reviews each persons condition regularly to ensure that they receive the correct medication regime or treatment where necessary. The manager confirmed that the home received good support from the local GP practice. For how the home has improved the AQAA said, “Staff have recently attended end of life care to support our service user who has a life limiting condition.” The manager also advised that a specialist nurse will visit the home to provide further training and advice on renal care should the person’s health deteriorate. Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 17 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 and 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. There are formal and informal systems in place to ensure that people’s views are listened to and taken into account in the day-to-day running of the home. Arrangements for protection from abuse are managed well to ensure that people who use the service are kept safe. EVIDENCE: We saw a complaints policy that provides clear details of how concerns would be listened to and acted upon. The two people living at the home would need total support to make a complaint and would rely on a relative, staff or advocate raising a concern on their behalf. The Manager works on shift most days per week and spends 1-1 time with each person to see if they are happy with their care and establish if they have any concerns. An easy read complaints procedure was also displayed in the home. We have received no complaints about this service since it was registered in April this year. Likewise, there have been no complaints received directly by the home. Records confirmed that staff are properly inducted on abuse awareness and there are policies and procedures for safeguarding adults that give clear specific guidance to those using them. An up to date local authority procedure was also available. We saw that the manager and staff received training on safeguarding vulnerable adults in June of this year. Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 18 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, 26 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with safe, comfortable and homely surroundings in a house that is kept clean and well maintained. People have spacious bedrooms that are designed and furnished to reflect each person’s individuality and meet their needs. EVIDENCE: Magnolia House provides a comfortable and homely environment for the people that live there. There is good access to local community facilities, services and transport links. Since our last inspection, the owners have moved out and now live within close proximity to the home. The existing bed spaces on the first floor have been redecorated and furnished as part of the owners’ application to vary the registration category. The home now offers a fourth single bedroom, staff room for sleep-in duties and a smoking room with seating and flat screen television. The two vacant bedrooms were pleasantly decorated and Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 19 comfortably furnished. A double bed has been purchased for the potential person considering using the service as they had requested one. We were not shown the staff sleep in room on this occasion. We met with one person in their bedroom which was well furnished to meet their needs and lifestyle. The room was personalised with things that were important to them and they seemed very contented. There is a spacious lounge and dining area with comfortable furniture and decor. One person spent some time looking at a book in the lounge during our visit. The other person chose to spend time in their room and we later met them on their way out to a day care service. Furniture and fittings were of a high standard and the home appeared very clean and tidy. The kitchen is domestic in nature and the existing two people can use the facilities with staff support. This was reflected in their individual care plans and risk assessments. Records showed that staff are routinely provided with training in basic food hygiene and infection control. There is also a second small lounge with door leading out to a well maintained garden. We saw that there was limited seating outside and the manager advised that new garden furniture had been ordered and she was awaiting delivery. The owner had arranged for the local fire authority to do a second inspection of the home in December 2008. We saw a letter which confirmed that the premises meet with current fire regulations. Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 20 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, 33, 34 and 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 by a stable staff team who have a range of skills and experience to meet their needs. Improved recruitment practices have meant that people are more fully protected from unsuitable workers. EVIDENCE: The staff roster indicated that, through a staggered shift pattern, there was a sufficient number of staff on duty and flexibility to meet people’s needs any time of the day or night. At the time of our visit, there were two people living in the home. Both the owner and manager, Mr and Mrs. McDonald provide most of the care and support with three other staff who are employed part time. Staff allocation was between one and two staff during the day with one staff available on a sleep in duty at night. The owners have moved out of the property since our last inspection and are on call in the event of an emergency. This is a small care home and the size of the staff team reflected the needs of the two people who live there. However, once two more people move in, staffing levels will need to be reviewed to ensure that staff arrangements will Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 21 meet each person’s specific needs. The manager discussed plans to increase staffing hours for the current staff team and will review staff working patterns once a third person moves in. We will check whether staffing levels are meeting people’s needs during the course of future inspections. The home has improved upon its recruitment practices to ensure that staff are vetted correctly before they begin work. We looked at records for one staff which contained all the required legal checks and documentation. The manager uses a checklist to verify that each staff has undergone the necessary checks. Each staff member had an up to date CRB and POVA check; proof of identity and a health declaration. As previously required, we saw that the newest staff member’s full employment history had been explored and recorded. In addition the manager had revised the job application to ensure that any future employees are required to declare their full work history before any consideration of appointment. This ensures that people using the service are further protected from unsuitable workers.The manager explained that most of the training is accessed through the local authority and also showed a commitment to ongoing staff training. The member of staff had a training portfolio to evidence both completed and planned training in a range of subjects to protect and enhance the lives of the people living in the home. Training since our last inspection has included health and safety, medication, safeguarding vulnerable adults, first aid and infection control. All staff have also completed training on mental health awareness as part of the provider’s application to provide a service to people with such needs. Records confirmed that staff had all received an induction to the home through the manager. It would be better if the induction process was based upon the Skills for Care standards. We have therefore repeated this recommendation. The manager explained that she had been trying to secure some external training on visual impairment and diabetes and was in the process of making further enquiries. We have again repeated our previous recommendation as people using the service have these specific needs. Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 22 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 and 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 manager has a good leadership approach to run the home in the best interests of the people who live there. The environment is safe for people and staff because health and safety practices are carried out. EVIDENCE: The registered manager has lots of experience in care work. This has included managing a 30 bedded care home for older people and supporting people with learning disabilities as part of an adult placement scheme. Since our last inspection Mrs McDonald has undertaken further training to keep her knowledge and skills up to date. Courses have included moving and handling, health & safety, infection control and safeguarding vulnerable adults. She has also attended training on ‘end of life care’ and advised that she hoped to Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 23 complete Leadership and Management NVQ L4 qualification within the next three months. In respect of the recent application to vary the service registration category, Mrs McDonald has attended a five-day course in Mental Health awareness. Discussions and observation confirmed that the manager is knowledgeable about each persons unique needs and understands the importance of person centred care and improving outcomes for people. In addition, she is aware of the home’s limitations in working with the wide spectrum of a mental health category and the impact it may have on existing users of the service. The home has good systems in place that aim to promote the health, safety and welfare of the people using the service, staff and visitors. In addition, there is clear policy guidance for staff to follow regarding a range of health and safety activities. The completed AQAA stated that all relevant safety checks were up-to-date. We confirmed this when we checked the servicing and maintenance records including gas and electrical safety. Records showed that fire equipment had been regularly tested to make sure it was safe to use. The owner Mr McDonald has previous experience as a fire officer and is qualified to provide fire safety awareness training to the staff. These positive safe working practices ensure that the health, safety and welfare of people living and working in the home are promoted. Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 24 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 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X 3 X X X X 3 X Version 5.2 Page 25 Magnolia House DS0000072954.V375110.R01.S.doc Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 YA35 Good Practice Recommendations That the induction process is based upon the Skills for Care standards to help ensure that all new staff entering into the care industry undergo a minimum level of initial training. Repeated from last inspection. All staff attend additional training on diabetes and visual impairment as it is specific to the needs of the two people living in the home. Repeated from last inspection. 2. YA35 Magnolia House DS0000072954.V375110.R01.S.doc Version 5.2 Page 26 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. 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