Care Home: Martha House

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What the care home does well The home is careful to ensure staff know about and could meet the needs of possible new residents. People can also visit and stay at the home to check if it suits them. Residents have plans showing their needs, likes and any risks. Plans help staff to know the care they need and their wishes so they can give them the right, safe support. Residents are enabled to take part in a range of activities and therapies that benefit them. Staff also support them to go out in the community. One person`s relative says in their survey "there are plenty of activities and therapy sessions to ensure that Xs life is of good quality with plenty of stimulation and interactions with others". Relatives of residents say they are very happy with the service provided. Their comments include "at Martha House the focus is solely on the wellbeing of residents" and the home "looks after people with great care and dedication, enhancing their lives" and "Martha House provides an excellent service of care, therapy and activity". Residents have good support from staff with their personal care. Their health needs are monitored and the home ensures that they have any aids and equipment they need. Staff also manage residents` medicines safely in the home on their behalf. Martha House is in a good place near Hereford city. It has large, lovely gardens and plenty of space and facilities inside. The house is well maintained and is kept safe, clean and fresh, so offering a suitable, comfortable and pleasant home for residents. Staff receive good training about the specific needs of residents` and how to manage them. This helps them to meet their needs properly and keep them safe. The service is well run by Martha Trust and the management team, who ensure that residents receive good and consistent care. What has improved since the last inspection? Since the last inspection on 12th June 2007 the following improvements were made:The home is setting up more "person centred" plans. These plans focus more on individuals` choices, personal interests and goals and the support each resident needs to meet and/or achieve them and have an individualised lifestyle. The home continues to seek opportunities for activities and enable residents to go out in the community more. This should help them to develop their life and social skills. There are two sittings at meal times. This means that mealtimes are quieter and staff have more time to give residents individual assistance. Staff had more training on safeguarding vulnerable people so they should know when, how and where to report an incident or suspicion of abuse or neglect of residents. There are ways of monitoring how the home is run, with plans made to improve and develop the service for residents` benefit that is also based on their relatives` views. What the care home could do better: Communication techniques, such as pictures, objects and signs, could be used more by staff to help residents make choices about their routines, activities and lifestyles. Make sure when bedside rails are used in the home that this has been assessed and agreed by relevant professionals with consent obtained, which is all recorded. This is so that only suitable bedside rails are used appropriately to keep residents safe. Make sure that necessary checks are always taken up for new staff. This is part of the process that confirms new staff are suitable to work caring for vulnerable people. Progress with their programme for more staff to achieve a social care qualification. This would give more of the team the knowledge and skills to support residents better Key inspection report Care homes for adults (18-65 years) Name: Address: Martha House Hampton Green Old Eign Hill Hereford Herefordshire HR1 1UB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Christina Lavelle     Date: 1 5 0 6 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 31 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 31 Information about the care home Name of care home: Address: Martha House Hampton Green Old Eign Hill Hereford Herefordshire HR1 1UB 01432279314 01432271585 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.martha-trust-hereford.org.uk Martha Trust Hereford Limited care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The home may also accomodate children who also have a physical disability The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 14 Date of last inspection Brief description of the care home Martha Trust Hereford Limited was established as a company in 1996 and is also a registered charity. Martha House was opened as a care home in 1997 to provide accommodation with nursing care for children and younger adults who have profound physical and learning disabilities and are non ambulant. This mix of age groups is unusual and runs counter to mainstream philosophy and current practice for social care services, however the continuity of service beyond childhood is central to the homes philosophy. The home provides lifelong care for twelve people with the other two Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 14 Brief description of the care home places allocated for respite care to support peoples family or carers. Martha House is situated in a quiet residential area about a mile from the centre of Hereford city. The premises are purpose built and many specialist aids, adaptations and equipment are provided. There are also therapy rooms such as for physiotherapy (with rebound therapy), sensory facilities, a music room and a hydrotherapy pool. The grounds are large and the gardens were designed with a number of separate areas including raised beds, lawns and patios. Pathways are all level and the gardens can be used for shared activities and as private space. People living or staying at the home all have their own bedroom and there is plenty of communal space. Information about the service is provided in a statement of purpose and residents guide document, which can be obtained from the home. Fee levels for the service are agreed between the Trust and the funding authorities of people using the service and are assessed depending on their individual care needs. No specific additional charges are made by the home. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is a key inspection of the service provided by Martha House. This means all the standards that can be most important to people using care services are assessed. As part of the inspection we, the commission, visited the home for ten hours over two days. Our first visit was made without telling staff or people using the service beforehand. Martha House staff, and others involved with the home, call people who live or have respite care there residents and we will refer to them as this in our report. We use a range of evidence to make judgments about the quality of the service. We discussed how the home is run and plans to develop the service with the manager and Trust director. It is difficult to ask residents directly about their lives and experience at Martha House because their disabilities limit their communication. We therefore spent time with them observing their activities and interactions with staff and other people. We spoke with four staff individually about their role, training and support and Care Homes for Adults (18-65 years) Page 6 of 31 residents care and lifestyles. We also discussed the service with several other staff and four of the residents relatives. We received surveys asking their views of the service from ten relatives of people who are currently using the service, five staff and four health or social care professionals. All their feedback is referred to in this report. We looked around the premises and at some of the records that care services are required to keep. They include residents care records and others about staffing, menus and medication. An annual quality assurance assessment (AQAA) had been completed before our visit. The AQAA asks managers to say what their service does well and how this results in good outcomes for people. It tells us what they could do better, what has improved in the last 12 months, their plans for future improvements and includes some numerical information about the service. All other information we have received about the home since the last key inspection is also considered. This includes events that had affected the health, safety and welfare of residents (we call these notifications), complaints and allegations. The AQAA shows 14 concerns were raised with the home since the last inspection. They were responded to and resolved within specified timescales. One complaint was made to the commission, which was referred under local multi-agency procedures for safeguarding vulnerable adults. This complaint included an allegation of staff misconduct that was referred back to Martha House for investigation and not upheld. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? Since the last inspection on 12th June 2007 the following improvements were made:The home is setting up more person centred plans. These plans focus more on individuals choices, personal interests and goals and the support each resident needs to meet and/or achieve them and have an individualised lifestyle. The home continues to seek opportunities for activities and enable residents to go out in the community more. This should help them to develop their life and social skills. There are two sittings at meal times. This means that mealtimes are quieter and staff have more time to give residents individual assistance. Staff had more training on safeguarding vulnerable people so they should know when, how and where to report an incident or suspicion of abuse or neglect of residents. There are ways of monitoring how the home is run, with plans made to improve and develop the service for residents benefit that is also based on their relatives views. Care Homes for Adults (18-65 years) Page 8 of 31 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that Martha House could support them. This is because a full assessment is made of their needs, which they, their family and representatives have been involved in. This means the home knows about the care they need and their likes and dislikes before they are offered a service. Evidence: It was confirmed in the previous inspection that Martha Trust has a written criteria and procedures in place for when people are referred for a placement at the home. This specifies that an initial assessment will be carried out of their needs and information will be obtained from their family, carers and relevant other people. There is a statement of purpose for the service, a brochure and website, which provide information about the home and the service and facilities provided. Residents families confirm in their surveys that they were given enough information about the home and most professionals in their surveys indicate that the homes assessment arrangements ensure accurate information is gathered and the right service is planned. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: The manager and senior nursing staff are responsible for assessing the needs of prospective residents or people requesting respite care. They always meet the person and complete a detailed pre-admission assessment of their needs. As their AQAA says they also see if they will fit in with existing residents. We looked at the care records of a person who recently moved into the home for a trial stay. They include details of their background, condition and needs with information about their health and assessments made by health care professionals. The homes pre-assessment had been fully completed with a description of the persons personality, likes, dislikes and leisure interests obtained from their family. We discussed this persons admission with one of the homes senior carers who is allocated to oversee their support. The process had involved their family visiting Martha House to look around and the person then spending four days at the home during the day to meet staff and residents. Following this a trial stay was arranged with one relative staying overnight to help them settle in and liaise with staff. The senior carer is now in daily contact with the family to discuss how they are getting on. An initial care plan was drawn up showing all the potential residents personal, health and any special needs. The senior carer says that staff continue to check out their wishes and preferences during their trial stay and an initial activities programme has been set up. A review meeting will be held at the end of their trial stay, with the individual and their family, home staff and their care manager, when a decision will be made about the suitability of the placement and a contract