Care Home: Mary`s Home

What the care home does well Since this services last annual review eight of our satisfaction questionnaires have been returned to us by people who use the service and/or their relatives, another eight came from staff who work there, and four more were completed by various health and social care professionals who represent a number of the people who live at Mary`s Home. The majority of the written feedback we received from all the aforementionedstakeholders was in the main very positive. Typical comments included - `the home caters for all my needs`, `the home is alright - I`m happy here`, `staff are always ready to help you and most are caring`, `you can do as you please here` `the home is one of the best Ive worked in`, `there`s been a lot of improvements made to the way the place is managed recently`, and `I reckon it`s a good place to live, and definitely a better place to work these days`. Furthermore, the general consensus of opinion expressed by the people using the service was the home provides you with all the care and support you needed; enough staff were `always` available when you needed them; and, staff `usually` listened to what you had to tell them. What the care home could do better: During a tour of the premises we noted the front door was dead locked from the inside, which the manager told us only staff hold the key for. The manager said this was a security measure to minimise the risk of certain people who use the service absconding. We reminded the manager that the front door was a fire exit and therefore must never be dead locked under any circumstances. The manager also confirmed that at least four people who currently reside at Marys home are capable of accessing the wider community without the need for any staff support, but are currently unable to leave the building without first asking a member of staff to open the front door for them. The practise of locking the front door in this manner not only represents a fire hazard, but also an unnecessary restriction on peoples freedom of movement and independence. The manager immediately unlocked the front door at our request and has agreed to have a more `suitable` locking device (i.e. a keypad) fitted within the next two weeks to enable anyone who is willing and capable of accessing the wider community without the need for staff support to do so as and when they choose too. The manager is also reminded that the keypad device must be linked to the homes fire alarm system ensuring it automatically releases the front door in the event of a fire. All the staff who returned our surveys told us their employer had carried out a full Criminal Record Bureau (CRB) check and obtained two written references before they were allowed to start working at Mary`s Home. We examined the personal files for all five of the people the manager told us she had recruited since the services last key inspection. All five staff files contained proof of these individuals identities, including a recent photograph; up to date Independent Safeguarding Association First checks; and, two written references. All this information had been obtained before these individuals were allowed to commence supervised working at Marys home as part of their probationary period of employment. A number of these files also included Home Office approved working visas obtained in respect of all the foreign nationals the manager had recently recruited. Furthermore, duty rosters we sampled at random revealed all the students currently employed at Marys home were restricted to working less than 20 hours a week in accordance with the terms and conditions of their entry into the UK. However, all the positive comments made above about the services recruitment procedures there remains considerable room to improve them. One staff file we examined in depth did not contain a Criminal Records Bureau (CRB) check, despite assurances from the manager that she had personally seen a copy of it. Furthermore, this individuals job application contained limited information about their recent employment history with nowritten explanations for the reason for the gaps or verification of why they had ceased to work with vulnerable adults. The manager acknowledged with the benefit of hindsight she should have asked far more vigorous questions when interviewing this candidate about gaps in their employment history and their disciplinary record with previous employers. The manager needs to significantly improve its staffs recruitment practises in order to keep the people who live at Marys home safe. Random inspection report Care homes for older people Name: Address: Mary`s Home 88 Warham Road South Croydon Surrey CR2 6LB two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lee Willis Date: 1 6 0 2 2 0 1 0 Information about the care home Name of care home: Address: Mary`s Home 88 Warham Road South Croydon Surrey CR2 6LB 02086882072 02086679242 hellenappah@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Helen Appah,Dr Edward N Osei Appah care home 29 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Conditions of registration: 29 The maximum number of service users who can be accommodated is: 29 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD of the following age range: 50 years and older Date of last inspection Brief description of the care home Marys Home is a privately owned residential care service that provides accommodation and personal support for up to twenty-nine generally older adults with a past or present experience of mental ill health. Jocelyn Owusu-Asabere was appointed as the homes new manager in February 2008 and is registered with us as a fit person to run a residential care service for vulnerable adults. Care Homes for Older People Page 2 of 13 Brief description of the care home Set back from a busy road in South Croydon the home is within fifteen minutes walk of the centre of town and is relatively near a wide variety of local shops, cafes, pubs, and banks. The home does not have its own transport, but hires vehicles as and when required. There is also