Care Home: Micado Homes Ltd

What the care home does well The home has now been established for two years with the last inspection being in 2007 when one client had moved in. At the time of this inspection the home was full. We were able observe that the environment was homely and comfortable and people who use the service appeared relaxed and at home. People living at the home communicated well with us during the inspection and we noted that interaction between people and staff was relaxed and informal. The Registered Manager discussed the ethos of the home part of which is to provide an environment people are able to respect, and support in the area of self care. At the time of the inspection we felt that these principles were observed in the home and the way in which people presented themselves. What has improved since the last inspection? The home has been able to demonstrate continual improvement since the last inspection particularly in the design templates for record keeping for clients and the daily schedule for clients. The home has demonstrated since the last inspection, when one person was in residence that a good quality service can be provided and standards are being maintained. What the care home could do better: We have not made any Statutory Requirements during this inspection. The home has identified areas for self improvement in the Annual Quality Assurance Assessment. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Micado Homes Ltd 38 St Marys Road Hayes Middlesex UB3 2JP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Woolnough-Singh     Date: 1 0 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 24 Information about the care home Name of care home: Address: Micado Homes Ltd 38 St Marys Road Hayes Middlesex UB3 2JP 02085731134 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Micado Home Ltd care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 5 The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Micado is set in a quiet location close to Hayes Town Centre. Micado is a four bedroom detached house with a substantial back garden and a patio area to the front for parking. There is ample communal space and the home has been renovated and decorated to a very high standard. The home caters for people who have enduring mental health problems and require help with the activities of daily living. 5 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 24 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: three star excellent 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: This was an unannounced inspection of Micado homes. The key National Standards for Younger Adults were assessed. We visited the home on the 17th June 2009 and the 10th July 2009. We met with the Registered Manager and four people who use the service. One person was temporarily absent at the time of the inspection. We toured the building and examined care records and staff recruitment, training and supervision records. We looked at quality audits that had been carried out by the Registered Manager. We also gathered information and data from the Annual Quality Assurance Assessment completed to a high standard by the Registered Manager. Care Homes for Adults (18-65 years) Page 5 of 24 What the care home does well: What has improved since the last inspection? 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 set out 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 6 of 24 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 7 of 24 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. The information sought by the home on the needs of the person prior to moving in is of a good standard. Associated professionals are consulted and the necessary information submitted. Evidence: The home provided information with regard to need assessment and moving into the home in the Annual Quality Assurance Assessment. The home ensures people are assessed prior to moving in and requests an information summary from associated professionals involved with the person. A New Client Information pack is completed for each person with information requested from the health or social services commissioning team. We sampled the files (care records of two people who use the service. The New Client Application Pack contains recent reports from social workers and psychiatrists, a needs assessment carried out by a social worker, risk assessments and CPA (Care Plan Approach) information. Care Homes for Adults (18-65 years) Page 8 of 24 Evidence: There is a twelve week trail period for each person. The home has identified the need to improve this by offering pre -admission stays and longer pre- admission visits. Care Homes for Adults (18-65 years) Page 9 of 24 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. A care plan is formulated and sets out the individual requirements for each person. People are supported by staff in their daily living skills. Risks are assessed and these are supported by guidance. Evidence: The home has informed us that the care plan is a continuation of the needs assessment. We looked at the care plan records of two people who use the service. For each an up to date care plan is in place. This contained information on general health, mental health, risk assessment and daily activity programmer. A care plan audit has been introduced and is placed at the front of each file. This covers ethnic needs, risk management, implementation, care plan agreement, and evaluation. The audit aims to make sure that the care plan record is kept up to date. Care Homes for Adults (18-65 years) Page 10 of 24 Evidence: We were able to see that risk assessments had been carried out and a risk management plan was in place. The plan contains information relapse with symptoms and behavior. Incorporated in the plan are areas of responsibility for associated professionals. A crisis plan is also available; this guidance is for staff and gives clear instruction on how to manage a given situation and telephone numbers for emergency contacts. We discussed this with the Registered Manager and ascertained that this enables staff to feel more confident in their work. The AQQA informed us that people have key workers who are responsible for the care plan and that people who use the service are consulted with regard to changes. People meet with their key workers once a month. People spoken with indicated that they felt supported by staff. Care Homes for Adults (18-65 years) Page 11 of 24 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 living at the home have opportunities for personal development and are encouraged to participate in activities in the community. People participate in menu planning and cooking meals, varied meals are taken in a pleasant and homely environment. Evidence: We spoke with three people who use the service and were able to took at two bedrooms. People spoke positively about their routines and the facilities in the home. Each person cooks for the rest of the home once a week and goes shopping with staff. Two people were interested in art and this was reflected in their rooms and art materials had been purchased. We were able to see the daily activity programmer for each person. This covers housekeeping tasks and leisure activities. A laptop computer has been purchased since the last inspection. People are encouraged to use this to Care Homes for Adults (18-65 years) Page 12 of 24 Evidence: keep in contact with friends and family. We were able to observe flexibility in the home and people going about daily routines. We spoke with the Registered Manager who indicated the importance of ensuring people have a schedule and some structure to their day. The AQQA sets out the intention to support enable people to utilize their time and seek further education. We received photocopies of menus from April 2009. The menu covers the main meal of the day. The menu looked varied and nutritious with mainly traditional British dishes and pasta dishes. We did not sample food on this occasion but observed two main meals. People eat together in comfortable surroundings. Menus are planned with staff on a weekly basis. Care Homes for Adults (18-65 years) Page 13 of 24 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. People receive the personal and health care support they require. There are policies and procedures in place for the safe administration of medication. PROTECTION Evidence: We acertained in discussion with the Registered Manager that