would be agreed. Care Homes for Adults (18-65 years) Page 12 of 31 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. Each resident has a care plan showing their needs and the support staff need to give them. Whilst their plans include their likes and dislikes they could better reflect peoples personal goals and how their choices and life skills are promoted. Possible risks to residents safety are also assessed so that they can be minimised. Evidence: The home recognises that residents should be involved in planning their own care and make choices about their lives and routines. One care worker says in their survey that we care for residents as individuals and are always thinking about their needs. The home is currently developing more person centred care. This means there will be a greater focus on individuals choices and goals so their plans should better reflect how they can be supported to achieve their goals and follow their personal interests. We looked at a sample of residents care plans. Some progress has been made to draw up more person centred plans, which include a personal account of individuals wishes and preferences. This can also include life books and some people have photos Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: of their families and activities they enjoy etc. providing information about them, their background and current interests and lifestyle. An important part of the person centred process is enabling people to make decisions about their lives. One resident has a communication aid and another uses a webcam to contact their family but there are other effective communication techniques that could be used such as pictures and objects of reference to help residents make more choices. Some peoples plans have limited details about their communication, for example one just says to offer them two choices but not how and in what situations. Some plans we looked at are based on needs assessments that were carried out quite a while ago. Although they cover relevant areas, and have been reviewed periodically, they focus mostly on needs not on peoples wishes and goals. Plans and daily reports should also reflect their achievements and progress to meet identified goals better. Senior carers are appropriately taking more of a role in developing person centred care. They are allocated to certain residents as their key worker and aim to have closer links with their relatives. Senior carers also oversee a team of key carers who offer more personalised support to their allocated residents. Families and advocates should also be involved in care planning and the AQAA says relatives are invited to care reviews and their comments and suggestions are obtained informally. Current residents have close family links but it was previously confirmed the manager is aware of the availibility of local advocacy and said that the home would access this service if a significant issue arises or for residents who do not have representatives. Risk assessments had been completed for each resident. They primarily relate to safety hazards associated with their personal and health care. The homes physiotherapist has assessed that some people need bedside rails and ensures the rails provided meet their individual needs and are safe. These risk assessments should also be agreed and signed by peoples family or an advocate on their behalf if they are unable to give their consent, as bedside rails are considered to be a form of restraint. Care Homes for Adults (18-65 years) Page 14 of 31 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. Residents are enabled to take part in a wide range of activities within the home and to go in the community. Their dignity is respected in their daily lives. The home supports and promotes residents family links and provides suitable, healthy meals they like and assists them in ways that meet their needs. Evidence: Staff understand that residents should be supported to take part in a range of therapeutic, developmental, social and leisure activities within the home and out in the wider community. The AQAA says the home provides a broad range of purposeful and therapeutic activities throughout the day time. Staffing ratios are high because of the level of support that residents need and qualified therapists are employed to provide physiotherapy, music, massage and other complementary therapies. Residents relatives are very positive about the activities and therapies the home offers. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: The home has a designated activities co-ordinator who organises activities and sets up individual weekday activity programmes based on peoples needs, with the involvement of senior carers and physiotherapists. These programmes should link in with residents person centred plans to reflect their personal interests and social needs and how they are being met and their life skills developed. The AQAA says that staff observe their activities and note which they enjoy most and suggest new activities. At home people use the hydrotherapy pool, rebound, music and sensory facilities. Sessions such as music, art, pet therapy and cooking are arranged. We saw residents being supported to join in with music and pet therapy groups, which they seem to enjoy. New opportunities are being sought out in the community. Although it is difficult for most residents to take up work or educational placements, due to their level of disabilities, since the last inspection some people are now involved in projects at a local college and farm. Some residents go out more to a local social club for people with learning disabilities, to pubs etc. and to do their personal shopping. The home has several vehicles that can accommodate wheelchair users for outings and annual holidays. Residents are also supported to go out in their wheelchairs locally to Church services, coffee mornings, shops and to a hairdresser/beauticians salon. Residents families say they are kept involved and updated about their relatives. Most people have families who take an active interest in the service and have ongoing input. Some go home to their parents often for weekends. The home has a designated family room where visitors can be seen in private or stay over, as one parent did recently when their child moved in for a trial stay. Families are invited to regular social events and are represented on the Martha Trust committee. One