a bus stop located just outside the home with excellent links to central Croydon. Built over three storeys this extended detached property comprises of twenty-three single occupancy bedrooms, of which sixteen have en-suite facilities; three doubles; a separate dinning room; large main lounge with a designated smoking room attached; kitchen; laundry and sluice room; an office; and staff room. The large garden at the rear of the property, which is mainly lawn, is very well maintained. The provider ensures information about all the homes facilities and services, including there cost, are made available to all prospective people wanting to use the service and their representatives through the homes Statement of Purpose, Guide and contracts. Care Homes for Older People Page 3 of 13 What we found: We carried out an unannounced Random Inspection of Marys Home on Tuesday 16th February between 10.50am and 13.50pm. During this three hour site visit we met five people who live at Marys home, albeit briefly, and spoke at length to the services registered manager, a senior support worker, and a new part-time member of staff. As part of the inspection process we also looked at the services - Guide; risk assessments; medication records; staff files; quality assurance systems; and various health and safety records. The remainder of this site visit was spent touring the premises. As required in the services last key inspection the manager was able to produce documentary evidence on request that showed us the people using the service have access to up to date information about the range of fees they are charged for facilities and services provided. Furthermore, the majority of people using the service and their relatives who completed our satisfaction surveys told us they had been given written contracts that set out all their terms and conditions of occupancy, which included how much their placement cost. Three care plans we looked at in depth contained up to date risk assessments that set out in detail how staff should intervene to support people using the service deal with their behaviours that sometimes challenged the service. A senior member of staff who has been managing the services medication handling practises for the past year was able to produce documentary evidence on request that showed us medication handling practises at Marys home had significantly improved since its last inspection. The manager told us the number of staff authorised to handle medication on behalf of the people using the service had been significantly reduced in the past year so that now only the services three most senior members of staff manage medication. The manager and the senior in charge of the services medication both told us they believed medication recording errors at Marys home had significantly decreased as a direct result of reducing the number of staff who were responsible for handling medication within the home. The service was required to improve its medication recording practises at its last inspection. No errors were noted on any of the medication administration records (MAR) sheets staff had used to record medication they had handled on behalf of the people using the service in the past four weeks. The manager and the senior in charge of medication also confirmed that monitoring of staffs medication handling practises had significantly improved in the past year as required in the services last inspection report. The senior told us they monitor all the services medication handling practises at least once a week and in addition to this the manager carries out her own medication spot checks at regular intervals. Documentary evidence was produced on request that showed us the three seniors who were the only staff authorised to handle medication in the home had all recently refreshed their medication training and attended a professionally recognised six months course in the safe handling of medication in a residential care setting. During a tour of the premises we noted all the Controlled Drugs currently held by the home on behalf of the people living there were kept in a metal box located in the first floor pharmacy Care Homes for Older People Page 4 of 13 cupboard. These storage arrangements do not meet current legislation and therefore the provider needs to supply the home with a more suitable Controlled Drugs cabinet that has a specified locking mechanism which is fixed to a solid wall or a wall that has a steel plate mounted behind it with either rawl or rag bolts. This storage point not withstanding staff do maintain a separate Controlled drugs register, which two staff always counter sign each time a Controlled Drug is handled, in accordance with good medication recording practises. This register also accurately reflected the current stocks of Controlled Drugs held by the home on behalf of the people using the service. The manager confirmed that behavioural modification medication are administered on an as required basis for a number of the people using the service. The manager told us no protocols have been developed by the service to make it clear to staff authorised to handle this type of medication when and how they should administer it. We recommend clearer guidelines for the safe handling of as required psychotropic medicines are established. The manager told us that it is custom and practise for people to be actively encouraged and supported to self medicate if they were willing and capable of performing this task safely. The senior in charge of medication at the home confirmed people who look after their own medication are allowed to keep their medication in their bedroom and that staff carry out discreet monitoring checks at regular intervals to minimise the risk of medication errors occurring. All the health and social care professionals who returned our surveys told us the service always supports people to administer their own medication where possible. Since the services last annual review we have received one formal complaint from an anonymous source concerned about poor medication and staff recruitment