Care Home: Marian House

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What the care home does well What has improved since the last inspection? The home has improved in a number of ways since the time of the last inspection not least in terms of improving the physical environment with the addition of a conservatory that provides a good view of the extensive garden and redecoration and refurbishment in a number of areas. In addition there was evident improvement in respect of documentation relating to residents health care needs, medication administration, equipment and premises checks, and some of the homes procedures (complaints and protection). Residents now have meetings where they can discuss menus for the forthcoming week, this an example of one of the ways in which participation is encouraged. There has been a focus on developing ways in which residents can express themselves within the home and the community through such as access to chosen churches, involvement in day to day routines at the home, enrolment at mainstream colleges and local drama groups as some examples. The above changes are without doubt the result of staff supporting residents to have a say and involvement in the service which all the residents spoken to were very positive about. What the care home could do better: There were areas where the home could improve most importantly in respect of the need to ensure there is clear instruction as to how to use `over the counter` medicines safely (based on the opinion of the individual`s G.P.) and making sure recruitment checks for staff are more thorough in some areas. (so as to ensure they are safe to work with vulnerable people). The continuation of developing alternative formats for presentation of information about the home with use of such as photographs, videos and such like maybe useful and discussion with the current resident group could assist development of these. In addition care plans and risk assessments can be more resident friendly through such as ensuring that care instructions are more compact, written consistently in a person centred way and with use of pictorial or more appropriate formats (dependent on the resident`s views). There is scope to improve the homes policies and procedures and some other areas of documentation as are detailed in the body of the report, not least in respect to the homes recruitment and medication procedures and the use of inventories to detail what property residents have at the home. CARE HOME ADULTS 18-65 Marian House 803 Chester Road Erdington Birmingham West Midlands B24 0BX Lead Inspector Mr Jon Potts Key Unannounced Inspection 15th January 2008 10:00 Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marian House Address 803 Chester Road Erdington Birmingham West Midlands B24 0BX 0121 373 6140 F/P 0121 373 6140 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) Mrs Annette Keogh Mr Thomas Keogh, Mrs Margaret Keogh Mrs Sharon Stirland Care Home 17 Category(ies) of Learning disability (17) registration, with number of places Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Residents must be aged under 65 years with a learning disability. The home can continue to accommodate 6 named service users over the age of 65 years. Than Marian House apply for a variation on behalf of other service users who reach the age of 65 years That details regarding how the specific care and social needs of those people over the age of 65 years will be met, must be include in the service users plan. The statement of purpose must be amended to reflect the age of the service uses accommodated. 23/11/06 5. Date of last inspection Brief Description of the Service: Marion House is a large three storey Victorian House situated close to Erdington, and has been established since 1980. It currently offers a service to residents whose primary needs related to their learning disability, although may in some cases also have a physical disability. The home has mostly single bedrooms (although there are a small number of doubles). There is one lounge, a dining room, a conservatory and two kitchens, one, which is used by the residents. There is ample room for parking on the front driveway and access to the building is via a ramp providing wheelchair access. The large gardens to the rear are well maintained. Local amenities such as shops, banks and GP practice are close by with good transport connections via bus and rail services. There are adapted bathing facilities on the ground floor and a stair lift for access to the first floor bedrooms. The home is managed by a partnership, which includes the registered manager. The home provides 24 hour staffing that consists of a number of seniors who supervise care assistants and some ancillary staff. The homes scales of charges are not currently displayed in its statement of purpose or service users guide. Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people that use this service experience good quality outcomes. This unannounced inspection was carried out over two days and involved the inspector assessing the homes performance against key national minimum standards for younger adults. Evidence was drawn from a number of sources and including tracking the care for three residents (this involving looking at all the documentation in respect of their care and cross checking this with outcomes for the individual), observation of practice, discussion with the registered manager, staff and review of management records. Central to the process was meeting with a number of residents including those whose care arrangements were examined in some depth. Information was also supplied pre inspection by the home’s manager in the form of an AQAA (the registered manager’s assessment of the home and its performance) and from some residents/relatives via CSCI survey forms. The residents and staff are to be thanked for their assistance with the inspection. What the service does well: What has improved since the last inspection? Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 6 The home has improved in a number of ways since the time of the last inspection not least in terms of improving the physical environment with the addition of a conservatory that provides a good view of the extensive garden and redecoration and refurbishment in a number of areas. In addition there was evident improvement in respect of documentation relating to residents health care needs, medication administration, equipment and premises checks, and some of the homes procedures (complaints and protection). Residents now have meetings where they can discuss menus for the forthcoming week, this an example of one of the ways in which participation is encouraged. There has been a focus on developing ways in which residents can express themselves within the home and the community through such as access to chosen churches, involvement in day to day routines at the home, enrolment at mainstream colleges and local drama groups as some examples. The above changes are without doubt the result of staff supporting residents to have a say and involvement in the service which all the residents spoken to were very positive about. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 7 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 Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 & 4 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs; this assisted by the use of gradual and planned pre admission process. EVIDENCE: Marian house accommodates long stay residents and as such there are only occasional vacancies that arise, this meaning that there was only one admission to the home through the whole of last year. This admission did not however take place until the home was confident it was able to meet the individual’s needs, with numerous records showing how the home had commenced a gradual process of integrating the person into the service with the use of short visits to the home, this building up to overnight stays and then admission on a three month trial. In addition the manager and staff spoke about how they visited the individual at a daycentre so as to get to know them and assist the admission to the home (subject to the residents agreement). Sight of planning minutes involving significant others (including the individual’s social worker and advocate) further demonstrated that the admission was planned and also gradual. This Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 9 approach also ensured that the individual was familiar with staff at the home prior to admission and that the views of staff could be shared with the manager. Documentation was seen that recorded information from trial visits and there were notes available as to the individuals needs per admission, this to inform the individual planning for needs post admission. A dedicated staff member was allocated following admission in the form of a key worker, this so that the resident had a dedicated point of contact for discussion. The key workers also have monthly meetings with individuals to discuss their progress and any potential concerns whilst giving them special attention, helping them to feel comfortable in their surroundings, and enable them to ask any questions about life in the home. Whilst the manager was clear admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident, and case tracking the individuals care evidenced that this was the case, there is a need to ensure that the home confirms in writing to the individual or their representative that they are able to do so pre admission. In addition whilst there was clear written evidence that the manager had carried out an assessment the use of a standardised format for recording this information would be useful, this to ensure that information is clearly documented and also dated in all instances. Residents are able to access copies of the homes service users guide as these are made available to them in their bedrooms and a statement of purpose (as well as the last copy of the CSCI’s inspection report) are readily accessible in the homes foyer. Numerous residents spoken to confirmed that they had access to this information. The use of alternative formats for presentation of information such as photographs, videos and such like maybe useful and discussion with the current resident group could assist development of these. The manager was also made aware that the scale of charges for provision of a service at the home need to be included in the homes statement of purpose and/or service users guide. Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Individuals are encouraged to be involved in decisions about their lives, and where possible play an active role in planning the care and support they receive. EVIDENCE: The service has established ways in which it involves individuals in the planning of care which affects their lifestyle and quality of life, this primarily through key workers having monthly sessions with residents where they discussion their satisfaction with the individual service provided to them. In discussion the staff were well aware of the need to support residents involvement and where possible control of their own lives, with individuals encouraged to make their own decisions and choices. This was confirmed by a number of residents spoken to. Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 11 Strategies for communication plans are included within plans although some of the detail could have been more specific as to exactly how staff communicate, with the knowledge of staff exceeding what was actually documented, this also seen to be the case in practice when communicating with individuals. Information that was seen to be documented in respect of communication was however seen to be accurate based on observation. Care plans are agreed with the individual and written in plain language (some type written in a larger than standard font), are easy to understand and look at all areas of the individual’s life, with reference to issues that impact on ensuring equality and diversity is considered within day to day care. Staff evidenced in discussion, and through observation of their interaction with residents that they have skills and ability to support and encourage residents to be involved in the ongoing development of their plan. A key worker system allows staff to work on a one-to-one basis and contribute to the care plan for the individual through a minimum of monthly reviews with the individual. There is however scope to develop such as care plans so that they make more use of pictorial formats, and are more concise so as to assist residents understanding, although