Care Home: Maria Skobtsova House

What the care home does well The home `creates a safe place with familiar faces who the residents know and trust`, said a staff member in a survey. A resident told us they appreciate the `family atmosphere`. Others said they like the art and craft facilities, and `nice food` was a common theme. This large house gives its residents plenty of space and a choice of rooms in which to be sociable if they choose. The care planning and risk assessment practice is thorough, reviewed regularly, and includes the service users. The opportunities for service users to join in planned or impromtu activities is very good indeed, with a programme of activities offered by the sister organisation, the Community of St Antony and St Elias (COMAE) as well as shopping trips and outings arranged within the house. Residents have plenty of choice of good quality food, and can help in its preparation. They are encouraged to be involved in work in the house and garden. One service user helps in the regular check on the household`s expenses. What has improved since the last inspection? A new House Manager and Assistant Manager have been appointed. They have introduced various improvements. A key worker system has been introduced, promoting the quality of interaction between service users and staff and also the accountability of individual staff. We found that the team spirit in the house was very good, and staff reported that this was a considerable improvement. The kitchen was made more suitable for residents to cook by the removal of the large cooker in exchange for two smaller domestic cookers. This enables a choice of meals to be prepared, as well as making it easier for people to cook together. The medication cupboard had been moved to the lower ground floor, to avoid congestion in the main hallway, and encourage the presence of staff on different floors of this large house. A kitchenette was installed in the room next to the kitchen where the medication used to be stored. Drinks and hot snacks can be prepared here at any time. This is particularly important at night, when risk assessment currently requires the main kitchen to be locked. What the care home could do better: The organisation has asked residents if they would like to be involved in staff recruitment. This initiative needs to be seen through, and residents consulted also in the movement of staff from this home to others administered by COMAE to ensure that they feel they are involved and know who will be providing their support. Residents should see the statement of terms provided by the home, and be encouraged to sign it, in order that they know what is included in the service, any terms of notice, and any other issue of importance to them. There should be further promotion of residents managing their own money and medication, within a risk assessment framework. Some good work is already taking place. The records of all medication - including homely remedies must be robust so that the Manager can account for all medication that comes into the house. Work needs to be done to bring the laundry walls to a satisfactory condition so that they can be kept clean. The Manager should apply to register with the Care quality Commission. Key inspection report Care homes for adults (18-65 years) Name: Address: Maria Skobtsova House 27 Houndiscombe Road Mutley Plymouth Devon PL4 6HG     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: Stella Lindsay     Date: 0 1 0 7 2 0 0 9 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 29 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) 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 29 Information about the care home Name of care home: Address: Maria Skobtsova House 27 Houndiscombe Road Mutley Plymouth Devon PL4 6HG 01752221328 01752225988 enquiries@comae.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Maria Skobtsova House Limited care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The home can also accommodate service users with a mental disorder and additional physical disabilities up to 65 years old. The home may accommodate 1 service user named elsewhere with a mental disorder and additional learning disability. Date of last inspection Brief description of the care home The last key inspection was carried out on 9th August 2007. Maria Skobtsova House Limited is a care home providing accommodation and personal care for up to eight people aged 18 - 65, with various mental disorders, some of whom may have a physical disability. Emergency admissions are not accepted nor is intermediate care provided. The home is not registered to provide nursing care. Maria Skobtsova House Limited was registered with the Commission for Social Care Inspection (CSCI) in January 2007. It is owned and administered by Maria Skobtsova Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 8 Brief description of the care home House Ltd. The senior management team is shared with its sister organisation, the Community of St Anthony and St Elias, a private sector organisation owning several other care homes in Devon. The care home is a three storey mid-terraced house located in the residential area of Mutley in Plymouth. All the homes bedrooms are single and are on all three storeys. They all have en suite toilets, and en suite showers or baths or one for private use nearby. On the ground floor there is a large kitchen-diner, two lounge rooms, and an arts and crafts room. The facilities include a shaft lift, and the house has some adaptations for people with physical disabilities, including one ground floor bedroom. The home has front and back gardens with a patio, grass and flowerbeds and all areas are accessible to the people living at the home. There is private parking at the rear of the property and on street parking (pay meter) is available at the front. A full range of amenities and facilities are within walking distance of the home, including bus routes and Plymouth railway station. At the time of this inspection the fees ranged from 1664.14 to 1905.55 