Care Home: Margaret House Respite Unit

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What the care home does well They ensure that people`s needs and wishes are assessed before they go to stay. This helps ensure that the Margaret House has the facilities to meet their needs. People told us that they were able to make decision about what they do each day at the home. Activities were available for people. People told us that the management and staff treat them well and that they always listen and act on what they say. The home provides a spacious comfortable and clean environment for people to stay. People knew who to speak to if they were not happy and knew how to make a complaint. Systems, policies and procedures were in place to protect the health and safety of all. People told us that they thought the service does well as they offer "care and assistance as needed", "friendly staff make you feel at home and relaxed", "rooms very comfortable and nicely decorated." One person told us "for me personally it would be hard to improve on." What has improved since the last inspection? This is the first key inspection of this newly registered service. What the care home could do better: They need to review their medication procedures so that staff have guidance on all aspects of medication administration. This will help ensure that medication is always managed appropriately. They should review and amend their safeguarding policy and procedures so that it contains information about the local joint agency safeguarding procedures. This will help ensure that staff are aware of how to deal with any concerns appropriately. Key inspection report Care homes for adults (18-65 years) Name: Address: Margaret House Respite Unit Margaret House Respite Unit Balfour Street Runcorn Cheshire North West WA7 4QT     The quality rating for this care home is:   two star good 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: Adele Berriman     Date: 1 1 0 6 2 0 1 0 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things 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 28 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 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Margaret House Respite Unit Margaret House Respite Unit Balfour Street Runcorn Cheshire North West WA7 4QT Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Emma Kelly Type of registration: Number of places registered: care home 15 Primrose Care Services emma@primrosecare.co.uk Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: The maximum number of people who can be accommodated is: 15 The registered person may provide the following category of service only: Care home only - Code PC, to people of the following gender: Either, whose primary care needs on Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 0 15 15 0 0 0 0 0 0 15 15 0 0 0 0 admission to the home are within the following categories, Learning disability - Code LD, Dementia - Code DE. Date of last inspection Brief description of the care home Margaret House is a care home providng personal care for up to 15 people requiring periods of respite care. The home is a single storey building that is accessible to all. All rooms are single and have an en-suite facility. The home is located close to bus and rail services with local shops and amenities close by. The registered manager of the home is Emma Kelly. Care Homes for Adults (18-65 years) Page 5 of 28 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: two star good 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 peterchart Poor Adequate Good Excellent How we did our inspection: We carried out an unannounced visit to Margaret House on the 9th June 2010 and a second announced visit was made on the 11th June 2010. These visits formed part of the first key inspection of this newly registered service. During our visit we spent time talking to a person who was staying at the home for a period of respite, the registered manager, the deputy manager and the cook. We looked at the communal living areas, bathrooms and toilets and a selection of bedrooms. We looked at a selection of records, policies and procedures which included care plans and staff files. Before we visited two people, one with the support of their relative, who use the service completed a survey form to tell us their experiences of Margaret House. Five Care Homes for Adults (18-65 years) Page 6 of 28 staff members also completed a survey form. The manager completed an Annual Quality Assurance Assessment (AQAA). This document gave them the opportunity to tell us what they do well, where they think they can improve and their plans for improvement over the next 12 months. The AQAA told us the information we asked for and also contained some numerical information that we had requested. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: 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. Care Homes for Adults (18-65 years) Page 8 of 28 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 9 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment of peoples needs prior to them staying at the home helps make sure that Margaret House has the facilities to meet the persons needs and wishes. Evidence: They told us that prior to a person staying at Margaret House an assessment of their needs takes place. If a persons stay at the home is arranged by a Local Authority the service accept their assessment of need. In addition the manager or deputy manager of the service visit people at their usual address to assess their needs. The purpose of the assessment is to ensure that service has the facilities to meet the individuals needs and wishes. We saw that for each visit a person makes to the home a new assessment is carried out. The manager told us that this was to help ensure that they are fully aware of any changes to peoples needs and wishes. We saw that copies of peoples care needs assessments formed part of peoples care plan files. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: They told us that people were invited to visit the service with their family, friends or advocate and have a meal and spend time with the staff before they make a decision to have a short stay at the home. Both people who completed a survey form told us that they had received enough information prior to going to stay. They told us in their AQAA that over the next 12 months they plan to improve the service by introducing all written documents in alternative format to meet the needs of people with different skills. Care Homes for Adults (18-65 years) Page 11 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information in peoples care plans helped ensure that they received the care and support they required. Evidence: We saw that each person had their own file that contained their personal information, care plan and pre admission assessment information. We looked at the care plans of two people who stay at the home and saw that they contained information about their day to day needs and wishes. They told us that each time a person comes to stay at the home their care plan is revised to ensure that it contains up to date information. We saw that individual risk assessments formed part of peoples personal files. For example we saw assessments relating to moving and handling, dressing and undressing and general assessment for peoples day to day living activities. All staff who completed a survey form told us that they are always given up to date information about the needs of the people they support. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: People told us that they make decisions about what they do each day and that they can do what they want during the day, in the evening and at the weekend. Care Homes for Adults (18-65 years) Page 13 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People staying at Margaret House are treated with respect and have access to day to day activities in the home and in the local community Evidence: We saw that a small library area and games room was available within the home. We saw that books, DVDs, drawing materials and board games were fully accessible to people. They told us that they had a mini bus to assist people with attending activities within the community which included fortnightly visits to a local club disco, swimming, the cinema and bowling. They told us in their AQAA that over the next 12 months they plan to develop an activity programme so that people will be aware of what activities will be available to them during their stay. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: They told us in their AQAA that where possible they will continue to support people with hobbies and leisure activities that are part of peoples day to day life during their short stay. They told us that whilst staying at the service people continue to attend their day services. People told us that they make decisions about what they do each day and can do what they wish during the day, evening and at weekends. One person who completed a survey form told that staff listen and respond to their relatives needs, keeps her occupied with lots of activities and treats her with respect. People told us that the care staff and managers treat them well and always listen and act on what they say. A menu was available to people and their visitors. However, we spoke to the cook who told us that people can have whatever they want at mealtimes. They told us that they do the shopping and purchased things specifically for people visiting the home. Food was available to access throughout the day and night. One person told us that the home does well as they deliver the care and assistance needed and provide them with a special diet. Care Homes for Adults (18-65 years) Page 15 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems were in place to help ensure that people received health care support if they needed it. Evidence: They told us in their AQAA that all personal care was delivered in private. As mentioned earlier in this report, people told us that care staff and the manager treat them well. One person told us that when they visit they store and manage their own medication. They told us that if they were not feeling very well through the night they call the staff who sit with them until they are feeling better. We saw that peoples medical information is recorded in their care plan. The manager told us that in the event of someone requiring medical attention during their stay either the own GP or a GP more local to the home would be contacted. We saw that a policy and procedures were in place for the safe handling of peoples medication. We saw that the policy did not include all of the information required. For example, the policy does not give information regarding the use of medication Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: prescribed on an as and when required basis (PRN) nor does it consider the disposal of medication. We saw that information relating to controlled drugs needed reviewing as it stated that health care professional would administer. To help ensure that staff are aware of good practice for administering medication the policies and procedures must be reviewed and updated to ensure that they contain up to date guidance. Lockable cabinets were available in the office area and in bedrooms to store the medication appropriately. They told us that people are encouraged to manage their own medication whilst staying at Margaret House. We saw that a self medication assessment formed part of peoples care plans. Staff were also available to help and administer medication to individuals. They told us in their AQAA that over the next 12 months their plans included seeking medication training for staff with Halton Borough Council, and to form relationships with a local chemist to support the medication needs of the service. Care Homes for Adults (18-65 years) Page 17 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems and procedures were in place to help people make a complaint about the service Evidence: We saw that they had a written complaints procedure, a copy of which was displayed in each bedroom and formed part of the service user guide. The manager told us that she intended to produce the complaints procedure in alternative formats, for example, pictorial, to promote more understanding of the procedure. A book was available in the reception area for people to record any comments they had about the service. No complaints had been received by the home or the Care Quality Commission about the service provided. People told us that they knew who to speak to if they were not happy and knew how to make a complaint about the service. All staff told us that they knew what to do if people had concerns about the home. Systems were in place for the safe keeping of peoples money and personal effects, this included lockable bedrooms with lockable cabinets and doors. We saw that they had a suspicion of abuse policy. We saw that some of the information in the policy was in need of reviewing and updating. For example, the Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: procedures need to state that all concerns must be reported directly to Halton Social Services without delay and that they will make any decision regarding the investigation of the concerns. The policy should also refer directly to Halton Social Services joint agency safeguarding procedures. This will help ensure that all concerns are managed appropriately. No