staff and the manager underlined the importance of verbally explaining information at a pace and in a way that the individual was able to understand. The plan is written based on information received from the individual or/and their representative, and includes a range of information that is important to them, this evidenced through discussion with the individuals and their key workers. There was indication based on individual’s comments that there were some areas where update maybe appropriate due to changes in preferences. Plans were supplemented by additional information in risk assessments that detailed how the individual could be kept safe with consideration of ensuring independence was not compromised. The home has developed separate health action plans that clearly showed a move to developing plans that were written in a manner that highlighted a person centred approach in so much that there was an effort to approach it from the resident’s perspective. The home ensures that residents are consulted regularly to gather information about their satisfaction with the home through key worker meetings and questionnaires (these in pictorial format). The later are used in the development and review of the service. Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 12 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): 12,13,15,16 & 17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The residents are encouraged to make choices about their life style, and supported to develop their life skills through leisure activity and occupational opportunities. Social, educational, cultural and recreational activities meet individual residents’ expectations. EVIDENCE: Based on discussion with the manager, staff and a number of residents and observation during the course of the inspection the service was seen to enable residents to develop or maintain their skills in a number of areas including independent living. Individuals are supported by staff to identify their goals, and work to achieve them. People who use the service have the opportunity to develop and maintain important personal and family relationships dependent on their wishes with Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 13 support from staff as needed. The practices of the home promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices through risk assessment. Staff are aware of the residents communication needs (although all this knowledge is not always transposed into care plans) and this is applied to assist residents with communication so as to enhance residents involvement in their chosen daily living activities whether within the house or community. The encouragement of residents involvement in regular art sessions is a way in which residents are able to express themselves, one resident spoken to clearly having pride in the paintings that he was able to display in the home. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities with planning assisted by key workers, on going review and the use of questionnaires to measure satisfaction. These activities include involvement in domestic routines (housework and cooking), leisure and where appropriate, education and occupational opportunities. Residents confirmed their involvement in college attendance and certificates of their achievements were displayed in the home. Where residents are able they are supported to pursue paid employment. The ethos of the home is to encourage residents to have involvement in the community and this can be access by residents independently (where they are able) with use of such as using public transport or with support from staff. The home has two vehicles to assist with transport, one large, and the other smaller. Discussion with the manager did however indicate that she was not complacent and wanted to further develop the opportunities available to residents by reviewing staffing so residents could have more late night activities where they could socialise (i.e. discos/concerts), more sport related activity (special Olympics, swimming, gym), locally based reading sessions and access to development of PC skills (with plans to fit a PC in the homes conservatory). These plans are based on the views sought from the resident group and reflect some of the plans in the homes quality assurance programme. The residents have weekly menu planning meetings, these seen to be documented, where they will plan the forthcoming weeks menu, this including two choices every day and a cooked breakfast every morning (this confirmed by residents spoken to). The menu is varied with a number of choices including a healthy option, and a variety of dishes that encourage individuals to try a range of foods. Residents spoken to expressed satisfaction with the quality of the meals available and the choice of foods, with confirmation that culturally appropriate options were made available. Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs and preferences with staff putting the principles of respect, dignity and privacy into practice. The homes medication policies, procedures and practices need strengthening in some areas to ensure they are safe. EVIDENCE: The home was seen to be developing a person centred approach to care planning through the recent introduction of healthcare plans which are written from a resident’s perspective unlike some of the existing care plans. Care plans are however clear as to how residents should receive personal support and discussion with some residents and key workers underlined the fact that these are understood and generally follow the residents expressed choices and needs (based on assessments). Discussion with residents and staff reflected ways in which individual personal support is responsive to the varied and individual needs and preferences of individuals with the support of key workers ensuring there are clear channels through which residents can discuss their satisfaction with the care provided. Staff are aware of how to show respect for resident’s Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 15 privacy and dignity and are sensitive to changing needs. The service listens and responds to individuals’ choices and decisions about who delivers their personal care. People said that they are supported and helped to be independent and can take responsibility for