people are encouraged to take a pride in their appearance and the home. We felt on observation that this was the case with people clearly having their own tastes in clothes and looking after their bedrooms and creating a personal space to reflect their personality and interests. Guidance on health care is contained in the care plan and covers all aspects of the persons mental and physical health. The record keeping in regard to health monitoring is also very good. A multi disciplinary contact form is kept for each person this covers all health care appointments, reviews and any educational appointments. In conjunction with this is a record of contact with professionals and the outcomes. We Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: were able to see that people had attended appointments necessary for health monitoring. One person is able to administer their own medication. We did sample records and guidance in this case as the person was temporarily away from the home. We looked at the medication folder; this contained basic information on peoples medication , a safety checklist for administration and the medication administration record. The AQQA informed us that the home has comprehensive policies in the administration of medication and that staff are familiar with these and have receive the required training. Care Homes for Adults (18-65 years) Page 15 of 24 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. A complaints procedure is avail be and accessible for people who use the service. Guidance and training is in place for staff on the protection of vulnerable adults. Evidence: We looked at the information on complaints and safeguarding adults contained in the Annual Quality Assurance Assessment. This told us that that a complaints procedure is available in the Service Users Guide and this contains the stages of complaint and external agencies that can be contacted. There had been no complaints since the last key inspection in 2007 and we had not received notification of any safeguarding adults incidents. The AQQA informed us that people who use the service had been given the relevant Local Authority Safeguarding Vulnerable Adults procedures. We looked at the files of two members of staff; there is a record that they have received a copy of the Whistle Blowing Policy. We were also able to see the dates when they had attended Protection of Vulnerable Adults Training. People are encouraged to take responsibility for their own finances and risk assessments are in place for this. Care Homes for Adults (18-65 years) Page 16 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises is homely and well maintained. People have a comfortable environment with personalized bedrooms. The home is kept clean and hygienic for the benefit of people who use the service. Evidence: We toured the premises with the Registered Manager. At the time of the last inspection one person had moved into the home. The environment was rated as excellent and this rating has been retained. On both days of the inspection we observed the home to be clean and tidy. The decor and fixtures and fittings are of a high standard. We discussed the environment with the Registered Manager who said that she encouraged people to take a pride in their environment. People are encouraged to participate in housework, cooking and laundry. We were able to see all of the communal areas including the kitchen and laundry. These were being kept to a good level of hygiene. The home is located close to Hayes Town and has reasonable public transport links to local venues and the West London area. Care Homes for Adults (18-65 years) Page 17 of 24 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. People who use the service are supported by a staff who are recruited trained and supervised to the to the required standard. Evidence: We looked at the recruitment files of two members of staff most recently recruited to the staff team. We were able to see for both staff that a recruitment checklist had been completed, this is a monitoring form to ensure that all the necessary documents have been applied for prior to employment. We were able to see for both staff that an application form was on file, references and Criminal Record Bureau checks had been obtained. Identity verification and where necessary Home Office information was available. We were able to see supervision and training records. Training records sampled on both files verified that staff had received mandatory training in fire prevention, health and safety, infection control,and safeguarding vulnerable adults. Training had taken place in medication and managing violence and aggression. Staff had completed the Skills for Care common induction standards. One member of Care Homes for Adults (18-65 years) Page 18 of 24 Evidence: staff had a professional qualification rated as NVQ 4 and above. The home employs staff on the Highly skilled Migrant Programme. The staff team comprises of the Registered Manager and four care workers. Information in the Annual Quality Assurance Assessment informed us that staff hours for the week prior to completion of the AQQA was 175 hours. We were able to look at the Rota for a period of six weeks and see that there are usually two members of staff on during the morning/day shift and one member of staff on duty from 19.30 to 07.45 the next morning. This shift includes a sleep in duty at the home. The rota is clear and also includes clinical appointments, escort duties and annual leave and staff training. Staff have received training on the Mental Capacity Act and this has been updated to include the Deprivation of Liberty Safeguards. New staff undertake and induction programme. This is the Skills for Care programme includes core areas of learning such as principles of care, understanding the organization, maintaining safety at work,effective communication and developing as a worker. An annual staff survey is sent to staff to ascertain their view on working in the home, this looks at areas such as staff supervision, appraisal, management and protection of people who use the service. Care Homes for Adults (18-65 years) Page 19 of 24 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 excellent 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 benefit from a well run home. People who use the service are consulted on their views. The Registered Manager regularly reviews standards in the home. The health and safety of people who use the service and staff is promoted and monitored. Evidence: The Registered Manager and her partner are provider owners of Micado Homes. The Registered Manager is a Registered Mental Health Nurse with experience in the community and impatient settings. The Registered Manager is responsible for auditing and monitoring the quality of care in the home and also works with people who use the service supporting them on a daily basis. She was able to demonstrate competence in both areas throughout the inspection. The Annual Quality Assurance Assessment had been completed to a high standard. Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: The National Minimum Standards had been reviewed and evidence for examination highlighted. Areas for improvement had been identified where necessary. We read the surveys completed by three people who use the service, one relative and three staff. The surveys had been completed to indicate high satisfaction with the home, with the exception where the quality of the food was scored at lower level of satisfaction. Record keeping in the home was judged to be of a high standard and was kept up to date, especially records pertaining to the health and welfare of people who use the service. We were able to observe during the inspection that the environment was clean and safe. The Annual Quality Assurance Assessment told us that a monthly environmental check takes place and that fire detectors had been services in May 2008 and fire equipment in July 2008. Gas appliances had been serviced in March 2009. The personal risk assessments of peoples files were of a high standard with risks identified and guidance for staff. Care Homes for Adults (18-65 years) Page 21 of 24 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 22 of 24 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 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 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 24 of 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!