Care Home: Matrixcare

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What the care home does well The home only offers a place to someone if they can meet their needs. The residents` needs are included in their care plans and updated when things change. They are supported to have their health and physical care needs met in the way they prefer. Each resident is supported to have their own chosen daily routines and take part in activities they enjoy and benefit from. They are supported to stay in close touch with their families. The house and garden are spacious, homely, comfortable and safe. Each resident has a nice bedroom and they are supported to keep lots of their own things. They have their own toilet and bathing facilities. The residents enjoy the meals and they are offered a choice. What the care home could do better: The residents should be supported to review their care and plan for their futures at least twice each year. All staff should be able to use signs to help residents with their communication. Pictures should be used more to help residents understand things and express their needs and choices. CARE HOME ADULTS 18-65 Matrixcare 369 Worcester Road Malvern Worcs WR14 1AR Lead Inspector Jean Littler Unannounced Inspection 30th November 2007 12:30 Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Matrixcare Address 369 Worcester Road Malvern Worcs WR14 1AR 01684 566983 01684 575837 matrixcare@aol.com www.matrixcare.co.uk Matrixcare 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) Vacant. Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home only accommodates service users with a primary diagnosis of Autistic Spectrum Disorder. Staffing levels are provided in accordance with the Residential Forum`s care staffing tool. 22nd August 2006 Date of last inspection Brief Description of the Service: 369 Worcester Road is the sole concern of Matrixcare. It was registered as a Care Home in April 2004. The building is a converted domestic residence situated in a residential area on the outskirts of Malvern Link, in close proximity to local leisure and shopping facilities. Accommodation is provided on the ground and first floor. Each resident has a single bedroom and there is ample communal space including large secure gardens. The service provides personal care, social care and accommodation for up to five adults who have a learning disability. The fees for each persons agreed care package are negotiated prior to admission depending on their assessed needs. The range of fees is not included in the Service Users Guide. Details of what is not covered by the fees is listed e.g. personal items such as clothes, toiletries and hobby items, transport costs, holidays, meals out and entrance fees for all community activities. Information about the service is available from the Home on request or from the provider’s website. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over 5 hours. The manager came in to help with the process. The inspector looked around the house and spoke with one of the staff. Some records were looked at such as care plans and medication. The providers sent information about the service to the inspector before the visit. The residents’ relatives and visitors were asked their views of the service in a survey. What the service does well: The home only offers a place to someone if they can meet their needs. The residents’ needs are included in their care plans and updated when things change. They are supported to have their health and physical care needs met in the way they prefer. Each resident is supported to have their own chosen daily routines and take part in activities they enjoy and benefit from. They are supported to stay in close touch with their families. The house and garden are spacious, homely, comfortable and safe. Each resident has a nice bedroom and they are supported to keep lots of their own things. They have their own toilet and bathing facilities. The residents enjoy the meals and they are offered a choice. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective residents are given information about the service. Their needs are carefully assessed and they are supported to trial the service. EVIDENCE: Information about the Home is available in a Statement of Purpose and a Service User’s Guide. The range of fees should be included in the Guide in line with the reviewed regulations. A version of this information has now been developed in a format more suitable for people with learning disabilities. Any prospective residents visit the home several times before moving in on an initial trial period. The same two men are resident in the Home and there are three vacancies. The manager reported that two people have been interested but did not take up the placements. The records relating to assessments that have been seen at past inspections showed that social workers have provided a full assessment and additional information collated through consultation with family and professionals involved in the person’s care. A brief care plan and daily routine guidance was developed from this information to guide staff during the trial visits and overnight stays. A full care plan was developed once the placement was confirmed. The providers reported in the AQAA that ensuring the residents are compatible is considered essential. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents can be confident that their needs are being kept under review and are recorded in their care plans. They are being supported to take appropriate risks so they enjoy life and become more independent. They are being enabled to make decisions about their lives but this is an area that can be further developed. EVIDENCE: Comprehensive care plans and risk assessments are in place for both residents. The information is being kept under review and updated. The risk assessments showed due care is being taken to safeguard residents whilst still allowing them to take part in normal activities that benefit them e.g. going horse riding, going into the community. Staff meeting minutes showed that strategies to manage risks are discussed with staff. Both residents have a person centred care plan folder. One has enjoyed being involved in developing his. It includes pictures of special people and activities he has enjoyed and visual images of things he likes and dislikes. It is being built on to form a life book that he can relate to and enjoy showing people. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 10 Daily records are made to record useful information for each resident. These are summarised each month by the two keyworkers. Both residents have short and long term goals. It has been identified in the monthly provider reports that these should better report if the desired outcomes for residents are being achieved. Staff gave positive examples of how residents have developed over the last year e.g. one resident is now using a drinking beaker independently and the other can now dress himself. The way goals are agreed and worked towards could be better planned and more consistently implemented. One worker described introducing new ideas and when the resident responded well some of the other staff starting to do the same thing. Behaviour intervention plans have been developed and agreed with parents and in some cases with professionals. Charts and graphs are used to monitor behaviours and issues are discussed at some staff meetings. As the service is designed to be a specialist one for people with Autism consideration could be given to showing more clearly in the care plan and goals how the triad of impairment is being addressed. This may also help staff develop their understanding of how support needs to be provided. Formal reviews are called periodically by the funding authority. The manager was advised not to be dependant on these but to hold review meetings at least every six months so relatives and others involved in each resident’s life can contribute to reviewing and planning for their needs to be met. These meetings could include a person centred planning session to help residents identify and plan for their own goals and ambitions. The manager acknowledged that she would benefit from further training or mentoring to develop this side of the service. The speech therapist reported that information requested is sometimes slow to be provided. When professionals are involved every effort should be made to maximise the benefits for the residents. The manager should consider allocating more then one keyworker for each resident to ensure there are no delays. This would also offer more staff opportunities to develop their skills. Each resident has a detailed communication profile. The one seen had not been reviewed in the last year, although changes have been introduced to how he is supported in this area. He has benefited from a move towards total communication methods. He understands his pictorial activities timetable that helps him know what his day holds and this has led to him using his speech more. The staff currently rely on the providers developing these communication aides as they have no access to the IT needed. This should be reviewed, as early signs show this resident could benefit greatly from this approach and staffs’ enthusiasm should be supported. Residents are being supported to make decisions such as how to spend their time, what to eat, when to go to bed etc. The manager has recently attended training on the Mental Capacity Act and keyworkers are starting to complete an assessment about the residents’ abilities to make decisions for themselves. Communication aides could further assist residents to make more decisions for themselves. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are benefiting from a personalised and flexible lifestyle. They are being enabled to develop life skills and opportunities for activities are being increased. They are supported to maintain close links with their families. Nutritious meals that the residents like are being provided and mealtimes are relaxed. EVIDENCE: The two residents have different interests, strengths and needs and therefore have separate daily routines. The Home’s vehicle has recently been replaced. One attends college three days a week in term time with a support worker from the Home. The courses he is attending give him opportunities for personal development. His worker found alternative options for day activities during college holidays such as bowling and the cinema. This summer he also spent time at the Home with a friend from college. A three-day break at an outward-bound centre was arranged with his one-to-one worker that was part funded by his family. When at home he often uses the second lounge as a games room and plays table football with staff. He also has specific hobbies Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 12 he enjoys such as watching his favourite videos and listening to CDs. The providers reported in the AQAA that they have consulted his family and they are satisfied with the activities and social opportunities being provided. Both residents attend an evening disco every two weeks and go horse riding regularly. They have started to attend a football session. The other resident has a lot less structured activities. This is reportedly due to his health conditions. He enjoys the large garden and has sensory equipment in his bedroom but seems to spend a lot of time wandering around the house. A worker said he really enjoys the riding and football sessions and will walk to local shops or go into town for lunch. She felt he needed one more regular activity to meet his needs. This should be achievable now staffing is being used flexibly to facilitate more outings. She also had ideas about how the residents could get involved in growing things in the garden. There is no activities budget