practises at Marys home. The service took the complaint seriously when we passed it on to them and the matter was promptly investigated by the registered manager in a very transparent and professional manner. The manager notified us in writing as soon as her investigation was complete that none of the concerns raised in the complaint were substantiated. As required in the services last report the manager now notifies us without delay about the occurrence of any significant incident or event that affects the health and welfare of the people living at Marys home. The manager also demonstrated a good understanding of what incidents she should be notifying us about without delay. During a tour of the premises we viewed the two bedrooms the manager told us the provider had recently redecorated as recommended in the services last report. Both bedrooms had been repainted, supplied with new furniture, and in one case fitted with new flooring. The manager told us she had recruited five new members of staff from very diverse ethnic and cultural backgrounds in the past year in order to go someway to addressing the imbalance that existed between the homes almost entirely white British service user group and non white staff team. All the written feedback we received from various people with a stake in Marys home was very complementary about the attitude and knowledge of the staff team. The manager provided us with documentary evidence to show us she had recently achieved her National Vocational Qualification in Management (level 4) and attended the Local Care Homes for Older People Page 5 of 13 Authorities safeguarding training as required in the services last report. The manager demonstrated a good understanding of what constituted abuse and what external agencies she needed to notify without delay if she suspected or witnessed abuse and/or neglect at Marys Home. The manager produced documentary evidence on request that showed us staff are receiving one to one supervision sessions with either herself or an experienced senior member of staff approximately once every two months. All the staff who returned our surveys said their manager gave them enough support and met with them on a regular basis to discuss their working practises. These positive points made above about the competency of staff at the home notwithstanding the manager did acknowledge that despite it being recommended in the services last report, she had not carried out any appraisals of her staff teams overall work performance. We repeat this recommendation for the second and final time in this report that the manager should assess her workforces strengths and weaknesses on an annual basis and use her findings to develop a time specific training plan to address any gaps in her staffs knowledge and skills. The manager produced a new fire risk assessment for the building, which we required the service to do at its last inspection. The assessment had been developed with the support of a suitably qualified fire safety expert employed by the provider. We are aware the London Fire and Emergency Planning Authority (LEAP) last visited the service in 2009 and identified a number of fire safety issues the provider needed to address as a matter of urgency. The manager assured us all these fire safety breaches had now been rectified. We saw evidence that as recommended by the LEAP the homes side-gate, which is also a fire exit, had been fitted with a more suitable locking device to ease access in the event of a fire; all persons who work at Marys home had recently refreshed their fire safety training; and, the homes fire alarm and emergency lighting systems are both now being tested on a weekly basis and appropriate records of these checks kept by staff. Other fire records revealed fire drills continue to be carried out on a quarterly basis and that all the homes night time staff participated in the homes last fire evacuation. Two staff we met demonstrated a good understanding of where the homes fire exits and fire assembly points were. A fire extinguisher we examined in the office had been tested by a suitably qualified professional in the past year in line with the manufacturers guidance, and both the fire resistant doors we tested at random automatically closed flush into there frames when we released them. As required in the services last report the manager produced documentary evidence on request that revealed hot water used in baths was now being tested at least once a week to ensure it remained below a safe 43 degrees Celsius. What the care home does well: Since this services last annual review eight of our satisfaction questionnaires have been returned to us by people who use the service and/or their relatives, another eight came from staff who work there, and four more were completed by various health and social care professionals who represent a number of the people who live at Marys Home. The majority of the written feedback we received from all the aforementioned Care Homes for Older People Page 6 of 13 stakeholders was in the main very positive. Typical comments included - the home caters for all my needs, the home is alright - Im happy here, staff are always ready to help you and most are caring, you can do as you please here the home is one of the best Ive worked in, theres been a lot of improvements made to the way the place is managed recently, and I reckon its a good place to live, and definitely a better place to work these days. Furthermore, the general consensus of opinion expressed by the people using the service was the home provides you with all the care and support you needed; enough staff were always available when you needed them; and, staff usually listened to what you had to tell them. What they could do better: During a tour of the premises we noted the front door was dead locked from the inside, which the manager told us only staff hold the key for. The manager said this was a security measure to minimise the risk of certain people who use the service absconding. We reminded the manager that the front door was a fire exit and