their personal care needs where possible as seen to be set out in plans. Staff were seen to listen to residents and had a clear knowledge of what was important to them that concurred with what the individual resident’s views. Personal healthcare needs including specialist health and nursing requirements are now recorded in health action plans that are written in a person centred way. Whilst there are not standardised risk assessments in respect of such as nutrition, moving and handling and tissue viability (where these are appropriate) details of such as an individual’s preferences as to how they are moved or what their nutritional needs are have been detailed in care plans. Where there maybe any issues with tissue viability assessment was seen to have been carried out by community health services. Overall there was a detailed overview of individual residents health needs documented and records showed how the home or over health services were responding to these. In respect of all those residents whose care was tracked there was clear evidence that access to healthcare and remedial services is supported by the home. Where ever able residents are encouraged to visit their G.P. at the local surgery and residents are encouraged to pursue healthy lifestyles with support for such as giving up smoking. Residents have the aids and equipment they need and these are well maintained to support them and staff in daily living, with adjustments made to the building wherever possible to support the changing needs of residents (an example been the provision of a downstairs ensuite bedroom for a resident with limited mobility). The home has a medication procedures although these are brief and do require expansion to provide more detail as to how to safeguard residents and ensure the procedures cover all areas of practice (for example homely remedies or medication that is not prescribed). There was evidence that the home does administer homely remedies such as homely remedies including such as paracetomol and Imodium without reference to the residents G.P. to ensure that there are no contra indications with other medication taken. There needs to be clear protocols in place stating what homely remedies that a resident may take safely, these agreed with the individual’s G.P. It was also noted that records of disposal did not include detail of exact amounts/number of drugs returned. Medication records in respect of administration were seen to be fully completed, contain required entries, and signed by appropriate staff (seniors that had participated in medication training). None of the current residents self medicate and the manager expressed the view that this was an area where working with some individual’s may give them the confidence to do so. Residents have given consent to the home handling their medication however. The home does not at this time handle any controlled drugs. Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure. Staff practices ensure that the need for limitations and restraint are reduced and residents are protected from abuse. EVIDENCE: The residents spoken say that they are happy with the service provided, feel safe and well supported by a management and staff team that has their protection and safety as a priority. The service has a complaints procedure that is clearly written and easy to understand, and is also available in an easy to understand pictorial format, this made available to residents in folders that they retain in their bedrooms. There are also regular key worker sessions with residents, meetings and questionnaires specific to certain activities with the home that give residents opportunity to raise comments or concerns. Residents spoken to are aware of the complaints procedure understand how to make a complaint and are clear about what will happen if a complaint is made. The home keeps a record of complaints, these brought to the attention of the CSCI where appropriate. Unless there are exceptional circumstances the service responds within the agreed timescale. The home learns from Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 17 complaints, and the manager sees any comments made as useful information that may assist with improving the service. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff in discussion were aware of what may indicate potential abuse and when incidents need external input and who to refer the incident to. The manager and staff understand the procedures for safeguarding adults. There have been no referrals made since the last inspection this judged to be as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. The home does not however have a copy of the local authorities safeguarding procedures and the manager was advised to obtain a copy of the same for use in the home. Training of staff in safeguarding is regularly arranged by the Home, this evidenced by certificates and the knowledge of staff. Staff understand what restraint is and alternatives to its use in any form are always looked for, this so as to avoid the use of such. An example of this is the use of moulded seat in wheelchairs to reduce the risk of residents falling forward in preference to lap belts which staff and management identified as a form of restraint. The approach of the home is to minimise any limitations and barriers to residents within the home and as such from case tracking three residents care there was seen to be little in the way of limitations above and beyond any physical restrictions due to resident’s abilities. There is a need for the manager to ensure that a copy of the guidelines in respect of the Mental Capacity Act 2005 is readily available within the home, this to inform staff practices and review of policies and procedures. Marian House DS0000016972.V345323.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25, 26, 28 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Management’s on-going improvement of the physical design and layout of the home is seen to be advantageous for the people who live there, providing them with a safer, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The home has been subject to a degree of updating since the time of the last inspection this to improve the physical environment. Improvements have included the following: • The addition of a new conservatory onto the rear of the property this providing additional communal space. • The provision of a downstairs en-suite bedroom for a resident whose needs would make use of the chair lift difficult. • A move to provide more single as opposed shared rooms. Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 19 • • On going redecoration/refurbishment that has included the fitting of additional lighting in some areas. Refurbishment of some of the bathrooms. The generally well-maintained environment provides a number of specialist aids and equipment to meet resident’s needs. The home is a very pleasant, homely and safe place to live the bedrooms and communal rooms meet the NMS or are larger. Residents are encouraged to personalise their bedrooms as was seen to be the case and those residents spoken to are positive about the environment in which they lived. Residents where ever able had access to keys to their rooms and told the inspector that they had access to lockable areas. All the home’s fixtures and fittings meet the needs of individuals and as seen through changes made at the home can be adapted to suit individual’s needs. The home is well lit, clean and tidy and smells fresh. The management and the staff spoken to understood the rudiments of good infection control. Management understood the need to seek advice from external specialists, such as NHS infection control staff if needed, and encourage their own staff to work to the home’s policy to reduce the risk of infection. Marian House DS0000016972.V345323.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34, 35 & 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service although some areas of recruitment procedure and practice need to be more robust to ensure residents are protected. EVIDENCE: The individuals that we spoke to have confidence in the staff who care for them and observation of staff interacting with residents showed evidence of positive relationships. Staffing rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busier times of the day and changing needs of the people who use the service. The manager has also identified where this could be improved further and has stated in the AQAA that staffing arrangements could be more flexible so that residents could have more late night activities. The staffing rotas, and validation of these on the days of the inspection show that there are consistently enough staff available to meet the needs of the Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 21 people using the service, with more staff being available at peak times of activity, this tailored as needed to address individual levels of dependency. Based on discussion with individual staff and sight of their staff files the staff team undertake external qualifications beyond the basic requirements of the NMS, this encouraged by the management who in discussion clearly identified the benefits of a skilled, trained workforce. Residents who use the service stated that the staff working with them support them in their chosen lifestyle and are consistently able to meet their needs. The manager does however need to develop a clearer overview of what training staff hold at any one time through use of a training plan that meets Skills for Care standards. Staff receive relevant training that is focussed on delivering improved outcomes for residents. The home puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people in a person centred way. The service has a basic recruitment procedure that needs review to ensure that it meets statutory requirements and the NMS. The procedure is followed in practice and there is recording at all stages of the process, although it was noted that: • • All the disclosures obtained by the home were standard and not enhanced as is required. The manager has given a written commitment to obtaining enhanced disclosures for all the staff team. There are occasions where there were gaps in the staff’s working histories. New staff are involved in working at the home in addition to the usual staff complement when first employed and then work through common induction standards and any necessary mandatory training. New staff are encouraged to commence a vocational qualification at this point. The manager despite having tried to source learning disability framework input has had difficulties due to the lack of availability within the local area. This is training the manager stated she is looking to source from a closer venue (so that staff are able to access). The home does not currently use agency staff, with any vacant hours covered by employed staff. There has been little turn over in the staff team and this has aided the consistency of the service, as well as assisting all staff to attain a vocational qualification to at least level 2 in care. There was also limited documented evidence of staff supervision (on a one to one basis) although discussion with staff did indicate that this did occur with the manager observing staff in practice and also setting them sample scenarios of practice situations for them to work through and discuss. This was confirmed by the manager who was aware that recording in this area needs to be better. Marian House DS0000016972.V345323.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39, 41 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and has a increasing emphasis on improvement that is driven by the views of residents, these elicited by a qualified, competent manager. EVIDENCE: The manager, who is also one of the joint owners of the business, has an NVQ level 4 and other management qualifications as well as training qualifications related to areas of mandatory skill needed by staff (i.e. health and safety, moving and handling). She also has numerous years of experience of working at a senior level at the home that have assisted a clear understanding of the key principles and focus of the service, and a vision for its future development that fits in with organisational values and priorities; these in part led by the Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 23 views gained from the residents. The manager was clear that despite improvements to the service she has clear plans to further improve so as to provide an increased quality of life for residents with part of this a continuing focus on equality and