pounds per week according to individual assessment of care needs. Care Homes for Adults (18-65 years) Page 5 of 29 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: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection took place on Wednesday 1st July 2009. One inspector carried out the inspection, but the report refers to we as it was carried out on behalf of the Care Quality Commission. Prior to the unannounced inspection we sent questionnaires to people who live at the home, and to people who work there. Their opinions have been represented in the report. The Manager sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It gave us information about the service, and some statistics and records. Care Homes for Adults (18-65 years) Page 6 of 29 During our visit we spoke with four of the five people who were living at the home, the Manager, and four other staff members. We met with residents in the lounge, kitchen and garden. We case tracked two people who use the service. Case tracking means we looked in detail at the care two people receive. We spoke to staff about their care and looked at records that related to them. We looked at staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. All this information helps us to develop a picture of what it is like to live at Maria Skobtsova House. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The organisation has asked residents if they would like to be involved in staff recruitment. This initiative needs to be seen through, and residents consulted also in the movement of staff from this home to others administered by COMAE to ensure that they feel they are involved and know who will be providing their support. Residents should see the statement of terms provided by the home, and be encouraged to sign it, in order that they know what is included in the service, any terms of notice, and any other issue of importance to them. There should be further promotion of residents managing their own money and medication, within a risk assessment framework. Some good work is already taking place. The records of all medication - including homely remedies must be robust so that the Manager can account for all medication that comes into the house. Care Homes for Adults (18-65 years) Page 8 of 29 Work needs to be done to bring the laundry walls to a satisfactory condition so that they can be kept clean. The Manager should apply to register with the Care quality Commission. 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 9 of 29 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 10 of 29 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. Service is offered to people following careful consideration of how their needs may be met, and the support that is needed. Evidence: The homes Statement of Purpose was updated in June 2009, and included up to date information about the staff working at the home and their qualifications. There was a full description of the house, and policies and procedures in place, including admissions. A formal referral from the persons consultant is expected, showing the purpose of the proposed placement, and assurance that the persons medication is stable, and not expecting change within the first six months. Senior staff from the sister organisation, the Community of St Antony and St Elias, would visit the person to make their own assessment of whether a service could suitably be offered. The Manager of the Maria Skobtsova House might accompany them. The person would then be offered as many visits to the house as they wanted. At the time of this inspection, a visit was anticipated from a resident of one of the other homes within the Community. The Manager told us that they were expected for a day visit the following week. There was as yet no written information for staff in the home. The Manager Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: undertook to ensure documentation would be in place before an overnight stay was attempted. We saw that statements of terms had been prepared, but not yet signed by the service user or their representative. This should be carried out, to make sure they know what is included in the service, and any terms of notice. Care Homes for Adults (18-65 years) Page 12 of 29 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. People are involved in their individual plan of care and are supported and encouraged in all aspects of their lives. Evidence: We saw that each resident had a care plan, that had been reviewed within the home. These covered important aspects of their lives, including daily living skills, contact with friends and families, and managing their finances. The residents were supported and encouraged to manage their own daily routines and personal decision-making within any necessary risk assessed restrictions. Care plans inspected were thorough in identifying individual needs and how these could be met. Residents were fully involved in reviews of their own care plans. The Manager had promoted a key worker system within the house. As part of this he had introduced a regular meeting between himself, the keyworker and the service user, to consider the residents care plan, any issues and any progress and ideas. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: Knives were locked away, not because of a foreseen threat of violence, but to ease the anxiety of a resident. All residents had cash held on their behalf in a safe in the house. The accountant for COMAE was appointee for all. There was no documentation in the house, but he told us that they all had bank accounts in their own names, and undertook to send monthly statements so they could see what savings they had, and any interest that had accrued. The Manager was considering whether any resident might benefit from having a small safe fixed to their bedroom wall or some other form of secure storage, to work towards managing their own money, subject to risk assessment. Care Homes for Adults (18-65 years) Page 14 of 29 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. There is a great variety of sporting and creative activities available to residents, and they are supported to explore new opportunities as well as follow their own interests. Residents are involved in choosing and cooking their meals, and encouraged towards healthy eating. Evidence: The Manager had replaced the large commercial cooker in the kitchen with two domestic cookers, to enable service users to cook alongside staff, promoting independence, and improving choice of meals. Everyone was encouraged to participate in all the domestic activities in the home. One person told us they prepare the meals, go out in the car, and do the shopping. They said they were looking forward to going out to buy a playstation. The weather was very warm on the day of this visit. Two residents had decided that morning to go wild swimming, and went in Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: the homes vehicle, accompanied by two staff, to a natural pool on Dartmoor. We were told that the Community employs an Out Door Activity worker, who checks venues for safety before trips are arranged. Staff had use of a car belonging to the organisation that they could use to transport people living at the home when necessary, although those who are able are encouraged to use public transport. One resident had been supported to obtain a ticket for a major musical event in the city. Staff were providing support and encouragement for them to attend. All care plans included plans for helping people to broaden their social horizons. Residents told us about camping and caravan trips, and visits to family members. Faiths were supported within this home. One person was a committed Church member, another accompanied them to services. The Manager said that though there was not a policy on equality and diversity in the home at present, it was at the core of the teams approach to their work with clients, and he planned to draft a policy. We were given a copy of COMAEs Activity Programme for the month that had just passed, illustrated with photos by a resident of this home. This presented interesting and challenging outdoor activities, including valley and moorland walks, canoe barbeques, surfing, and gardening and conservation projects. Craft sessions were connected to community events. For example, lantern-making was anticipated later in the week at Maria Skobtsova house, in preparation for a lantern procession. There were other regular events, including singing, guitar workshops, and indoor swimming. During this inspection we shared lunch with the people who were in the house at the time. One resident chose a toasted cheese sandwich. We were offered an attractive mixed salad, and all sat together round the kitchen table. Care Homes for Adults (18-65 years) Page 16 of 29 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. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: No clients needed assistance with personal care, but prompting, encouragement and support were given, as set out in each persons care plan. One person told us they shower twice a day. We saw clients records showing that they were supported to access health care they needed. There were specific instructions with respect to diabetes support. Each resident had there own consultant psychiatrist. The home also benefits from the attention of a psychiatrist employed by the Community of St Antony and St Elias, who holds a weekly clinic at the home. She is also available for advice and support if emergencies occur out of hours. Observing and responding to residents state of mind and anxiety levels is an integral part of the staffs work in the home. The medication room had been moved to a room that had been newly designated as an office, on the lower ground floor. This was in order that staff are regularly present on different storeys in this large house. It also prevents the main hall being blocked by people receiving their medication, and allows for better privacy. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: None of the people living in the house were assessed as safe to look after their own medication. There was no policy available with respect to self medication, but the Manager was aware that the sister company had such a policy. Painkillers had been purchased over the counter. We were told that a record would be made on the MAR sheet when these were administered, but there was no method of recording how many were or should be in the home. Records for regular medication were seen to be kept reliably, including records of medication taken out during day trips. The Manager undertook to provide a list of staff who had been assessed as competent to administer medication, along with an example of the signature they use in the Medication Administration Records, for accountability. Care Homes for Adults (18-65 years) Page 18 of 29 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. Residents are protected by the openness of communication within the house, and by staff training and knowledge of the procedures to follow in the event of a complaint or allegation of abuse being made. Evidence: Residents who returned surveys all said they knew who to speak to if they were unhappy, and they knew how to make a complaint. The Manager told us that a new Complaints Pack is being compiled, and will be given to all residents. Manager and Assistant Manager have attended training on the Deprivation of Liberty Safeguards. These do not currently affect any resident. All staff had received training on the Protection of Vulnerable Adults from abuse, and those we spoke to knew what to do if they were made aware of any allegation. The homes policy on dealing with abuse did not include the Alerters guidance on what to do in the event of an allegation being made, but the Manager was aware, and undertook to put this in. No formal complaints had been reported to us since the previous inspection. One had been received within the home, which had been from one service user about behaviour of another person who was resident at the time, and whose behaviour was