therefore must never be dead locked under any circumstances. The manager also confirmed that at least four people who currently reside at Marys home are capable of accessing the wider community without the need for any staff support, but are currently unable to leave the building without first asking a member of staff to open the front door for them. The practise of locking the front door in this manner not only represents a fire hazard, but also an unnecessary restriction on peoples freedom of movement and independence. The manager immediately unlocked the front door at our request and has agreed to have a more suitable locking device (i.e. a keypad) fitted within the next two weeks to enable anyone who is willing and capable of accessing the wider community without the need for staff support to do so as and when they choose too. The manager is also reminded that the keypad device must be linked to the homes fire alarm system ensuring it automatically releases the front door in the event of a fire. All the staff who returned our surveys told us their employer had carried out a full Criminal Record Bureau (CRB) check and obtained two written references before they were allowed to start working at Marys Home. We examined the personal files for all five of the people the manager told us she had recruited since the services last key inspection. All five staff files contained proof of these individuals identities, including a recent photograph; up to date Independent Safeguarding Association First checks; and, two written references. All this information had been obtained before these individuals were allowed to commence supervised working at Marys home as part of their probationary period of employment. A number of these files also included Home Office approved working visas obtained in respect of all the foreign nationals the manager had recently recruited. Furthermore, duty rosters we sampled at random revealed all the students currently employed at Marys home were restricted to working less than 20 hours a week in accordance with the terms and conditions of their entry into the UK. However, all the positive comments made above about the services recruitment procedures there remains considerable room to improve them. One staff file we examined in depth did not contain a Criminal Records Bureau (CRB) check, despite assurances from the manager that she had personally seen a copy of it. Furthermore, this individuals job application contained limited information about their recent employment history with no Care Homes for Older People Page 7 of 13 written explanations for the reason for the gaps or verification of why they had ceased to work with vulnerable adults. The manager acknowledged with the benefit of hindsight she should have asked far more vigorous questions when interviewing this candidate about gaps in their employment history and their disciplinary record with previous employers. The manager needs to significantly improve its staffs recruitment practises in order to keep the people who live at Marys home safe. 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 set out on page 2. Care Homes for Older People Page 8 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 13 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The providers must supply 17/05/2010 the home with a more suitable Controlled Drugs cabinet that has a specified locking mechanism which is fixed to a solid wall or a wall that has a steel plate mounted behind it with either rawl or rag bolts. This will ensure a greater deterrent against diversion and theft, and should also serve as a constant reminder to care workers that these medicines are potent. The service must ensure the 03/03/2010 front door is never dead locked preventing its use as an easily accessible escape route in the event of fire. This will ensure all the people using the service and staff are kept safe and can exit the building in the event of fire. Before allowing any prospective new member of 01/03/2010 2 19 23 3 29 19 Care Homes for Older People Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 staff to start working at the home the provider must obtain in respect of them A full Criminal Records Bureau check; full employment history, together with satisfactory written explanation of any gaps in their employment; and, where a person has previously worked with vulnerable adults, written verification of the reasons why they ceased to work in that position. This will ensure the manager has all the information they require to make an informed decision about whether or not someone is fit to work with vulnerable adults. 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 9 The service should establish detailed protocols for the use of as required behavioural modification medication to ensure staff are clear when and how to administer it. The service should fit a suitable locking device (i.e. keypad linked to the fire alarm system) to the front door and give front door keys to anyone who is willing and capable of accessing the wider community without the need for staff support. This will ensure the people using the service are free to come and go as they please and too live their life as independently as they can. 2 19 Care Homes for Older People Page 11 of 13 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 3 29 The way in which the service recruits new staff should be reviewed as current arrangements do not ensure enough information about prospective new staffs disciplinary records with their previous employers is available to the manager. This information will help the manager to make a more informed decision about whether or not a prospective new member of staff is fit to work with vulnerable adults. All staff who work at the home should have their work performance appraised at least once a year and an annual training and development plan developed by the manager to address any gaps identified in her staff teams relevant knowledge and skills. 4 30 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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