comments that we are welcomed whenever we visit, always without notice and another as parents we are always made welcome and staff are always prepared to listen and discuss Xs needs. The home has a policy about visitors and ex-staff visiting the home. The principles of respect and dignity are covered with staff as part of their induction. Staff were seen to be kind and caring to residents and to give them personal support quietly and sensitively. There were no raised voices or rushing about seen and the atmosphere in the home was calm and relaxed even at the busier times of the day. Professionals say in their surveys that privacy and dignity are always respected. One comments the home helps residents to live as fully and happily as possible and another it offers residents a varied and enjoyable life to the best of their abilities. Regarding food provided by the home the AQAA says there are now two meal sittings and menus are displayed in the dining room. The home employs qualified cooks and other catering staff. We spent time in the kitchen at lunch time and spoke with the Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: cook. The kitchen was very clean and there are appropriate hygiene arrangements and cleaning schedules and fridge temperatures are checked, with records kept. The cook understands healthy eating. Menus include nutritious meals, which are all prepared using fresh ingredients and seasonal vegetables. Fresh fruit is provided and also used in puddings etc. Although the set menu only covers two weeks there is an imaginative range of meals. Todays home made quiche with sweet potato mash and honey looked and tasted delicious. We saw that food stocks included yoghurts, cereals, porridge, wholemeal bread, lots of fresh fruit and vegetables including leeks, beetroot and peppers. Cook says that meals cater for individuals needs and they set up menus with managers, choosing meals that are most suited to vulnerable people. Residents food likes, dislikes and special dietary needs are listed and known by cooks. Each person has a food chart and special plan with guidelines for staff on particular techniques so they receive appropriate support when assisted to eat and drink. Some people have aids such as placemats and cutlery to help them support themselves. One person has input from a dietician and their food intake is closely monitored. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive the personal support they need. Their health needs are monitored; relevant input is given or sought and if necessary there are procedures in place for staff to follow. Residents medicines are managed safely in the home for them. Evidence: Residents plans include their personal and health care needs and their prescribed medication. Any special needs relating to such as continence, nutrition and skin care (with risk assessments) and their morning and night routines are also specified. Most people require a lot of personal support from staff and charts are kept of all aspects of care they receive, for example teeth cleaning. We saw that residents were well presented and appropriately clothed to suit their age, disabilities and activities. Residents specific needs in relation to their condition and physical disabilities have been assessed by relevant professionals, in particular physiotherapists, and they have any individualised aids and equipment they need such as hoists and wheelchairs. Therapists are employed and they access input from other health care professionals as needed. Staff receive training in areas relevant to care provision such as moving and handling, posture management and facial and oral tract therapy (FOTT). It is good Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: that further training from a speech therapist and on sensory impairment is planned. Plans detail support people need in relevant areas with records of physical checks such as weight and food intake kept and body charts completed to show rashes, marks or injuries. There are guidelines for staff about conditions such as epilepsy and diabetes. Nursing staff carry out routine checks such as blood pressure and senior nursing staff take responsibility for an aspect of practice including continence management, medication and pressure area care. Any health care input and appointments attended are recorded showing any treatment and outcomes. Feedback from health care professionals surveys confirms residents health needs are always monitored, reviewed and met. They also confirm that the home always seeks advice to meet residents needs and improve their wellbeing and manages their medicines appropriately. Although all the evidence indicates that residents health care needs are being monitored and met the Department of health recommends that people with learning disabilities should have an individual health action plan (HAP). These HAPs would help to confirm that residents good health is being promoted through preventative, as well as routine and specialist care, input and through having a healthy lifestyle. Regarding medication the home has a policy and procedures for management in the home. There are separate guidelines for specific medicines, controlled drugs and when any can be taken as and when required. The home has a suitable lockable storage cupboard, a controlled drugs cabinet, a medication fridge and a trolley taken out at meal times. Only qualified nurses hold the keys and administer medicines. It was previously confirmed that new staff have an induction, working alongside other trained staff and then have an annual medication medication management refresher. Each residents records include their photograph, prescribed medicines, any allergies and specific guidance and protocols. Their relatives had signed consent forms on their behalf, as none are able to self administer. Records of medications kept, administered, ordered and received are completed and we saw are being maintained appropriately. There are also systems in place to check medication stocks so there can be an audit trail and any discrepancies would be noted and followed up. One senior nurse takes primary responsibility for ordering and monitoring medication in the home. Care Homes for Adults (18-65 years) Page 19 of 31 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. If people have concerns about the service they know how to complain and their concerns are looked into and dealt with. There are