Care Home: Mayfield House

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What the care home does well People who live at the home and their relatives said they were happy with the home. Comments included: `My room is nice, I like living here` `I love my home` `I could not find anywhere better` `Like it here`. Staff have very good knowledge of people`s individual support needs and can describe people`s routines well. Staff showed they had a good understanding of how people communicate. Staff were thoughtful, discreet and respectful of people`s dignity when attending to any needs. People who live at the home looked well supported, well dressed and groomed. People who use the service said they were happy with their lifestyle at the home. There was a warm and calm atmosphere in the home. It is clear that people who live at the home get on well. When asked what the home does well, people who live there and their relatives said: `Take us on trips` `Meals` `Cares for the individuals needs to give a better quality of life`. People who live at the home said they enjoy the food, they said, `The food is splendid` `Really good food` `Always enjoy it`. People`s health needs have been identified, acted on promptly and monitored well for most people. Staff are very committed to making sure people get prompt medical treatment and access to treatment. A relative said, `The care service users get is superb, the service is excellent` and `The service is always alert as (name of person) is constantly ill. I am very pleased with the home they do a good job`. The home is clean, homely, modern and well maintained. People who use the service said they were happy with the standards of cleanliness in the home. They said the home is `always` clean and fresh. A relative said, `The home is spotless`. People who live at the home and their relatives spoke highly of the staff. Their comments included: `The staff are very loving to the residents` `Staff are good fun``The staff are nice and look after us`. Staff and people who use the service spoke very highly of the manager and how she leads her team. Their comments included: `She is very, very good` `She has a keen eye on service user`s needs, desires and goals` `Service users come first, always, with her` `She is very supportive and enables us to be the same` `She`s brilliant` `A very good manager, best we`ve ever had`. What has improved since the last inspection? People who use the service have a contract with the organisation. This shows the cost for their placement. These are now up to date so people know what their placement costs. They have been produced in an easy read format and are part of the Service User Guide. Care plans and risk assessment records have improved since our last visit to the home. They are person centred and individual to each person. The plans now have clear and detailed instruction on how the needs of people who use the service are to be met. Records showed that people now experience a wider variety of activity at the home. The staff and manager said that they now have more staff who can drive and a new mini-bus that is better adapted for people with mobility problems which helps them get people out more. There have been a number of improvements made to the look of the home that has made it more modern and comfortable for people who live at the home. These have included: New decor to lounge, conservatory, dining room, hallways and people`s bedrooms. New modern furnishings to conservatory, lounge and dining room. New carpets to lounge, conservatory and some bedrooms. Artwork from people who use the service displayed attractively on the walls. Soft furnishings and ornaments to create a more pleasing environment. Vinyl floor covering to the dining area. Doors fitted to the conservatory area so it can be used for a quiet area or for people to see their visitors in private.A hot food trolley has been purchased to make sure food is kept hot until served. Staff turnover at the home has reduced and there is more stability and consistency within the staff team. Staff said they enjoyed their jobs and `love coming to work`. They said they now receive regular one to one supervision meetings to discuss how they are getting on in their job and feel well supported. The manager said that staff have all received up to date trainig on moving and handling. This means they will be using safe techniques with people. The manager now analyses accidents on a monthly basis to check for any patterns or trends or ways of avoiding future accidents. What the care home could do better: All staff must receive training in epilepsy management. This will make sure they are confident in managing and dealing with the needs of people who have epilepsy. Where doors need to be propped open, a device must be fitted that activates door closure on the sound of the fire alarm. This will make sure that people are safe in the event of a fire. Key inspection report Care homes for adults (18-65 years) Name: Address: Mayfield House Woodhouse Lane East Ardsley Wakefield West Yorkshire WF3 2JS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Dawn Navesey     Date: 2 2 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Mayfield House Woodhouse Lane East Ardsley Wakefield West Yorkshire WF3 2JS 01924828181 01924872623 mayfield.house@craegmoor.co.uk www.craegmoor.co.uk J C Care Ltd care home 15 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) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home Mayfield House is owned by J C Care, which is a subsidiary of Craegmoor Health Care. Mayfield House is a semi-detached property, which is joined to another care home owned by the same company. The home is situated in its own grounds and ample parking is available. The care home is on Woodhouse Lane, which is within easy walking distance of the main road. The area is well served by public transport. There are a number of local facilities and people who live at the home can make use of amenities in the area. The care home is registered to provide accommodation and care services for up to fifteen people with a learning disability, who may also have a physical disability. There are thirteen people currently living at the service. The home is spread over two floors. There is no passenger lift, however some ground floor bedrooms are available. The home provides staff over twenty-four hours. The home also employs a maintenance officer and domestic staff. At present there are no catering staff employed, care staff cook all meals. Current information about services Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 15 15 15 15 Brief description of the care home provided at Mayfield House in the form of a statement of purpose, service user guide and the most recent inspection report published by the Care Quality Commission are available by contacting the home. The current scale of charges at the home is 411 1588 pounds per week. Additional charges are made for outings, toiletries and various activities. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Care Quality Commission (CQC) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk This visit was unannounced and was carried out by one inspector who was at the home from 1:30pm - 6:45pm on the 22 September 2009. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people living there. And also to monitor Care Homes for Adults (18-65 years) Page 6 of 33 progress on the requirements and recommendations made at the last inspection. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. An AQAA (Annual Quality Assurance Assessment) was completed by the home manager before the visit to provide additional information. This was well completed and gave us all the information we asked for. Survey forms were sent out to people using the service, staff and health care professionals. A number of these have been returned and comments made in them have been included in this report. During the visit a number of documents and records were looked at and some areas of the home used by the people living at the home were visited. Some time was spent with the people who use the service, talking to them and interacting with them. Time was also spent talking to staff and the manager. Feedback at the end of the visit was given to the manager. The last inspection of this home was on 8 November 2007. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: People who live at the home and their relatives said they were happy with the home. Comments included: My room is nice, I like living here I love my home I could not find anywhere better Like it here. Staff have very good knowledge of peoples individual support needs and can describe peoples routines well. Staff showed they had a good understanding of how people communicate. Staff were thoughtful, discreet and respectful of peoples dignity when attending to any needs. People who live at the home looked well supported, well dressed and groomed. People who use the service said they were happy with their lifestyle at the home. There was a warm and calm atmosphere in the home. It is clear that people who live at the home get on well. When asked what the home does well, people who live there and their relatives said: Take us on trips Meals Cares for the individuals needs to give a better quality of life. People who live at the home said they enjoy the food, they said, The food is splendid Really good food Always enjoy it. Peoples health needs have been identified, acted on promptly and monitored well for most people. Staff are very committed to making sure people get prompt medical treatment and access to treatment. A relative said, The care service users get is superb, the service is excellent and The service is always alert as (name of person) is constantly ill. I am very pleased with the home they do a good job. The home is clean, homely, modern and well maintained. People who use the service said they were happy with the standards of cleanliness in the home. They said the home is always clean and fresh. A relative said, The home is spotless. People who live at the home and their relatives spoke highly of the staff. Their comments included: The staff are very loving to the residents Staff are good fun Care Homes for Adults (18-65 years) Page 8 of 33 The staff are nice and look after us. Staff and people who use the service spoke very highly of the manager and how she leads her team. Their comments included: She is very, very good She has a keen eye on service users needs, desires and goals Service users come first, always, with her She is very supportive and enables us to be the same Shes brilliant A very good manager, best weve ever had. What has improved since the last inspection? People who use the service have a contract with the organisation. This shows the cost for their placement. These are now up to date so people know what their placement costs. They have been produced in an easy read format and are part of the Service User Guide. Care plans and risk assessment records have improved since our last visit to the home. They are person centred and individual to each person. The plans now have clear and detailed instruction on how the needs of people who use the service are to be met. Records showed that people now experience a wider variety of activity at the home. The staff and manager said that they now have more staff who can drive and a new mini-bus that is better adapted for people with mobility problems which helps them get people out more. There have been a number of improvements made to the look of the home that has made it more modern and comfortable for people who live at the home. These have included: New decor to lounge, conservatory, dining room, hallways and peoples bedrooms. New modern furnishings to conservatory, lounge and dining room. New carpets to lounge, conservatory and some bedrooms. Artwork from people who use the service displayed attractively on the walls. Soft furnishings and ornaments to create a more pleasing environment. Vinyl floor covering to the dining area. Doors fitted to the conservatory area so it can be used for a quiet area or for people to see their visitors in private. Care Homes for Adults (18-65 years) Page 9 of 33 A hot food trolley has been purchased to make sure food is kept hot until served. Staff turnover at the home has reduced and there is more stability and consistency within the staff team. Staff said they enjoyed their jobs and love coming to work. They said they now receive regular one to one supervision meetings to discuss how they are getting on in their job and feel well supported. The manager said that staff have all received up to date trainig on moving and handling. This means they will be using safe techniques with people. The manager now analyses accidents on a monthly basis to check for any patterns or trends or ways of avoiding future accidents. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: In the AQAA, the manager desribed the pre-admission assessment procedure. She said, All new prospective service users have a personal assessment of their choices/needs and aspirations which is carried out in the service users own living enviroment. Based on the information given during the assessment and information already obtained the Home Manager will then focus on if Mayfield House can meet the needs and aspriations, positive improvement, achieving goals and improving quailty of life for the service user. New prospective service users are invited to spend a day at the home. Overnight visits are also planned and can be extended to several days if required on occasion. Introductory visit are documented and continuing assessment of compatabilty and Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: homes capacity to meet their need is ongoing. We looked at pre- admission assessments for some people. We saw that peoples needs are assessed properly before they move into the home so that staff can be told about any specific needs they might have and know what help and support to provide. People who live at the home and their relatives said they were happy with the home. Comments included: My room is nice, I like living here I love my home I could not find anywhere better Like it here. A staff member said, They all seem very happy living here. People who use the service have a contract with the organisation. This shows the cost for their placement. These are now up to date so people know what their placement costs. They have been produced in an easy read format and are part of the Service User Guide. Care Homes for Adults (18-65 years) Page 13 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to make decisions about their lives and are involved in planning their care and support. Evidence: In the AQAA, the manager said, All service users at Mayfield House are supported and encouraged to take an active role in making decisions and promoting their independence as much as possible. She said they do this by making sure, Each service user has a named key worker and is involved in developing an individualised person centred plan detailing current needs/goals/aspiration and staff intervention required. This includes discussions with the service users about how they are feeling and views on what actions are required by staff. She also said, Support plans have been written to reflect what we know about how a person makes choice and how they prefer their needs to be met. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: In the AQAA, the manager also told us how she was planning to improve the service. She said, Our training on person centred thinking is being rolled out to assist staff who support service users understand the true ethos behind person centred planning. We plan to have had all the staff team trained over the next 12 months. We looked at care plan and risk assessment records for some people who live at the home. We found them to have improved since our last visit to the home. They were person centred and individual to each person. The plans had clear and detailed instruction on how the needs of people who use the service are to be met. They had some good information about how people should be supported with personal care, communication, social and health needs. There is also a clear emphasis on furthering peoples independence and involving them in the daily life of the home. Staff said they now found the care plans better and that they gave them more information on how to support people. Staff said they were especially useful when they first started to work at the home in helping them to get to know people. There were some minor gaps in information on care needs, which could lead to some oversights. On discussing this with the manager she said she would make sure she reviewed these plans. Staff were familiar with what was written in peoples care plans and could talk confidently about the support they give. They had very good knowledge of peoples individual support needs and could describe peoples routines well. People who use the service or their relatives had clearly been involved in the drawing up of the plans. Plans were signed by people and one person told us they had written their own plans and notes. Care plans are reviewed and evaluated regularly to make sure they are still relevant for people. Key workers do this on a monthly basis with people who live at the home; this makes sure they are still meeting peoples needs properly. People who use the service told us they always make decisions about what they do each day and that they can decide to do what they want. People are encouraged to make choices and decisions about what they do. Staff said they encourage people to make choices in their every day lives such as what to do, what to eat, what to wear and where to go out. We saw people being offerred choices throughout the visit. Staff also responded well to requests for anything from the people living at the home. We saw people were supported to make choices, using a variety of communication methods such as pointing, signing, touch and facial expression. Staff showed they had Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: a good understanding of how people communicate. When we asked staff what they thought the home does well, one said, Staff ensure that service users are given choice, are treated with dignity and respect and supported to live an independent life as possible. In the AQAA, the manager said, We have service user meetings once a month (your voice) all the service users are invited to attend and the meetings are minuted. People told us they enjoyed the meetings and that they usually discussed holidays, food, activities they would like to do and any staff matters such as recruitment of new staff. The manager told us of changes that had been made in the service as a result of the suggestions made at the meetings. These included: A request to grow vegetables in the garden has resulted in the development of a vegetable patch. To have a barbecue area and new garden furniture. A new mini-bus with adaptatations which make it easier for people with mobility problems. New decor and furnishings in the home. Care Homes for Adults (18-65 years) Page 16 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle. Social, educational, cultural and recreational activities meet peoples expectations. They also benefit from a good, healthy and varied diet. Evidence: In the AQAA, the manager said, The homes aims and objectives are to promote independence and for service users living at the home to live a full and enjoyable life style. She also said, Staff encourage all service users to have their own hobbies and interests, days out and individual days activities are arranged within the home. We have ensured that we have a full staff team to ensure that the lifestyle choices made and planned by our service users are carried out and they are supported at all times to attend activities. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: She also said she was planning to make improvements to the service. She said, We will continue to develop programmes of weekly activities that reflect personal choice that will encourage and maintain independence. These structured programmes will help service users to plan their days, and include daily living skills and activities in house or out. People who use the service said they were happy with their lifestyle at the home. They said they enjoy their independence and doing what they could for themselves. One person said they always make their own breakfast, another said they enjoyed helping in the kitchen. One person said they enjoyed going out and about in the local village and going to church on their own. There was a warm and calm atmosphere in the home. It is clear that people who live at the home get on well. When we asked staff what the service does well, one said that people who live at the home are allowed to live independant lives. Other comments included: Service users live an active and as normal life as possible. The home supports the service users to carry out daily living skills and integrate into the community and live a normal life. When asked what the service could do better, one staff said, I feel more 1-1 support for service users would benefit them. In discussion with the manager she also said she was looking into provision of more evening activity such as club nights to meet the needs of some of the people better. Most people we spoke to said they did not go out much in the evenings. It was not always clear if this was their personal choice or that they didnt get the opportunity to do so. People who live at the home told us they had enjoyed holidays this year or were looking forward to holidays that were planned. They also said they enjoyed the evening entertainment when on holiday. Records showed that people now experience a wider variety of activity at the home. The staff and manager said that they now have more staff who can drive and a new mini-bus that is better adapted for people with mobility problems which helps them get people out more. On the day of the visit, a group of people went out to the airport plane spotting. Others were watching TV, listening to the radio, playing musical Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: instruments or generally interacting and chatting with staff. When aked what the home does well, people who live there and their relatives said: Take us on trips Meals Cares for the individuals needs to give a better quality of life. We looked at menus at the home. These are planned around peoples likes and dislikes. People who live at the home said they enjoy the food, they said, The food is splendid Really good food Always enjoy it. Staff also make sure that any special dietary requirements such as calory controlled or soft diets are catered for. Menu records showed a wide variety of food is available. People who live at the home said they can help themselves to snacks and drinks whenever they want. We observed the tea time meal. The food looked appetising and well presented. The meal time was seen as a social occasion with plenty of chatting and interaction. People who needed support to eat their meals were given this with great thought for their comfort and dignity. They were not hurried or rushed and staff sat with them to ensure their safety. Care Homes for Adults (18-65 years) Page 19 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, peoples general healthcare needs are well met and based upon their individual needs. Evidence: In the AQAA, the manager said, Within the person centred plan is an individual Health Action Plan completed with the service user, the service users GP for historical medical information, families and other health professionals involved in their support. She also said, We have made and maintained good working relationships with the local GP and multi disciplinary teams enabling us to source the relevant health checks when needed. The GP understands the needs of the service users and will make home visits if necessary for the service users who are unable to access the surgery. Staff had good knowledge of peoples personal support needs. Staff were thoughtful, discreet and respectful of peoples dignity when attending to any needs. People who live at the home looked well supported, well dressed and groomed. One said, when asked what the home does well, Look after me Helps me to be more independent, offers me choice. Staff said, provide good care and support and Mayfield House Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: provides an excellent standard of care and support to individuals that use our service. Good records are kept of health appointments and their outcomes. Staff make sure that people are given support to attend appointments to meet their health needs. People are referred to health professionals when needed. It was clear from records we saw that peoples health needs have been identified, acted on promptly and monitored well for most people. Staff are very committed to making sure people get prompt medical treatment and access to treatment. A relative said, The care service users get is superb, the service is excellent and The service is always alert as (name of person) is constantly ill. I am very pleased with the home they do a good job However, when we asked staff about a persons epilepsy management they were not totally confident or consistent in what actions they would take in the event of a person using the service having a fit. Some of the staff had not been trained in epilepsy and others had been trained but were not clear on the persons care plan and management. They all did however say they would