to facilitate staff planning how best to use funds to benefit the residents. Residents pay for all entrance fees, meals and drinks out and rather unusually staff have to pay for themselves if they eat or drink anything while supporting a resident in the community. The manager and staff reported that the residents’ independence is being encouraged and information under care planning confirms this. As mentioned work to further develop communication systems has begun. Both residents have close links with their families and see them regularly. One resident has Italian heritage and shows an interest in the language and other cultural links. These areas of need could be further explored through person centred planning. The menu seen showed a good variety of nutritious meals are being provided. Staff cook the meals and weekly local shopping is purchased by the providers. Preferences and special diets are considered and one resident has been supported to lose excess weight since moving in. Alternatives to the menu are recorded. As part of the total communication work a set of photographs of preferred meals should be developed to encourage residents to choose the meal they want. The meals observed have been relaxed and residents are encouraged to get involved with these e.g. clearing their plates and drying up. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are being provided with good personal care in a very personalised way. Their health needs are being met with some input from external professionals. Medication is being safely managed. EVIDENCE: The provider reported in the AQAA that daily routines are flexible and that staff are fully trained to meet the residents’ care and health needs. The manager reported that training had recently been provided by the dental hygienist to help them provide better oral care for one resident. The worker spoken with confirmed that routines are flexible, such as mealtimes. She gave some examples of how residents’ physical care needs are met in a personalised manner. Both have bathroom facilities that are used exclusively by them in different parts of the building, which helps maintain their privacy. Both residents were well presented and appropriately dressed. The care plans contained detailed information about the way the residents’ personal care should be provided and a consistent approach is promoted. One resident has not made much progress towards a personal care goal over the last year. It is recommended that the approach be reviewed with the help of the professionals currently involved with the service. Consideration should Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 14 also be given to changing how one area of this person’s personal care is provided to make it more age appropriate and dignified. Records and discussions provided evidence that physical health care is prioritised. The provider reported in the AQAA that a first aider is always on duty. Residents have a Health Action Plan, their weights are monitored and healthy eating is promoted. One resident is under the care of a specialist and staff have been given training about his condition. Well-man health checks have been arranged. Daily records showed their health and general wellbeing are being monitored. The care plan for one resident contained clear information about epilepsy and the staff action needed to respond to a seizure. It is positive that care planning is being supported by professionals e.g. psychology and speech therapy, with reported benefits for the residents. As the service does not include specialist support this is being arranged through the Worcester Community Team. The medication is being appropriately stored and the key kept securely. Records seen were up to date and showed doses are being given as prescribed. Two staff sign for each dose that is administered and other systems are in place to help reduce the risk of errors. Staff are provided with appropriate training and are not permitted to administer medication until the manager has assessed their competency. Medication is checked periodically by the supplying pharmacist and during the monthly provider’s monitoring visits. Care plans contained medication profiles that include the reason the medication has been prescribed. The medication prescribed has been kept under review and the effects of changes are closely monitored. Neither resident can self-administer their medication, however one has learnt why he takes medication and is becoming more aware and involved with the process. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents and their representative’s views are listened to and acted upon. Arrangements are in place to help protect the residents from abuse. EVIDENCE: There is a complaints procedure in place. This has now been developed into a format with pictures to help one resident understand his right to complain. Both current residents have relatives and keyworkers to advocate for them. No complaints have been received by the Home or the Commission since the last inspection. Some positive action has been taken to address one resident’s relatives wishes for more evening activities to be offered to their son. Adult Protection and Whistle Blowing policies are in place. The staff handbook contains these and staff are given a copy of the General Social Care Council code of conduct. The worker spoken with reported that there was an open culture and any concerns or abuse would be reported immediately. Some staff have attended an adult protection training course in 2005. The subject is covered in the induction and the Learning Disability Award Framework (LDAF) foundation programme. The manager agreed to see if free training is still being provided by the Worcestershire Adult Protection Team to support the training already provided. One event since the last inspection led to concerns being raised about one resident. The providers reported this to us and were advised to refer this under the local council’s adult protection procedure. They cooperated fully and said the events raised their awareness of matters to report. No physical restraint is used and arrangements to respond to residents’ behaviours are improving. The provider reported in the AQAA that residents Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 16 are being better protected now new staff are only permitted to start work when a full satisfactory CRB check has been returned. A sample of one resident’s financial records was seen. These were clear and showed that expenditure was being monitored and used for the resident’s direct benefit e.g. haircuts, clothes and activities. The manager checks the balances regularly. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. The residents are living in a clean, attractive and well-maintained home that gives them the opportunity to live in the community in family style accommodation. They have private and personalised bedrooms and good sized communal facilities. EVIDENCE: The Home is situated close to the town’s amenities in an established residential area. It is on a busy road so the front door and access to the front of the house from the garden are kept secure. The house has three good-sized communal rooms, an office, large kitchen, laundry, two communal toilets and bathrooms. There are five bedrooms, two of which have en-suite facilities and one that has a bathroom next-door. One of these is currently used as a sleeping in room for staff. The property continues to be well maintained internally and externally and it is fitted with suitable fire prevention equipment. One resident now has fire evacuation information provided in a pictorial form. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 18 The house is attractively decorated and furnished with comfortable good quality items. Both residents have personalised bedrooms that reflect their interests and practical needs. One communal room is used as a games room and this has doors leading onto a patio area in the large enclosed garden. Specialist equipment has been provided where needed and two of the baths have air-bath facilities. The residents were seen to move around the Home freely and they have access to the kitchen. The laundry is kept locked but it is large enough for residents to use with staff support. The dining room door was being wedged open. If this is needed to allow the residents and staff easy access then a selfclosing mechanism should be fitted so the fire exit route to the front door is not compromised. The Home was clean and tidy and suitable infection control systems are in place e.g. fridge temperature checks and the use of protective clothing. The fridge was clean and opened food was covered and dated. The provider’s monthly monitoring reports demonstrate that any repairs are dealt with promptly and that the residents’ home is always clean and comfortable. The provider reported in the AQAA that repairs are dealt with quickly and cleaning schedules are used to keep standards high. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are being supported by a stable and suitably trained staff team in sufficient numbers to meet their needs. They are being protected by the Home’s recruitment practices. EVIDENCE: At least two staff are on duty at all times when the residents are at home. At night one worker is awake and one sleeps-in. Half an hour is built into the rota to allow staff to hand over information as the shifts change. Permanent staff are asked to cover gaps were possible and agency staff are not used. There are currently no staffing vacancies. Turnover is relatively low with three new staff starting since the last inspection. The team is a mixture of full and parttime, male and female staff. One resident has a dedicated worker who supports him to attend college. It is positive that the staffing resources are being used more flexibly to enable evening and weekend activities to be accessed more often. Now one resident’s health needs have changed more staff may be able to be authorised to support him in the house alone, which will further increase opportunities for staff to take the other resident out. The file of a new worker was sampled. This showed that the Home’s recruitment procedure had been followed and all appropriate checks were in Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 20 place before the person took up post. It is positive that staff are no longer being started before a full CRB has been returned. The management continue to demonstrate a positive attitude towards employing people with disabilities or special needs. The provider reported in the AQAA that staff are provided with appropriate training and are supported to do their jobs through regularly supervision sessions and staff meetings. The worker spoken with confirmed that these were helpful processes and that she was encouraged to express her views and ideas. She felt ideas were sometimes slow to be implemented. Team spirits have been low at times as staff continue to wait for new residents to move in. Feedback from residents’ relatives was positive about staffs’ attitude. One is concerned that unless new residents are admitted staff will not be stimulated enough. The provider’s monthly visits reports continue to provide positive information about the staff team and their working practices. Staff are provided with walkie-talkies to enable them to contact each other for support when needed. One staff member’s file showed she had been taken through an induction with the manager during her first few weeks and then provided with core training such as health and safety and food hygiene. New staff complete the Learning Disability Award Framework and then go on to NVQ awards. Staff are expected to pay back costs of attaining an award if they leave within a one year period. Over half the staff team now hold a qualification, (66 ) and others are working towards one. The manager felt that training was now better organised and it was positive that more external courses were being accessed. All staff now take part in regular fire drills. Specialist training is accessed, such as epilepsy and all staff now complete a workbook about Autism. The way staff transfer this knowledge into their daily care practice can be further improved e.g. in working consistently. Total communication courses are being accessed locally and these techniques are starting to be brought into practice. More staff need to learn basic sign language to support communication, in particular with one resident. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents are benefiting from a well run Home. EVIDENCE: There have been two managers in post, who split the role between them. The registered manager has recently resigned after being on a period of extended leave. The remaining manager is going to apply to become registered. She has recently completed the Registered Managers Award and continues to work towards her NVQ 4 in Care. She has recently attended training on the Mental Capacity Act and is starting to implement the guidance. She appears capable and committed and has good ideas about how to further improve the service. She agreed to find out more about how person centred planning meetings can be linked into the care review process. Positive feedback has been received from staff and stakeholders about her attitude and skills. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 22 The providers are closely involved in the running of the home. The manager is not currently responsible for all operational areas for example she does not manage budgets. It is positive that she is now more involved in managing residents finances. The providers reported that the respective roles of the management team are kept under review and the manager will be facilitated to take on more responsibility as she gains further skills, experience and confidence. Currently she has five hours a week allocated administration time but the provides reported that she can arrange additional staff cover if she needs more time. The person carrying out the monthly visits provides the manager with supervision sessions. A member of the management team is on call at all times to provide the staff with support. A quality assurance system is in place that includes a system of internal audits and feedback surveys for stakeholders. The manager demonstrated how issues that have been raised in the surveys have been addressed. Staff meeting minutes showed that one family’s request for their son to increase the frequency of horseriding lessons had been actioned. The audits have helped ensure the Home’s policies and procedures are being implimented and recording standards maintained. The providers reported in the AQAA that all policies have been kept under review. The monthly provider visits continue to be carried out by an external professional to ensure they are objective. The AQAA contained some aims for the coming year. It is good practice to consult the stakeholders and staff and develop an open business plan for the year ahead. Progress can then be reported upon in the 2008 AQAA. The records seen are detailed throughout this report. Those sampled contained appropriate and useful information. The standard and frequency of record keeping are routinely checked during the monthly monitoring visits. The providers reported in the AQAA that all equipment has been regularly serviced and that regular checks are carried out e.g. fire alarm tests. Appropriate infection control arrangements are in place and checks are carried out to reduce the risk of Legionella. Risk assessmenets are carried out when hazards are identified and staff are made aware of these. These systems are monitored during the monthly provider visits. Weekly health and safety checks are carried out and these areas are also covered in the quality assurance audits. Fire drills have been held much more frequently since the last inspection. Staff are provided with core safety training through in-house workbooks that end with a test to ensure they have taken in the information. Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 4 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 x 2 3 3 3 3 3 x Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 YA1 Good Practice Recommendations The Service User’s Guide should include information about the range of fees charged. The providers should consider removing the reference that access to GP and CLDT services are included within the fees, as these are not services provided by the Home. 2. 3. YA6 YA7 Hold review meetings at least every six months and link these into person centred planning approaches. Continue to develop strategies to help the residents communicate and make choices e.g. using objects of reference and pictorial communication aids. Continue to explore activity options for residents to enhance their quality of life. 4. YA12 Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 25 5. 6. 7. YA32 YA37 YA39 All staff should learn how to sign to support one resident’s communication needs. The providers should enable the manager to take on a full operational role. As part of the quality assurance process improvement aims for the service should be agreed with the stakeholders and staff and the progress reviewed periodically. Install a self-closing mechanism to the dining room fire door so it can be kept open without compromising the residents’ safety. The providers should provide the manager with an activities budget and funds so staff do not have to pay for their own drinks and food when they support residents to access community cafes and pubs. 8. YA42 9. YA43 Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Matrixcare DS0000059194.V346571.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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