systems in place to safeguard residents from abuse and neglect and the home takes action to follow up allegations. Evidence: Martha Trust provides a complaints procedure and residents families are given a copy. Their relatives all say in their surveys they know about the complaints procedures, one comments we visit several times a week and if we are unhappy we are able to broach this with Xs senior carer, primary nurse or the director of nursing. The AQAA says that staff are encouraged to raise concerns with senior staff and managers and that they are dealt with promptly. The homes management has made efforts to become more accessible to staff and now regular meetings of the various staff teams are held when they can raise issues and express their views. Staff confirm they would know what to do if any concerns are raised with them. The AQAA shows 14 concerns were raised with the home in the 12 months before it was completed. The home keeps an appropriate log of complaints, which we checked. It is apparent that efforts are made to record any concerns raised and they had all been looked into promptly and action taken to resolve them and/or an apology given. One complaint had been raised with the commission, which alleged that care practices Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: by certain staff had adversely affected the welfare of some residents. This was referred through local multi-agency procedures for safeguarding vulnerable adults. Martha House co-operated with other agencies and carried out an internal investigation. Its findings were that the allegations were not substantiated. The complaint also included an allegation related to staff misconduct, which was referred directly back to Martha Trust for invesitigation and was not upheld. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Martha House provides accommodation that suitably meets residents needs and gives them a comfortable, pleasant, well kept, safe and clean home. Evidence: Martha House is situated in a quiet residential area about a mile from Hereford city centre on a main bus route. The property is all on one level and was purpose built. The home is therefore adapted and has aids, facilities and equipment to meet the needs of people with physical disabilities who are wheelchair users. This includes a variety of therapy areas, such as for physiotherapy (with rebound therapy), two rooms with sensory facilities, a music room and a hydrotherapy pool. The grounds are large and very pleasant, having being designed to provide different and discrete areas for people to relax in, including lawns, patios, vegetables and flower beds (some raised). Pathways around the home are all level and there is a parking area. The accommodation is well maintained and furnished, decorated and equipped to a high standard. Maintenance and gardening staff are employed and work to continually improve the environment in both the house and grounds. Since the last inspection this has included redecoration, opening up some pathways in the garden and upgrading the main kitchen. There are plans to upgrade one bathroom, replace carpetting and address some aspects of the buildings external lighting. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: Residents have single bedrooms, which are of a reasonable size but do not have en suite facilities. They have enough space for peoples specialist equipment such as beds, chairs and tracking hoists. The bedrooms of people who live at the home are well personalised and decorated to individuals tastes, or from consulting with their relatives. Communal areas are spacious and there is a designated family room. We visited most parts of the home, which were all found to be clean, tidy, fresh and bright. There are comprehensive infection control policies and procedures for staff to follow. The home employs a separate domestic staff team and they follow cleaning schedules. Laundry and sluicing facilities are suitable and there are appropriate arrangements in place for the disposal of soiled and clinical waste. We were notified about an outbreak of sickness in the home and the input of the Health and Protection agency was also appropriately sought. Necessary action was taken by the home to minimise risks of cross infection and there was no indication of any lack of infection control or food hygiene on the part of the home. Care Homes for Adults (18-65 years) Page 23 of 31 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. Residents needs are met and they are kept safe because there are enough competent and appropriately trained staff. The support they receive should be enhanced when more care staff are qualified. People can be confident in staff because checks are normally carried out to help to ensure new staff are suitable to work in a care home. Evidence: Martha House employs a large staff team including qualified nurses, therapists, care, catering, domestic, administrative and maintenance staff. The AQAA states the home has an integrated staff team of different cultures and different backgrounds. They aim to maintain a high level of support to residents by providing one to one staffing to facilitate activities during weekdays. We saw there were plenty of staff on duty to enable and escort people with therapies, to go out and assist them at mealtimes. There is always qualified nurses on duty, at least two during the day, as well as the manager and deputy on weekdays. Whilst staff turnover is quite high, in view of the size of the team this does not adversely affect the continuity of care and recruitment is ongoing. Staff confirm in their surveys that there is usually enough staff. In respect of staff selection and recruitment the AQAA and staff surveys state that necessary checks had been taken up including a criminal records bureau (CRB) check Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: and references before staff started work at the home. Overall Martha Trust operates thorough procedures, which staff records we looked at confirm. One staff member had just one reference however, although two are required. We were told this person only had one contactable previous employer but a second reference should be sought from a creditable source, such as a college tutor, clergy or other professional person. New care staff complete an extensive induction programme, which meets with the specified standards. They are also expected to read and