diversity issues and promoting human rights, especially in the areas of dignity, respect and fairness. The manager saw the views of residents as essential in shaping service delivery in respect of their lifestyles, cultural needs and day-to-day care. The AQAA received from the service was found to contain clear and relevant information that is supported by a wide range of evidence, with sampling of the same validating the statements and information given by the manager. Whilst there has been some review of the homes policies and procedures these do require further review to ensure they reflect the full expectations of the NMS and current developments and outline clearly how the home is to meet all its legal obligations and address its aims and objectives. The staff team did however understand the manager’s expectations and from discussion with a number of staff there was evidence that staff receive constructive feedback on their work. The home works to a clear health and safety policy. Staff spoken to are fully aware of the safe working practice and have received training in the same. Regular random checks take place in respect of the safety of the building and its fixtures, fittings and equipment. There are no issues where the home has any difficulties meeting relevant health and safety requirements and legislation; this assisted by improved monitoring arrangements of late. Records are of a fair standard and are routinely completed. The manager ensures individual risk assessments involve the residents in their production although there are some areas where general risk assessments in respect of safe working practice would benefit from review (although some were found to be thorough) based on the expectations of the NMS and the local environmental services department. People are supported to manage their own money where possible and discussion with residents indicated that they were satisfied with the arrangements that were in place. Systems for the management of resident’s money showed that there was a clear audit trail where the home handled these. Where residents lack capacity the manager needs to ensure that any decisions made are in accordance with guidelines set down in response to the Mental Capacity Act 2005. Individuals were seen to have access to their records as was evidenced by their signing them and having information available in their rooms. There was noted to be a lack of inventories completed for each individual, and the manager was advised that these would be beneficial in ensuring that the home and the resident was clear as to exactly what property of theirs was kept in the home, this in the advent of items going missing or been misplaced. Marian House DS0000016972.V345323.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 X 2 3 3 3 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 3 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000016972.V345323.R01.S.doc 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 4 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Marian House Score 3 X 3 X 2 2 X Version 5.2 Page 25 3 3 2 X Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The registered persons need to ensure that there are clear protocols in place stating what homely remedies a resident may take safely, these agreed with the individual’s G.P. Timescale for action 15/03/08 2. YA34 18 1(A) 19 (4) This in part is a repeated requirement from the previous inspection report that was to have been met by the 14/1/07. The registered persons must 15/05/08 develop the homes recruitment policy to ensure: • That new and all existing staff have an enhanced disclosure (as opposed to a standard one). • That gaps in applicant’s employment history are accounted for. This is to be carried out to ensure staff are safe to care for vulnerable adults. Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 26 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. 2. Refer to Standard YA1 YA1 Good Practice Recommendations The registered person’s should continue development of the use of alternative formats for presentation of information such as photographs, videos and such like. The registered person’s should ensure that the scale of charges for provision of a service at the home are included in the homes statement of purpose and/or service users guide. The registered person’s should develop a standardised assessment format for use when assessing potential admissions to the home, and for reassessment of existing residents. Based on such an assessment process the registered person’s should also confirm in writing to a prospective resident that the home is able to meet their needs. The registered person’s should consider ways in which care plans and risk assessments can be more resident friendly through such as ensuring that care instructions are more compact, written consistently in a person centred way and with use of pictorial or more appropriate formats. The registered person’s should ensure that the medication policy and procedures are reviewed and revised in accordance with Royal Pharmaceutical Society guidelines for care homes. The registered person’s should ensure that records of medication disposal (returns to pharmacy) detail the exact amounts/number of drugs returned. The registered person’s should obtain a copy of the local authorities safeguarding procedures for use within the home. The registered person’s should obtain a copy of the guidelines in respect of the Mental Capacity Act 2005, this to inform staff practices and review of policies and procedures. The registered person’s should develop a clearer overview of what training staff hold at any one time through use of a training plan that meets Skills for Care standards. The registered person’s should ensure that there is an inventory of individual residents property completed; this DS0000016972.V345323.R01.S.doc Version 5.2 Page 27 3. YA2 4. YA6 5. YA20 6. 7. 8. YA20 YA23 YA23 9. 10. YA35 YA41 Marian House to ensure that the home and the resident are clear as to exactly what property of theirs was kept in the home, this in the advent of items going missing or been misplaced. Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Marian House DS0000016972.V345323.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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