abusive. The Manager took effective action, not only to prevent further harm at the time, but which has also made the house safer and calmer in the longer term. The Manager notified the CQC of the event at the time. The residents care manager was not informed, and there had not been a case review since this event. Care Homes for Adults (18-65 years) Page 19 of 29 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. This spacious house offered residents a choice of places indoors and out for social activities, and all residents had a private room and facilities to suit them. It was well maintained and comfortable. Evidence: Maria Skobtsova House is on a residential street in Mutley, central Plymouth. It is a large and spacious house on three floors. The front door leads into the middle floor, with the lounges, art room, kitchen diner and one bedroom and bathroom. The kitchen is also a general meeting room and has a large wooden table, where all may sit to eat or talk. There are extensive views from windows across a valley and cityscape. A new kitchenette had been provided, where residents can make hot drinks and snacks whenever they like. This is important as it is considered necessary to lock the main kitchen by night. There were two lounges. One was a large room, with a window to the front and to the back of the house, giving a cool breeze on this warm summer day. There was also an arts and crafts room, with many beautiful artifacts made by residents. There is a shaft lift to all floors, as well as staircases. There are three bedrooms upstairs, a bathroom, and the Managers office. On the lower ground floor there are Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: further bedrooms and a care office. Wheelchair users may get to most parts of the house, but not the laundry. Doors lead onto the patio and small garden, again with a great outlook. There is access to the lane at the back where the homes vehicle is parked. A small covered porch had been provided for smokers. The Manager told us they planned to involve residents in designing and building a gazebo, as an improved smokers area. The home is registered for eight residents, who would all have their own room and toilet and shower facilities. There were only five service users in residence at this time. Residents did not have lockable storage space in their rooms, but they had locks to their bedroom doors for privacy and security. The staff on duty had a master key in case of emergencies. Furniture was provided by the home. One resident had purchased a large cupboard with a sliding door and a new bed, by their own choice. The walls in the laundry were rough and dirty, and needed attention. The staircarpets were worn, and the Manager told us that arrangements had been made to have these replaced. A maintenance worker for the company was fitting light bulbs and making other repairs during this inspection. Staff had received training in the control of infection and in food hygiene. Care Homes for Adults (18-65 years) Page 21 of 29 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. The home was staffed by a competent and well motivated team. Management had obtained documents to meet the regulations, and were making arrangements for service users to be involved in recruitment. Evidence: One resident said, - Staff are really good to me, another said they had friendly staff. Another told us they felt they did not always get the 1;1 support they needed when they were down. We saw that staff levels were generally good. On the day of this inspection, the Deputy Manager and three Support workers were on duty, and the Manager later returned to the house from other duties. A resident told us they had been short staffed the previous evening. Three staff had been supporting five service users. We consider this should be sufficient, if staff are effectively deployed, depending on the health and well being of residents at the time. The rota showed that there are between three and five people on duty at all times. Staff said that because of the size of the house, three workers is not enough. This must be given careful consideration, and staff should have a way of communicating with each other on different floors, as well as in the garden and when they are out with clients. We were given a staff rota, which showed staff deployment not only in this house, but also across all the homes of COMAE. The rota is published monthly, usually in the last week before they become current, and staff may be deployed in any of the homes. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: Staff told us they do not mind being flexible, as they keep to the same shift pattern. Service users do not have control over these changes. The Manager pointed out that residents still see previous workers they have built good relationships with at social activities shared by people from the different houses. The Manager said he thought it was refreshing for staff to work with different clients. One of the current staff had been unhappy about being moved from a home in Totnes to one in Plymouth, and was able to discuss this with the Manager during supervision. Transport to work problems are not a great issue however, because the staff work long shifts of up to 48 hours, with accommodation provided for sleeping-in duties. We saw that staff were committed and motivated, and that the residents found them approachable and accessible. A Support Worker told us they enjoy working at this home because you can be yourself and work on your own initiative, living life and not as a rat race. Staff recruitment is carried out by the HR department of the Community of St Antony and St Elias, with involvement of the homes managers. In the kitchen a poster was displayed, inviting service users to be involved in recruitment of the people who would work with them. Service users had met with staff during taster days, during which staff visit some of the homes within the group as part of the recruitment process. The Manager told us that service users views are sought