sign up to all the homes policies and procedures. They have to work at least 20 shadow shifts and complete a six month probationary period. During this time they are allocated a senior as mentor to support them and are closely supervised before their appointment is confirmed. The AQAA states regular training is arranged and staff do NVQ. This includes all the mandatory health and safety areas and topics relating to residents special needs such as food and oral tract (FOTT) and postural therapies. Senior nurses specialise in particular aspects, for example continence, infection control and tissue viability and instruct staff on them. Nursing staff attend relevant external courses to update their practice and train the trainer so they can provide the in-house training. Only eight care staff hold a National Vocational Qualification (NVQ) currently, although the National Minimum Standards specify at least half the care staff team should achieve NVQ. We were told three senior staff are to do NVQ assessors training so the programme of NVQ can be progressed. This would improve their knowledge and skills in line with currently accepted good care practice. In addition residents could benefit if staff had training on person centred planning and effective communication. Care Homes for Adults (18-65 years) Page 25 of 31 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. People can have confidence in the home because it is run and managed appropriately. More person centred care practice is being developed and there are plans for other improvements, based on what people involved with the service want. The environment is safe for people because necessary health and safety procedures are followed. Evidence: Feedback we received from residents relatives and health or social care professionals is very positive overall about the service provided by Martha House. The home accepts they need to develop a more person centred approach, which is in line with currently accepted good care practice. However it is evident the homes facilities and care residents receive ensures their needs are met and they have caring support and active lifestyles. One health professional comments in their survey that the home puts the needs of residents first and provides a caring and stimulating environment. Martha Trust has a board of trustees who participate fully in the business of the charity and the home. The Trust director Sue McBride is responsible for all aspects of running the service and the nursing directorPeter Leach (who is also the registered Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: manager) is responsible for all care aspects. Ms McBride and Mr Leach both report to the board of trustees and so there is clear leadership and accountability. Mr Leach is a qualified nurse and has a social care qualification and many years senior management experience. The home also has a deputy manager and a team of qualified nurses and senior carers who share aspects of the management task and take responsibility for the day-to-day running of the home. The AQAA contains clear relevant information showing how what the service does well results in good outcomes for residents. The manager also identifies areas in need of improvement, which include person centred planning, residents communication, more evening activities, staff training and further upgrading of the premises. Communication between staff groups is also included, which is good as some staff feel communication could still be better between care staff and management. Another issue the home is rethinking is their trial of having a centralised area for nurses in the lounge. Whilst this was to make nurses more available the confidentiality of personal care records kept in this area should be considered. The home has developed a quality assurance and monitoring system since the last inspection. Ms McBride carries out required monthly visits to check how the home is run and writes a report on its conduct. Martha Trust now has a quality management team that meets regularly to discuss these reports and produce an annual development plan and longer term proposals for the service. The home has also sent out questionnaires and appropriately includes feedback from residents relatives. Regarding health and safety staff are trained in all the mandatory areas. There are also relevant policies and procedures in place for staff to follow. The AQAA confirms required checks on the fire safety system and equipment are carried out and the heating, electrical appliances, call bell system and hoists etc. are serviced regularly. Risk assessments have been completed and we did not observe any safety hazards. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 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 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 6 The home should continue to implement person centred care planning. This means there will be more focus on identifying residents choices, interests and personal goals and support they need to meet and/or achieve them. The home should use more ways to support residents to communicate their preferences such as pictures, signs, photographs and objects of reference. Such techniques could enable residents to make more choices and decisions about their daily routines and lifestyle. Risk assessments carried out by health care professionals when it is necessary to use bedside rails in the home should be agreed and recorded. This includes consent from the person about using bedside rails, or their representative on their behalf. This is to ensure that suitable bedside rails are used appropriately to keep residents safe. Efforts should continue to progress the programme of NVQ training for care staff. This would provide more of the staff team with knowledge and skills of care practice to help them give better support to residents. 2 7 3 9 4 32 Care Homes for Adults (18-65 years) Page 29 of 31 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 5 34 The home should have a system in place to ensure two written references are always taken up for new staff from a creditable source, even if they have only had one previous employer. This is part of the process that helps protect residents from unsuitable staff caring for them. Care Homes for Adults (18-65 years) Page 30 of 31 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. 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