Care Home: Maryville Care Home

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What the care home does well What has improved since the last inspection? The home has met the requirements on medication made at the previous inspection. What the care home could do better: The small amount of medication which is not in the Monitored Dosage System needs to have its stock recorded, and regular checks undertaken, to ensure that an audit trail can be provided.The home is aware that further activities could be offered and opportunities for activities and outings, on a regular basis, need to be available for those who wish to participate. Although there is a good level of National Vocational Qualifications training, it needs to be shown that all of the staff have up-to-date basic and advanced training in line with the work they perform. CARE HOMES FOR OLDER PEOPLE Maryville Care Home The Butts Brentford Middlesex TW8 8BQ Lead Inspector Ms Jane Collisson Unannounced Inspection 26th September 2008 10:00 X10015.doc Version 1.40 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 Maryville Care Home DS0000022899.V372222.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 Older People. 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. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maryville Care Home Address The Butts Brentford Middlesex TW8 8BQ 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) 0208 560 7124 0208 560 7126 helen.nolan@smg.org The Poor Servants of the Mother of God Manager post vacant Care Home 37 Category(ies) of Learning disability (0), Learning disability over registration, with number 65 years of age (0), Old age, not falling within of places any other category (0) Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st October 2007 Brief Description of the Service: Maryville is a Care Home for 37 older people, which is divided into three units. There is an eight bed residential unit on the ground floor, a fourteen bed nursing unit on the first floor and a fifteen bed unit for older people with learning disabilities on the second floor. The home was purpose built and was registered in November 2001. The Registered Provider is the Frances Taylor Foundation, which is a registered charity. There is accommodation on three floors. All bedrooms are single and have ensuite facilities, which include a shower. Each floor has its own lounge and dining facilities, with a kitchenette. In addition, there is a well-equipped kitchen where all the meals are prepared. There are two passenger lifts and accessibility for wheelchair users in all areas. There is a large, well-maintained attractive garden and well-equipped activity room. The home is located with easy access to shops, local amenities and public transport. The Frances Taylor Foundation is a Roman Catholic organisation and the majority of the residents are Catholics. However, the home accepts residents from other faiths and supports them to attend their place of worship, if required. There is a chapel within the home where services are held every day. The fees range from £419 to 790 per week. Maryville Care Home DS0000022899.V372222.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 3 star. This means the people who use this service experience excellent quality outcomes. This unannounced inspection was carried out on the 26th September 2008 from 10.00am to 5.00pm. The Acting Manager (who will be referred to as the Manager in this report) was on leave. The Senior Staff Nurse assisted us with the inspection. The Registered Manager had left the home in July 2008. The Acting Manager had been the Deputy for more than two years and was about to apply to the Commission for Social Care Inspection for registration. We met him on the second visit to the home, which was during the afternoon of the 3rd October 2008, when we were able to complete the inspection. The inspection took a total of twelve hours. We were accompanied on the first day of this inspection an Expert by Experience. The Commission for Social Care Inspection is trying to improve the way it engages with people who use services so as to gain a real understanding of their views and experiences of social care services. It now uses ‘Experts by Experience’ who are an important part of the inspection team and help Inspectors get a picture of what it is like to use a social care service. The term ‘Expert by Experience’ used in this report describes a person whose knowledge about social care services comes directly from their experience of them. During the inspection we looked at a variety of records, including care planning files, staff recruitment files, training records, complaints, finances, maintenance and medication. We met with most of the residents during the course of the inspection. We had also sent surveys to the residents and staff and we received thirty from residents and fourteen from staff. The majority of the comments were very positive and have been used in the report as appropriate. We toured the home on the first visit with the Senior Staff Nurse. Some people from the learning disabilities unit were at a day centre. Others people were relaxing in their rooms or in the lounges. A church service took place at 12 noon, and people were also using the church for private worship. We had a pleasant lunch with residents in two different units. Some people are fairly independent and able to go out alone. Other people, particularly in the nursing unit, were being nursed according to their dependency, with some remaining in their rooms. The atmosphere in the home, on both visits, was very relaxed and peaceful. The Expert by Experience said that “One of the most striking features of this Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 6 home is the sense of peace and tranquillity that is felt as soon as one enters the building. Nothing is hurried, everyone is calm and the feeling of serenity is almost tangible”. The Manager provided us with the Commission for Social Care Inspection’s Annual Quality Assurance Assessment, which gave us information about the service, its plans for the future and statistical information about the people using the service, staff and documentation. The ethos of the home is that of a Christian one, but adherence to the religion is not a criteria for admission. Most of the people in the home are from white British and Irish backgrounds. Because of this, the home does not have, at present, any other cultural and religious needs to be met. Although the Expert by Experience said that she felt the residents could be encouraged to become further involved with the local community, she said “I must add that it was a delight to spend time in a gentle, caring, friendly tranquil home which, because of its calm atmosphere and caring staff, can only serve to enhance the life of its residents”. What the service does well: What has improved since the last inspection? What they could do better: The small amount of medication which is not in the Monitored Dosage System needs to have its stock recorded, and regular checks undertaken, to ensure that an audit trail can be provided. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 7 The home is aware that further activities could be offered and opportunities for activities and outings, on a regular basis, need to be available for those who wish to participate. Although there is a good level of National Vocational Qualifications training, it needs to be shown that all of the staff have up-to-date basic and advanced training in line with the work they perform. 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. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 (6 not applicable) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are provided with all of the information they need to help them to make a decision about the home. People are fully assessed prior to admission and have the opportunity to visit the home. The home has a range of services to meet individual needs. EVIDENCE: We found that there is a large pack of information provided to people who may wish to move into the home. This includes a Statement of Purpose, Service Users Guide, revised in August 2008, contracts/terms and conditions, an assessment guide, a sample menu, complaints procedure, a copy of the contract and information about the Frances Taylor Foundation. A copy of the last Commission for Social Care Inspection’s report is also included. The Service Users Guide is provided in a large print and a visual format. The complaints procedure is also in an easy to follow format. However, some Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 10 information regarding the Commission for Social Care Inspection needs to be changed to be up-to-date. We saw a sample of the assessments and found that these were satisfactory. A very full assessment procedure is used to ensure that people are suitable for admission to the home. The home has a range of different services which include a unit for people with learning disabilities. The majority of the residents in this unit have lived in the home, and the former home on the same site, for many years so know the area and many of the staff well. The residential unit and the nursing unit have many residents who are Sisters of various Catholic orders, but the home also takes people from the community. One person was on respite and the home has applied to increase the number of beds, by using accommodation previously reserved for guests, so that it can increase the respite provision. Although the home is not registered for dementia care, two people have developed this illness. The Manager confirmed that their needs can be within the nursing unit. The 2008 training records showed that nine staff have had training in dementia and twelve had attended training for the Mental Capacity Act, but no learning disabilities courses are included in the training plan. The Manager needs to ensure that staff have all of the training to meet the varied needs of the people living in the home. A requirement had been made under the relevant section of this report. The Manager confirmed that people have the opportunity to visit before they make a decision about moving into the home and this would include the chance to have a meal and speak to other people living in the home. There is currently a waiting list for the home. Most people confirmed that they had sufficient information about the home before making the decision to move although some said they had been “recommended” to the home and did not have the full information in advance. Most of people living in the learning disabilities unit had moved when the Maryville had replaced their previous home in 2001. Others had moved in when their former homes had closed. The home does not provide Intermediate Care so this National Minimum Standards could not be assessed. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Care plans are person centred and are agreed with the individual. Plans are written in plain language, are easy to understand and look at all areas of the individual’s life. They include evidence that the service values good outcomes for people using the service. People are protected by comprehensive risk assessments which are regularly reviewed. Any limitations on freedom, choice or facilities appear to be in the person’s best interests and people are encouraged to be independent. Some medication procedures could be improved. EVIDENCE: We examined samples of care plans in each of the units and eight in total. In each unit, the care plans are different as each unit is individual in its emphasis. Some care plans are completed to match various National Minimum Standards which demonstrates how they are being met. We found that the care plans contained nutritional assessments, dependency and skin integrity. Monthly reviews of the care plans take place. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 12 We saw a range of risk assessments in the files, including those for moving and handling, falls and medication. We saw from the records that health needs, and the outcomes of visits by the general practitioners or visits to clinics, are recorded. In the nursing unit, the staff undertake the usual health checks. The Manager said that the home has no insulin dependent diabetic residents. Suitable medical procedures were in place for dealing with the various illnesses and disabilities that people were experiencing, including regular hospital care. The Expert by Experience said “One client was bedbound and had dementia but one of the carers had taken the trouble to leave the radio on – it was playing classical music – because they knew the person liked that type of music and they would not be left completely alone if the radio was on. I personally thought that was a very caring gesture. The home had recently brought another resident a specialised wheelchair which