Care Home: Merthyr

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What the care home does well The home obtains information about people prior to them moving in so as to ensure individual needs can be met. Good care planning and delivery takes into account peoples` needs and preferences, which ensure that health and social care needs can be met. Staff act in a caring and respectful manner towards people, and work hard to provide opportunities for a wide range of social and therapeutic activities at home and in the local community. The meals at the home provide a varied diet and take into account people`s likes and dislikes. Relatives are welcomed at the home and people are encouraged and supported to have good communication with families. Relatives are encouraged to be involved and participate in the care planning and reviewing process. Concerns and complaints are taken seriously and people are protected from abuse or harm by well informed staff and good reporting procedures. People`s finances are protected by rigorous systems. A team of staff who are competent, qualified and well supervised supports people living at the home. The health, safety and welfare of people living at the home is promoted and protected. What has improved since the last inspection? Since the last inspection in 2007 the home has redecorated the kitchen and hall making it lighter and brighter. Plans of care have continued to improve and now include more individual, person centred information to enable staff to care and support people living at the home. Details now include information about individual spiritual and religious wishes. This means that people can be supported to maintain their beliefs as they wish. An area of tarmac to the front of the house that was a hazard at the last inspection has been repaired and made safe. CARE HOME ADULTS 18-65 Merthyr Exminster Exeter Devon EX6 8AT Lead Inspector Michelle Oliver Unannounced Inspection 2nd June 2008 09:30 Merthyr DS0000071089.V363792.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 Merthyr DS0000071089.V363792.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. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merthyr Address Exminster Exeter Devon EX6 8AT 01392 823702 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) Guinness Care and Support Ltd Mrs Hazel Jane Macmartin Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 5. Date of last inspection New Brief Description of the Service: Merthyr is a care home providing residential services to up to five adults who have a learning disability. The home has a shared lounge and dining area, kitchen, bathrooms and laundry facilities. all clients have single rooms. The house is set in a large garden area. The home is under the ownership and organisation of Guinness Care & Support Ltd. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place over 4.5 hours on Monday 2nd June 2008. During the inspection 3 people were case tracked. This involves looking at peoples’ individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. None of the people currently living at Merthyr are able to communicate verbally so we could not discuss their life at Merthyr with them. We spoke and observed people living at the home and staff throughout the day. We also spoke with 2 staff and the manager. A full tour of the buildings was made and a sample of records was looked at, including medications, care plans, the fire log book and staff files All people currently living at the home have very limited verbal communication skills, and as we are not skilled in their other methods of communication it was difficult for us to have any meaningful communication with them. However, the interaction between the people living at the home and those who care for them was closely observed. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . What the service does well: The home obtains information about people prior to them moving in so as to ensure individual needs can be met. Good care planning and delivery takes into account peoples’ needs and preferences, which ensure that health and social care needs can be met. Staff act in a caring and respectful manner towards people, and work hard to provide opportunities for a wide range of social and therapeutic activities at home and in the local community. The meals at the home provide a varied diet and take into account people’s likes and dislikes. Relatives are welcomed at the home and people are encouraged and supported to have good communication with families. Relatives are encouraged to be involved and participate in the care planning and reviewing process. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 6 Concerns and complaints are taken seriously and people are protected from abuse or harm by well informed staff and good reporting procedures. People’s finances are protected by rigorous systems. A team of staff who are competent, qualified and well supervised supports people living at the home. The health, safety and welfare of people living at the home is promoted and protected. 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. Merthyr DS0000071089.V363792.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 Merthyr DS0000071089.V363792.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 Quality in this outcome area is good. The assessment process ensures that people considering making Merthyr their home can be confident that their needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose that provides relatives and professionals with information about the home. An easier to read guide for has been produced to help people understand the services they should be provided with. Information about fees, services and what people living at the home are expected to pay extra for is included in the home’s terms and conditions, which each person is provided with. Most of the people who have made Merthyr their home have lived there for more than 17 years. There have been no new admissions to Merthyr since the last inspection. At the time of the last inspection the file for the person who had most recently moved in was looked at and contained a detailed assessment, which clearly identifies their needs. During this inspection the manager described the way a person would be introduced to the home. This Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 9 included the person and their family visiting the home, having a meal if they wished, meeting those already living at the home and staff. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 10 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. Staff are provided with good information to meet peoples’ needs and goals safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager completes plans of care for each person living at the home. The care plans set out individual needs, goals and any associated risks. This enables staff to have the information they require to help meet peoples’ needs safely. During this inspection we looked at the files for three people living in the home in detail. Each file included comprehensive care plans, which had been regularly reviewed and updated, detailed risk assessments covering various aspects of daily life, activities and behaviour and daily records. All information Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 11 recorded was up to date and sufficiently detailed to enable all staff to know how to meet individual needs. The manager and staff said any decision about peoples’ lives are discussed with them, or if they are unable to communicate, with relatives, care managers and other professionals. This is to ensure decisions are being made in peoples’ best interests. Books containing pictures of different foods and places around the local village have been compiled so that people living at the home can be encouraged and supported to make choices. The manager told us that plans for a notice board to enable people to know what’s going on day to day, using various communication methods, are underway. Any hazards within the home or with individuals are assessed and any action needed to minimise risks to people is recorded. This ensures staff have the information they require to keep people safe. Staff demonstrated a good awareness of individual risks. Staff were able to discuss how they communicated with people living at the home and met their needs. People living at the home have access to other health professionals as well as a local doctor’s practice. We saw records of people attending dentists, receiving visits from chiropodist, optician, community nurses and psychologists. Since the last inspection the manager has encouraged any representatives of people living in the home to be involved in the care planning process. We saw one file where a representative had been involved in the planning of care and had written “the manager and staff have been as committed to me as well as [my relative] which has been very helpful and caring. I would not wish for better care for [them] anywhere else”. We saw staff caring for people living at the home with kindness, gentleness, patience and with respect for their privacy and dignity. Staff were able to communicate well with people and understand different ways people had of making their needs known. The atmosphere at the home was relaxed, warm and friendly. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good The preferences of the people living in Merthyr are ascertained and recorded and they are encouraged and supported to lead meaningful lives and participate in a variety of activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Throughout this inspection staff were seen and heard being kind and respectful to people living at the home All staff spoken to during this inspection demonstrated how well they knew the people living at the home. Staff told us about peoples’ likes, dislikes, ways they preferred to be addressed and things they liked to do. We were told that one person enjoys sitting in a summerhouse in the garden. The manager and staff have begun to add wind chimes, mobiles and paintings to this space to make it Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 13 more of a sensory experience for the person. We went out to the summerhouse and one person was sat in comfortable furniture and was happy and relaxed. Staff encourage people living at the home to take part in a range of activities both in the home and in the community. We were told that they go out for lunch, go to the pub, go out shopping and enjoy walking. People also enjoy the garden and often eat outside when the weather id suitable. We saw numerous DVD’s that we were told people enjoy watching as well as listening to music and watching the TV. We were told the home plans to improve activities for people by looking into joining some social clubs and finding appropriate events to suit their needs. The manager stated that although not everyone has contact with relatives, those that do are encouraged to keep in touch. She also said that family members are always welcome to visit the home and all family contact is recorded. We were told that people are offered a choice of foods daily although the home has a 3 weekly rotating menu. During this inspection one person did not want what the others were having for lunch and chose something they liked. Staff were helpful and supportive to the person during this process and cooked, and presented the persons choice, in a timely manner. The records of foods eaten showed that a healthy and varied diet is provided at the home. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 14 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): 19, 20 & 21.Quality in this outcome area is good. Health needs of people living at the home are well met and their dignity and privacy is respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The ethos and atmosphere of the home is very much about giving people choice, respecting their rights and providing a relaxed and respectful atmosphere. Staff had a gentle, caring and respectful manner when talking about people living at the home and when communicating with them and described ways in which they respect privacy and dignity if offering support for personal care. Throughout the inspection there was laughter and fun and staff were respectful and kind. It was clear that people living at the home have a relaxed, trusting and friendly relationship with staff. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 15 Individual care plans provide staff with information to enable them to provide personal care in a person centred way and to be aware of how much support is necessary. This means that people are cared for as they wish and their independence is supported and encouraged. There are good records of peoples’ health care needs and how they are monitored and evidence that such monitoring takes place. Staff support and encourage people to attend medical appointments. Details were seen of additional health appointments being undertaken such as optical, dental and chiropody. Good records are maintained of the outcome of appointments ensuring that peoples’ health care needs are met. The service has a medication policy, which requires staff to be trained to dispense the medication. All staff who administer medication have received appropriate training. The home uses a monitored dosage system from a pharmacy. Currently no person living at the home looks after their own medicines. All medication is stored in a locked cupboard and all documentation was accurate and up to date. This ensures that people receiving medication are protected by the home’s procedures.. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 16 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. People living at the home and their relatives or representatives are assured they are listened to and complaints are dealt with appropriately. People living at the home are protected from harm or potential abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy in a variety of formats, and this is included in the Service User Guide, to ensure people living at the home, relatives and staff know how to make a complaint. People currently living at the home have difficulty communicating verbally so were unable to tell us if they understood the information or what they would do if they were unhappy about anything. Staff told us how they would be aware of a person being unhappy about anything, by their behaviour and body language. Training in Adult Protection is included in the homes’ training package, which all staff at the home undertakes. The home has a whistle blowing policy to encourage, support and ensure that staff report any incidents of concern. Staff demonstrated a good knowledge and understanding of Safeguarding Adults issues. They clearly described forms of abuse, including infringing on people’s rights and choices; and knew what to do should they suspect any abuse or Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 17 poor practice. The home also has policies and procedures and local guidance on abuse awareness and what to if it is suspected. All people living at the home have their own bank accounts where some benefits are paid into. The home maintains small amounts of cash for peoples’ personal spending. Good records with receipts are kept. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 18 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 & 30.Quality in this outcome area is good. People living at Merthyr live in a clean & homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The house is bright, clean and cheerful with a warm homely atmosphere. The home has a comfortably furnished lounge/ dining room, a well-equipped separate laundry, two bathrooms, toilet, a separate office and individual personalised bedrooms. The lounge has a TV, video player and a music system and comfortable furniture. The home does not employ domestics and staff undertake all cleaning and laundry chores at the home. The home has an infection control policy and procedure and all staff have had training in infection control. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 19 On the day of the inspection the home was clean and free from offensive odours. Hand washing and drying facilities were available. Gloves and aprons are used when necessary protecting people from the risk of cross infection. Merthyr is run as a family home and as such people living there and staff undertake not only the daily cleaning and laundry chores but also the decoration of the home. People’s bedrooms are decorated and furnished to their personal tastes and preferences; the kitchen and hallway have recently been redecorated and are bright and clean. Some areas of the home are looking tired and would benefit from redecoration. The manager said there are plans for this to be undertaken and to replace some of the carpets in peoples’ rooms and are hoping to have a new kitchen fitted sometime in the near future. This will ensure that people live in a well decorated, comfortable and personalised environment which suits their needs and wishes. We spoke to the manager about the arrangements for routine maintenance at the home. We were told that a report would be made to the Company head office and a visit from a maintenance person would be arranged. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 20 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, 34 & 35.Quality in this outcome area is good. People living at the home are protected by robust recruitment procedures and are supported by a trained, experienced and caring team of staff This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection three staff were spoken to and observed. It was clear they were experienced and skilled in their knowledge of the needs, preferences and goals of each person living at the home.. The manager is on duty 5 days a week and also aims to have 2 staff on duty throughout the day and night. During the night one waking and one sleeping members of staff, who will be called if necessary, are on duty. Recruitment records were seen for staff; they are stored securely and well organised. They contain the necessary checks required such as references and Criminal Records Bureau (CRB) checks. Ensuring the recruitment procedure is Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 21 consistent and that all required information is obtained for all employees will protects people, as only those who have undergone this robust procedure will be employed to work at the home. All staff have received a good range of training that helps them to understand and meet peoples’ needs, the training includes, mandatory health & safety training, protection of vulnerable adults, medication administration, epilepsy, safe holding techniques and infection control. Over 50 of care staff have obtained NVQ qualifications level 2 and above. This is a national recognised qualification where staff have reached the standards of care expected in care homes. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 22 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, 39 & 42.Quality in this outcome area is good. The home is being run in the best interests of people using the service. Systems to review, develop and improve the home have been developed ensuring that peoples’ safety and welfare are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff spoke highly of the manager confirming that she provided a clear sense of direction and leadership. It was clear throughout the inspection that the manager was working hard to raise standards and have better and clearer recording systems in place, for example improving care plans & risk assessments. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 23 The manager completes audits of the service through, for example, care plan reviews, staff supervision and meetings, environmental and health & safety checks, audits of medication, accidents, complaints and finances. Health care professionals have recently been consulted about their views on the home and services. This quality audit ensures the home is being run efficiently and effectively and in the best interests of people who live there. We were told that as a result of listening to people who use the service different places to visit on days out, more 1:1 time for people living at the home to meet their needs, an area has been made in the garden by using a summer house as a quiet room and activities area that enables staff to spend more 1: 1 time with individuals. The CSCI obtains information prior to inspections. The information includes conformation that all necessary policies and procedures are in place and are up to date. These are not inspected on the day but the information is used to help form a judgement as to whether the home has the correct policies to keep people who live at the home, and staff, safe. Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X 2 3 3 X 4 X 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 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 3 3 X X X X 3 X Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 25 N/A Are there any outstanding requirements from the last inspection? 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. Refer to Standard Good Practice Recommendations Merthyr DS0000071089.V363792.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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