safeguarding concerns had been raised about the service. Care Homes for Adults (18-65 years) Page 19 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Margaret House provides a clean, comfortable and pleasantly furnished environment for people to stay. Evidence: The home is a single storey building set in a residential area close to bus stops, train station and local shops. A parking area is close to the building. We saw that an outside courtyard with plants, flowers and seating area was available to people. A large kitchen was available for the preparation and cooking of meals which were served in the communal lounge and dining area. People had access to the games room and small library area. A public telephone was available for people to use in private. Individually decorated single bedrooms with en-suite facilities were available throughout the building. We saw that regular maintenance of the building was taking place. To enable people to maintain their independence around the home we saw that several adapted bathing and shower facilities were available along with a hoist and support rails. We saw that different beds were available to people which included those that were adjustable. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: We saw that the building was accessible to all. The environment was light and airy. The We looked at the communal areas of the home and a selection of bedroom. We saw that the decoration, furnishings and floor coverings were of a good standard which helped provide a comfortable place for people to stay. One person told us that they were always given a choice of what room they wanted to stay in. People told us good things about the accommodation. These comments included rooms very comfortable and nicely decorated and the facility is loverly and offers a friendly supportive environment. We saw that appropriate laundry facilities were available along with hand soap and towels by each sink to promote good hygiene practices. Care Homes for Adults (18-65 years) Page 21 of 28 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 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 trained and flexible team of staff. Evidence: On the days that we visited the manager and the assistant manager were on duty. On our second visit the director of the home was also present. They told us that the number of staff on duty was determined by the number and the needs of the of people staying at the home. During our visits we spoke to the manager, the assistant manager, the cook and the director of the company. All demonstrated a good awareness of the needs of the people who stayed at the home. All of the staff who completed a survey from told us there were always enough staff on duty to meet the needs of the people they support. People told us good things about the staff at the home. These comments included friendly staff make you feel at home and relaxed and the staff are fantastic. We looked at the recruitment files of two members of staff. Information on the files demonstrated that appropriate recruitment checks had been carried out, which included a record of the persons Criminal Record Bureau check disclosure number. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: We saw that staff had received induction training into their role at Margaret House. All staff stated that their induction covered everything they needed to know. We saw the services training matrix. It demonstrated that staff had received training in moving and handling, emergency first aid, medicine management, adult protection, fire safety, the Mental Capacity Act 2005, catheter care, risk assessment, challenging behavior and confidentiality. We saw that all care staff working at Margaret House had achieved an National Vocational Qualification (NVQ) level 2 and 3 for their role. All staff stated that they were being given training that was relevant to their role, that helped them understand and meet peoples individual needs and that keeps them up to date with new ways of working. We saw evidence on staff records that they had received supervision for their role. Staff told us that their manager gives them enough support and meets with the regularly to discuss how they are working. They told us in their AQAA an area they thought they could improve on was to access more local training opportunities. Care Homes for Adults (18-65 years) Page 23 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place help ensure that Margaret House is run in the best interest of the people who stay there. Evidence: The registered manager had several years experience in working in a social care environment. She had her Registered Managers Award. During this inspection the manager demonstrated a clear understanding of the aims of the service and person centered care practices. The manager completed an Annual Quality Assurance Assessment (AQAA). This document gave the service the opportunity to tell us what they thought they do well, areas they can makes improvements in and their plans for improvement over the next 12 months. The AQAA contained the information we asked for and also some numerical information that we requested. They told us that their policy for quality assurance is accessible to all. They told us they measure the quality of the service by assessing information from staff meetings Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: and gaining peoples views on the care and support they had received at the end of their stay. They told us in their AQAA that internal audits of the service will be carried out annually with the results being published. We saw that they had a health and safety policy. They told us in their AQAA that they had a health and safety officer and that the manager would carry out health and safety audits every six months. We saw that policies and procedures were in place to help protect the health and safety of all. We saw that these documents were last reviewed in September 2009. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R 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 26 of 28 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 Requirement 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 Requirement Timescale for action 1 20 13 The medication policy must be reviewed and more information added. This is to ensure that information and guidance is available for all medication procedures. 20/08/2010 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 1 23 The safeguarding procedures should be reviewed and updated to ensure that it contains clear information about Halton Social Services joint safeguarding procedures. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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