met her needs”. The majority of people said that they “always” had the support they needed, and the remainder said “usually”. One person did remark that “staff were sometimes busy” but another said that “staff answer bells quickly”. People felt that staff listened to them, and acted upon what they said whenever it was possible. A resident said “carers are always kind and understanding” and “actively seek to meet our needs”. Some resident meeting minutes were seen, the last meeting being held in September 2008. The Expert by Experience said “staff seemed able to communicate effectively not only with the residents but with each other and were respectful at all times and I witnessed members of staff knocking on residents doors before entering thereby maintaining a level of privacy and dignity”. At the last inspection in 2007, there were a number of medication requirements. A sample of medication was checked and found to be in order in one unit but there was one shortfall in another unit. The “as and when” medication stock had not been carried forward, so that a stock check could not easily be completed. The Manager was advised that this should be done so that regular checks could be made. He was also advised to ensure that the checks are recorded. The majority of the medication is in 28-day blister packs. In the nursing unit, the staff nurses given the medication and in the other units, trained staff undertake the administration. Where people are able to self-medicate, this is encouraged and risk assessments are in place. People have a lockable facility for this. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service actively supports people to be independent and involved in all areas of daily living in the home. Activities take place on a regular basis but could be more varied and frequent for some of the residents. Meals are generally well received. EVIDENCE: There is a range of interests to accommodate the people in the home. Some of the people in the learning disabilities unit attend a day centre for older people. A number of people are quite independent and the home encourages people to keep as fit as possible. A small number of people enjoy going out of the home independently. The Expert by Experience said “There was a very large activities room where residents had displayed their artwork and it was noted that there seemed to be a gardening project which encouraged the residents to grow cuttings for replanting in the main garden. The home had also recently purchased a piece of sensory equipment for residents’ use”. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 14 However, it was a requirement at the last inspection that further activities are on offer and the Manager said that it is planned that an Activities Organiser will be recruited. Five of the thirty people responding to the surveys said that they only “sometimes” had enough activities, with the remainder saying “always” or “usually”. People acknowledged that they had different tastes, so the activities offered, mainly art, exercises and bingo, did not always suit them. Some people spoke to us about their visits to the other home, which is located in the same grounds, where they have enjoyed dances, and about visits to a day centre and a local church centre. We saw that people are able to follow their own pursuits where it is physically possible for them to do so. People were seen to use the chapel, the garden and to stay in their rooms if they wished to do so. For those unable to go out independently, some outings are provided but we had comments from staff that they would like to have the opportunity to provide more. Although extra staff are on shift for the pre-planned appointments and outings, the opportunity for occasional spontaneous outings appears to be more difficult. We noted that the mobile library attends on a regular basis and there are many books around the home, and areas where they can be read in peace. The Expert by Experience observed that Mass was held in the chapel before lunch and those residents that could not or did not want to go to the chapel could watch the service via the closed circuit television, either in their own rooms or in the lounge. Those residents who wish to do so can participate in regular religious activities. The Expert by Experience said “I know that the home does accept residents of other faiths but I feel that that the Catholic faith plays such an important part of the residents’ lives it could be difficult for someone that does not share that faith”. However, we spoke to people who did not regular attend services as they did not wish to do so and this is respected. People are able to meet with their relatives as they wish and a number of the residents with learning disabilities spoke about their family members. Wherever possible, arrangements are made for them to stay in touch. The Expert by Experience said that she found “visitors are encouraged and for those residents whose visitors travel a long way there is a facility to stay overnight in the convent next door”. People had also been supported to visit their families on occasions. Staff said that people were generally very clear about what they wanted to do and are able to exercise their choices. This was evidenced by the way people chose to stay in their rooms, use the many communal spaces or, in the case of a few residents, go out independently. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 15 We had lunch with the residents in two of the units. The Expert by Experience said “I shared lunch with the residents on the first floor, was served in a pleasant unhurried way and the vegetables which, on the day in question, were swede, peas and potatoes were placed on the table in a serving dish allowing the more able residents to serve themselves”. Soup was served before the main course and there was dessert of apple and blackberry crumble and custard. An alternative of stewed apple and custard was available for diabetic residents. Yogurt and fresh fruit were also offered. We found that there are menus are available in the dining rooms, but not in a format which was easy to see and read. It is recommended that the home considers ways of making menus more accessible to the residents by having them displayed, perhaps in larger print and on the tables. Approximately three quarters of the people responding to the questionnaires said that they “always” liked the meals, the remainder said they “usually” did. One person said, “there is not a great amount of variety” but it is “good quality and there is plenty of it”. Another person said “it had improved recently but lacks taste and presentation”. The Expert by Experience also said “Those residents that required help to eat their lunch were given all the support they needed and dealt with respectfully. As one resident told me “it’s always good food and there is usually plenty of it”. This was confirmed when everyone was asked if they wanted more. It was obvious that the staff appeared to be aware of the residents’ likes and dislikes with regard to their food and lunch was an enjoyable period when the residents could all share a meal together. One of the residents told me that “she always has breakfast in bed” but could “come into the dining room if she wanted to but was never forced”.” Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. Residents and others involved with the service, including staff, say that they are happy with the service provided, feel safe and well supported by the organisation. EVIDENCE: People are issued with a copy of the complaints procedure when they are admitted to the home. We saw that there were three complaints recorded since the last inspection. One was recent and had not yet been resolved. The other two had been satisfactorily resolved. The complaints procedure is produced in a format which is easy to follow. People said that they were confident about making complaints. All but one of the thirty people replying to the surveys said they were aware of how to make a complaint. The Expert by Experience said that one person’s comments had been, “there never seems to be a reason to complain” but they were sure “the matter would be resolved if there was a problem”. Training in safeguarding adults is undertaken by the officers from the Local Authority, although the training records did not show that everyone has had training in the last two years and this training should be part of the regular training programme. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 25, 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The environment is fully able to meet the changing needs of people, along with their cultural and specialist care needs. It is fully accessible throughout to people with physical disabilities, and adaptations and specialist equipment are designed to fit within the homely environment. The home is kept to very good standard of cleanliness. It is a very well maintained, attractive home and there is easy access to community facilities and services. EVIDENCE: We found the home to be maintained in good order with comfortable, pleasantly furnished and homely areas for the residents to enjoy. There are a number of small areas where people can enjoy a quieter space. The larger lounges have large screen televisions for easy viewing. The Expert by Experience wrote “Each lounge had a very warm homely feel due mainly to the fact that each one had a fireplace and was laid out with easy Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 18 chairs and bore a strong resemblance to a lounge that you would find in any private house.” It was noted that there was also a quiet room at the side of the lounge away from the television for residents to sit and chat or read. She also said “The passages and stairways were very clean and well decorated and the bedrooms were very light and airy and of a particularly good size and the majority of them showed signs of being personalised i.e. had picture/photographs on the wall and other small personal belongings”. Much of the artwork was undertaken by the residents in the art classes. All of the bedrooms have their own shower and toilet. Assisted bathrooms are available should a bath be preferred. The home has a good sized, and extremely well maintained garden, which is shared with the convent and St Raphaels care home which are in the same grounds. There are patios, seating and attractive planting. The home employs a gardener who we met during the inspection. The home is suitable to meet the needs of people with physical disabilities. In the nursing unit, six people require the use of a hoist which is undertaken by two staff. The home has wide corridors and there are two lifts. One is generally used by staff and goods only, but is available should there be a breakdown. We found all areas of the home to be very clean and hygienic. The kitchen was recently inspected by the Local Authority’s Environmental Health Officer and gained “5 stars”. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a consistent staff team which provides continuity for the residents. The staff recruitment processes are satisfactory. Although National Vocational Qualifications targets are met, a more comprehensive programme of basic and advanced training needs to be in place. EVIDENCE: The current staffing levels for the day and evening are a staff nurse and two carers in the nursing unit, two staff in learning disabilities unit and one staff in ground floor unit. The staff nurse on duty in the nursing unit is in charge of the home in the absence of the Manager. The home had recently reduced the night staff from four to three. Although the majority of people said that felt the staff were attentive, not all of the staff felt that there were enough staff on duty at weekends. The post of Deputy Manager may not be continued and the Staff Nurses have taken on the role of being in charge while the Manager is not on duty. We discussed with the Manager that the staffing levels need to be monitored on a regular basis to ensure that there is no detrimental effect for the residents, such as waiting longer for attention during the night or not being able to go out at the weekends. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 20 There has been only a small turnover of staff. We examined a sample of three staff records. The records required were in place although the older records did not have confirmation of the Criminal Records Bureau disclosure number which had been obtained by the Frances Taylor Foundation. However, in the later record, the information had been recorded. Disciplinary matters were seen to have been dealt with appropriately. We were provided with the 2007/08 training spreadsheet for the staff team and plans of training for the next six months for the basic courses. Staff said that they had up-to-date manual handling training and the records showed that almost everyone has the training in 2007 or 2008. The majority of the staff also has safeguarding adults training in the last two years. However, the records did not evidence when all of the staff last had their training in all of the basic courses such as first aid, food hygiene, fire protection and medication training. The Manager was able to furnish some of this information but it needed to be evidenced that all of the staff have the training appropriate to their roles and responsibilities. He undertook to get this information collated. Fourteen of the care staff have National Vocational Qualifications. Five have Level 3, the remainder Level 2. As mentioned elsewhere in this report, the specialist training in dementia, learning disabilities and mental capacity has not been extended to all staff and the home needs to consider this. It was also recommended to the Manager that he keeps an ongoing record of training on the spreadsheet, with the last date that the staff member had the training, so that it is clearer when staff require their training to be updated. The frequency that the training is renewed should also be included to demonstrate that everyone has the training they are required to undertake. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has the required qualifications and experience and is competent to run the home. The systems are in place to ensure that the record keeping in the home is well maintained. Peoples’ finances are safeguarded by the procedures in place. EVIDENCE: The current Manager was the home’s Deputy Manager, taking over when the Registered Manager left in July 2008. He has worked in the home for more than two years, has the Registered Managers Award and is a registered nurse. No agency staff are used in the home but there is a bank of staff to cover for leave and vacancies. Staff commented that the service gives training and support to its staff and said the Manager is very approachable. Many of the Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 22 staff have worked in the home for some years and there is good continuity, with a low turnover. We found that the home consults its residents regularly. The Manager informed us that he was in the process of completing a report in respect of its latest surveys completed by the people living in the home. We saw the surveys for 2007, which covered the environment, meals and activities. A report had been produced, including a chart of the findings. The Manager confirmed that these are circulated the residents. The Manager provided us with the Commission for Social Care Inspection’s Annual Quality Assurance Assessment which gave us details about how the home is run, including what it does well and its future plans. We looked at the way in which the finances of the people living in the home are managed. One of the Sisters maintains the finances of the people in the nursing and residential units, which are usually only small sums of money for personal expenditure. In the learning disabilities unit, the finances are paid to the Frances Taylor Foundation and the personal allowances are transferred to the residents’ own individual accounts. Regular checks are made to ensure the accounts are kept in good order and we examined a sample of these. The Manager confirmed that there are regular meetings with staff and samples were seen of the minutes, the last one in September 2008. They also have health and safety meetings, covering issues such as infection control, and meetings for the night staff. Supervision sessions are planned for four to six times a year. There are Team Leaders in each unit who carry out the supervision with the staff. We recommended that these are increased to ensure that the National Minimum Standards of six a year is met. A list of the policies and procedures were provided in the Annual Quality Assurance Assessment. We saw that some were last reviewed in 2005 and recommend that these are considered for review in the near future, particularly those for manual handling, fire safety and health and safety. We found the records to be well maintained, including those for maintenance. The home’s insurance, valid to the end of March 2009, was seen We also looked at records for the fire equipment and alarms, which were serviced in August 2008. The fire alarms are checked weekly. The last fire drill was held in March 2008 and the Manager was advised to hold these more frequently. A fire risk assessment was in place, dated January 2007. There was information on the evacuation needs of individual residents. There is also a protocol for several emergency situations, including accidents, missing persons, theft, loss of heating, and seizures. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 23 The gas servicing took place in August 2008, the Legionella testing in September 2008 and small electrical testing in October 2007 and was to be done again shortly. Hot water is tested on a monthly basis. Maryville Care Home DS0000022899.V372222.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 Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 X 4 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 4 4 4 4 4 X 4 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 4 3 3 4 Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement The Manager must ensure that the stock of “as and when” medication is recorded so that regular monitoring can take place. The Manager must ensure that sufficient and varied activities for people are offered to people who would like additional outings or activities within the home. The Manager must ensure that all of the staff are shown to have up-to-date basic and advanced training in line with the work they perform. Timescale for action 31/10/08 2 OP12 16 (n) 30/11/08 3 OP30 18 31/01/09 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 Refer to Standard OP15 Good Practice Recommendations It is recommended that the home considers making menus more accessible to the residents so that they can be displayed, perhaps in large print. DS0000022899.V372222.R01.S.doc Version 5.2 Page 26 Maryville Care Home 2 OP30 It is recommended that the Manager keeps all of the records on the training spreadsheet to ensure that it can be shown that staff have up-to-date and relevant training. Maryville Care Home DS0000022899.V372222.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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