seek advice and contact the emergency services if the person had continuous fits. Training must be provided for all staff on epilepsy management and staff must be aware of what action to take for each person who has epilepsy. This will make sure peoples needs are properly met. Staff have received some training on meeting the specialist health needs of people who live at the home. This has included dementia awareness, stoma care and specialist moving and handling. The home uses a monitored dosage pre-packed system for medicines. There are good ordering and checking systems in place. We checked some medication administration records (MAR) sheets. These were found to be in good order. In the AQAA, the manager said, All staff complete administration of medication training and do not administer medication until they are fully confident and competent, we have in depth medication policies for our staff to follow and we carry out medication competency assessments and these are audited. Care Homes for Adults (18-65 years) Page 21 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and are protected from abuse. Evidence: In the AQAA, the manager said, We are able to listen and act upon all complaints openly and transparently. All staff are aware of the complaints policy. Service user your voice meetings provide a forum to allow complaints and concerns to be aired. An easy read complaints procedure is available in our service user guides. The manager told us they had not received any complaints in the last year. People who use the service and their relatives said they knew how to complain and said they would talk to the manager or staff if they were unhappy about anything. One relative said, No concerns. All staff said they knew what to do if anyone who uses the service raised concerns with them. It was clear from staffs interactions with people that the people who live at the home seemed confident to raise their wishes or concerns. The manager also said in the AQAA, All staff undertake regular Safeguarding Adults training with annual updates - the compliance of our training is reviewed by the Area Manager on a monthly basis to ensure compliance is maintained to ensure service users are protected from abuse, neglect and self-harm. Staff said they have received training in safeguarding adults. They were able to say Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. They were familiar with the whistle blowing procedure and said they would have no hesitation in using it if they thought they needed to raise concerns outside of the home or organisation. There are good systems in place to make sure people who live at the home have their money looked after well. In the AQAA, the manager told us, We receive unannounced internal financial audits by the internal auditors - the report is published within 1 week of the audit and a star rating is given with any actions to address to improve the management of client monies, this is closely monitored by the Area Manager. Statements are printed monthly in order for the Home Manager to review statements. The manager said they had recently achieved a 100 rating from an internal audit, where all areas of managing peoples finances had been checked. Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is homely, comfortable and safe for people who live at the home. Evidence: In the AQAA, the manager said, We have reviewed Mayfield house with a look of creating a more homely atmosphere. There have been a number of improvements made to the look of the home that has made it more modern and comfortable for people who live at the home. These have included: New decor to lounge, conservatory, dining room, hallways and peoples bedrooms. New modern furnishings to conservatory, lounge and dining room. New carpets to lounge, conservatory and some bedrooms. Artwork from people who use the service displayed attractively on the walls. Soft furnishings and ornaments to create a more pleasing environment. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: Vinyl floor covering to the dining area. Doors fitted to the conservatory area so it can be used for a quiet area or for people to see their visitors in private. A hot food trolley has been purchased to make sure food is kept hot until served. In the AQAA, the manager also said, Service users have been at the forefront of decorating and personalising their own rooms and had active involvement with choosing and purchasing furniture for the home. One person told us how much he had enjoyed doing this and said, I love my room and the wall paper. A tour of the home was carried out. Communal areas, bathrooms and bedrooms were visited. The home looked very clean, homely, modern and well maintained. People who use the service said they were happy with the standards of cleanliness in the home. They said the home is always clean and fresh. A relative said, The home is spotless. The manager said they were going to be looking at modernising bathrooms in the home and making some adapatations in the kitchen in the future. The kitchen adaptations would include work surfaces that can be height adjusted to enable people who use wheelchairs better access in the kitchen. Clinical waste is properly managed. Staff have received training in infection control as part of their induction and were able to say what infection control measures are in place. Care Homes for Adults (18-65 years) Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are, in the main, trained skilled and in sufficient numbers to support people who use the service. Evidence: People who live at the home and their relatives spoke highly of the staff. Their comments included: The staff are very loving to the residents Staff are good fun The staff are nice and look after us. In the AQAA, the manager said, We have robust recruitment policies and procedures that are implemented at point of interest from a potential candidate. We have a thorough interview and selection process in order to short list candidates. We involve service users in supporting the Home Manager to show potential candidates around their home and gain feedback where able in order to make decisions about appointments. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: We looked at recruitment records These showed that recruitment is properly managed by the home; interviews are held, references and CRB (Criminal Record Bureau) checks are obtained before staff start work and checks are made to make sure staff are eligible for work. Staff turnover at the home has reduced and there is more stability and consistency within the staff team. Staff said they enjoyed their jobs and love coming to work. In the AQAA, the manager told us of a scheme run by the organisation that she thinks has helped them to keep staff. She said, We have award ceremonies on a national basis for Shining Stars - this is where staff can be nominated for the award by service users and staff within the company. (Mayfield house maintenance man was one of the ten finalist in 2008) We have an Area Leading Light Award which then goes to Divisional and National Vote. (Mayfield house won the area leading light 2008) The reward schemes have improved the drive across the team. Also the company has introduced a making a difference reward scheme, home managers can nominate staff who they think make a difference to the lives of the people we support. This reward is quarterly. We looked at staffing levels and they showed that there are sufficient staff and that they work flexibly to meet the needs of the people who use the service. Induction training is based on the Skills for Care common induction standards. Staff said their induction had been good and prepared them well for their job. They said they worked with the manager to complete their induction work books and make sure they had understood their training. We also looked at training records and these showed that most staffs training was up to date or if updates were needed, they were planned. Staff said they were pleased with their training and confirmed they got updates when needed. In the AQAA the manager told us that over half of the staff team have achieved their NVQ (National Vocational Qualification) in care at level 2 or above. She also said that most of the other staff are enrolled to start this training. This means they will be qualified to carry out their job. In the AQAA, the manager said the service could do better and wants staff to develop more experience in service users needs and requirements, by providing more specialised training. As mentioned in the health and personal care section of this report, some staff have not yet received training in managing epilepsy and were not totally confident in what actions they would take in the event of a person using the service having a fit. This training must be provided to make sure all staff know what to Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: do. We looked at staffs supervision records and saw that regular one to one sessions are being provided for staff to discuss their roles. Staff said they were very happy with the support they get. Care Homes for Adults (18-65 years) Page 28 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed, the interests of the people who use the service are seen as important to the manager and staff and are properly safeguarded. Evidence: In the AQAA, the manager said, The Home Manager is skilled and experienced to enable her and staff team to meet the needs of service user and support the staff team and has sound knowledge of meeting the stated aims and objectives of the service.The Home Manager operates an open door policy and is always available to support and advise both service users and staff. The home is managed in an open and transparent way and the Home Manager is committed to providing positive leadership and a relaxed atmosphere. Staff and people who use the service spoke very highly of the manager and how she leads her team. Their comments included: She is very, very good Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: She has a keen eye on service users needs, desires and goals Service users come first, always, with her She is very supportive and enables us to be the same Shes brilliant A very good manager, best weve ever had. The manager has the Registered Managers Award and an NVQ level 4 in care management. This means she is qualified to carry out her job. She has also received training recently on the Mental Capacity Act and Deprivation of Liberty Safeguards. This means she has a greater understanding of the rights of people who live at the home, their liberty and decision making process. She said that this training will now be extended to the rest of the staff team. Records we looked at showed that regular health and safety checks are carried out and that health and safety is well managed. In the AQAA, the manager said, Health and safety committee meet every three months to discuss environmental issues and ongoing improvements and repairs. Service users representative also attends these meetings. We did however notice that the office door in the home is propped open with a door wedge. This poses a risk in the event of a fire. Where doors need to be propped open, a device must be fitted that activates door closure on the sound of the fire alarm. This will make sure that people are safe in the event of a fire. The organisation provides a comprehensive manual of policies and procedures for staff to refer to. We looked at accident reporting and spoke to staff about this. Staff were clear on their responsibilites and how to report and record accidents or incidents. The manager also analyses accidents now on a monthly basis to check for any patterns or trends or ways of avoiding future accidents. The organisations area manager conducts monthly provider reports with detailed requirements for improvement. The manager receives regular supervision from the area manager to support her in her role. The organisation also sends out annual questionnaires to people who use the service and their relatives. This means they are always seeking peoples views on how the service can improve. The questionnares have not yet been sent out for this year. Care Homes for Adults (18-65 years) Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 35 18 All staff must receive training in epilepsy management This will make sure they are confident in managing and dealing with the needs of people who have epilepsy. 31/12/2009 2 42 13 Where doors need to be 31/12/2009 propped open, a device must be fitted that activates door closure on the sound of the fire alarm. This will make sure that people are safe in the event of a fire. 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 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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