following these encounters, and contribute to the decision-making. We looked at the files of recently recruited staff. The documents needed to demonstrate protection of residents from potential harm had been gathered centrally, and copies had been retained in this home, for inspection purposes, and so the Manager had any pertinent information to hand. We saw that written references and CRB clearances had been obtained. We saw that end of probation appraisals had been recorded. Staff in surveys said that induction covered most of what they needed to know when they started their job. The Manager told us in the AQAA - We have continued to deliver our equality and diversity training as part of our induction training that won a national award. Staff in surveys told us that they felt their induction training mostly covered everything they needed to know when they started their job. They were all pleased with the on-going training provided by the company. Over the past year this had included sessions on Communication - with dignity, understanding body language, using plain English; Deescalation, and Breakaway training, Moving and handling, and Health and safety. We saw that staff were generally well educated, and were supported by management to achieve NVQ levels 2 or 3. Care Homes for Adults (18-65 years) Page 23 of 29 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. This home was being managed with energy and integrity. Senior management was playing a supportive role. Consistency is needed now to take this service forward. Evidence: There had been three managers at Maria Skobtsova House since the last inspection. The current House Manager had worked within the care sector for the past seven years and in a junior management roll for three of those. He held an NVQ 3 in Health and Social care and was studying for an NVQ 4 in Health and Social Care. He told us he is attending a course on supervising adult learners, with a view to supervising social work students in the future. These are good skills for supporting the team. An Assistant Manager had also been appointed. They told us they felt well supported by senior management. The Responsible Individual for Maria Skobtsova Ltd, Mr Simeon Ramsden, is also the Managing Director for COMAE. All administrative support and other resources are shared. It has long been the organisations practice to hold a managers meeting on Monday mornings. Traditionally these were held in Totnes, but over the past year they have been held once a month at Maria Skobtsova House. Staff told us it had the desired effect of being more inclusive, and providing improved Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: support for the Plymouth services. They said they had been through difficult times, but were now happy in their work. The Manager had improved communication with the staff team, by providing pigeon-holes for their post, so they reliably get post and other information, and by promoting the keyworker role within staff supervision. Maria Skobtsova House shares the Health and Safety Policy of the Community of St Antony and St Elias that incorporates policies and procedures relating to all relevant areas including COSHH, RIDDOR, Manual Handling, Food Hygiene and other general workplace requirements. Regular safety audits carried out by staff included the contents of the sharps cupboard, temperatures of fridges and freezers, and hot water temperatures. This is good practice, except that the record said that the water temperature of the downstairs bathroom was cool, but in fact it was very hot, though there was not a thermometer we could use to check it. During the handover to new staff coming on duty (generally at 48 hour intervals) as well as discussing the wellbeing of residents and schedule for the day, staff together check any cash held on behalf of residents, and check the balance of medicines. One of the residents helped check the household cash balance. This was good practice for accountability and inclusion. The fire alarm system had been professionally serviced on 2nd June 2009, and the extinguishers checked during April. The Manager provided us with records of staff fire safety training. It showed that only four of the eleven Support Workers had received this training during the past year, but in-house training occurs on a three-monthly basis provided by a house Manager who is qualified to provide this effectively. The Manager was booked on to a course to train as a Fire Warden later in the summer. Room by room fire risk assessments were due to be carried out professionally later in the month. Care Homes for Adults (18-65 years) Page 25 of 29 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 29 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 There must be a method of recording homely remedies which enables audit so that the manager can account for any medication that comes into the house. 22/08/2009 2 30 13 The walls in the laundry must be smooth so that they can be kept clean and hygienic. 18/09/2009 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 2 3 5 7 20 Statements of terms should be signed by the service user or their representative, as evidence that the contents Service users should be assisted to manage their own money, subject to risk assessment. This home should have a policy on the service users right, within a risk management framework, to administer their own medication. Service users Care managers should always be informed Page 27 of 29 4 23 Care Homes for Adults (18-65 years) 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 when an event takes place in the home that affects their well being. 5 37 The Manager should apply to register with the Care Quality Commission, in accordance with regulation 9 of the Care Homes Regulations 2001. Care Homes for Adults (18-65 years) Page 28 of 29 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. 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 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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