Care Home: Myland House.

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What the care home does well The service provides the people who live there with a comfortable and homely environment, which is suited to their needs. Before moving into the home staff from the home will assess people`s needs to make sure that Myland House will be suitable for them. People will be encouraged to spend time at the home to make sure that it will meet their needs. The service offers a flexible structure to the day, people were observed moving freely around their home and told us they are happy living there and that they are supported to do what they want to do. Myland House provides people with good size individual rooms and a pleasant environment and garden. People are always made welcome and residents can enjoy having visitors at any time. People told us that the staff members working at the home are good, helpful and caring. What has improved since the last inspection? Myland House DS0000017893.V376775.R01.S.doc Version 5.2 The previous inspection of this service had resulted in a requirement for risk assessments to be developed where radiators were not covered and people with poor or unsteady mobility may have been at risk. This requirement had been met. The communal kitchen had been redecorated since the previous inspection visit. The staff recruitment process has improved since the previous visit. This means that people living at Myland House are protected by the safe recruitment of professional and friendly staff. The previous inspection of this service had resulted in a requirement for water temperatures to be regularly checked to safeguard people from scalds. This requirement had been met. People tell us they have an induction in line with Common Induction Standards however there needs to be evidence available at the home to confirm this. What the care home could do better: The service has a Service User Guide and a Statement of Purpose however these documents need to be updated to reflect new management arrangements and the regulatory body`s contact details. This is so that people have access to accurate and up to date information about the service. Consideration should be given to producing a policy in relation to the option of a minimum seven-day annual holiday outside the home, which residents help choose and plan. This is so people are aware of their rights and responsibilities. Medications received into the home that are not included in the pharmacy blister packs should be marked with the date they were opened and amounts remaining at the end of the month need to be `carried over` to the new Medication Administration Record (MAR) chart. This is so there is a clear record and audit trail to show what medications are in the home at any time. All staff members, including bank staff members, should receive the basic core training necessary to promote and protect the health, safety and well being of the vulnerable people living at the home. This should include Safeguarding Vulnerable Adults, Health and Safety, Fire Awareness, Moving and Handling, infection control, Common Induction Standards and any other training relevant to the specific needs of the people living at Myland House. An annual quality assessment process should be developed to include the views of the people living at the home, their representatives, the staff and outside professionals involved with the home. This is so that the registered provider can undertake an accurate evaluation of the services and facilities, care and support provided for the people living at Myland House.Myland HouseDS0000017893.V376775.R01.S.doc Version 5.2 Key inspection report CARE HOME ADULTS 18-65 Myland House 81 Mile End Road Colchester Essex CO4 5BU Lead Inspector Jane Greaves Key Unannounced Inspection 22nd July 2009 09:00 Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 2 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 Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Myland House Address 81 Mile End Road Colchester Essex CO4 5BU 01206 853604 01206 853604 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) The Brain Injury Rehabilitation Trust Mrs Suzette Anne Doherty Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th September 2008 Brief Description of the Service: Myland House is one of a number of homes owned and run by the Disabilities Trust. The Brain Injury Rehabilitation Trust (BIRT) are part of the Disabilities Trust and are the registered providers for Myland House. The service is registered to provide care to five people aged between 18-65, who all have an acquired brain injury. The home is a detached former family dwelling located in an established residential area of Colchester. It is situated within walking distance of all of Colchesters main shopping facilities. The accommodation is arranged on the ground floor and first floor of the premises. Furnishings throughout the home are in keeping with the needs of the people who live there. Fees for accommodation range from £906.60 to £1,237.20, an additional charge is made for one to one care hours, where required. Items not covered by the fees are personal items, such as clothing, toiletries, hairdressing and newspapers. This was the information provided at the time of the previous key inspection in 2008; people considering moving to this home may wish to obtain more up to date information from the care home. Myland House DS0000017893.V376775.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 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key site visit that took place on a weekday over 8 ½ hours. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken; care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home and staff. Feedback on findings was provided to the manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the manager, and the staff team for the help and co-operation throughout this inspection process. What the service does well: What has improved since the last inspection? Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 6 The previous inspection of this service had resulted in a requirement for risk assessments to be developed where radiators were not covered and people with poor or unsteady mobility may have been at risk. This requirement had been met. The communal kitchen had been redecorated since the previous inspection visit. The staff recruitment process has improved since the previous visit. This means that people living at Myland House are protected by the safe recruitment of professional and friendly staff. The previous inspection of this service had resulted in a requirement for water temperatures to be regularly checked to safeguard people from scalds. This requirement had been met. People tell us they have an induction in line with Common Induction Standards however there needs to be evidence available at the home to confirm this. What they could do better: The service has a Service User Guide and a Statement of Purpose however these documents need to be updated to reflect new management arrangements and the regulatory body’s contact details. This is so that people have access to accurate and up to date information about the service. Consideration should be given to producing a policy in relation to the option of a minimum seven-day annual holiday outside the home, which residents help choose and plan. This is so people are aware of their rights and responsibilities. Medications received into the home that are not included in the pharmacy blister packs should be marked with the date they were opened and amounts remaining at the end of the month need to be ‘carried over’ to the new Medication Administration Record (MAR) chart. This is so there is a clear record and audit trail to show what medications are in the home at any time. All staff members, including bank staff members, should receive the basic core training necessary to promote and protect the health, safety and well being of the vulnerable people living at the home. This should include Safeguarding Vulnerable Adults, Health and Safety, Fire Awareness, Moving and Handling, infection control, Common Induction Standards and any other training relevant to the specific needs of the people living at Myland House. An annual quality assessment process should be developed to include the views of the people living at the home, their representatives, the staff and outside professionals involved with the home. This is so that the registered provider can undertake an accurate evaluation of the services and facilities, care and support provided for the people living at Myland House. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 7 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. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 8 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 Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4. People using the 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 considering making Myland House their home could be sure their needs would be met based on a thorough assessment. EVIDENCE: No new residents had been admitted to Myland House since the previous inspection site visit. One person was in the process of considering making Myland House their home. At the time of this visit the person had been invited to have trial visits involving 1 day time and 1 weekend visit. Records showed us, and the manager confirmed that an advocate was involved in supporting the person to make their decision. The manager had met with the person, their advocate and key worker. The prospective resident had already been enrolled in a college local to the home and the manager had facilitated contact between the new college placement and the previous one so they could liaise regarding the person’s strengths and weaknesses. The prospective resident had already picked out the colours etc for their new room so that it could be decorated in readiness for their arrival. The manager was able to demonstrate that the service had already been sourcing activities for this person. There was no formal assessment of needs yet undertaken, the Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 10 process of gathering information was still in progress at this time. The Statement of Purpose and Service User Guide were in the process of being amended to reflect the new management arrangements at the home and changes in regulatory body contact details. The Service User Guide was available in an ‘easy read’ format and provided for each person to have a copy in their rooms. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the 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 could expect their care to be delivered and to be supported to take risks and make decisions according to an individual plan. EVIDENCE: We looked at care plans for two people living at Myland House. These covered the main needs and risks experienced by each person and guidance to staff as to how these should be managed. Where planned interventions infringed the rights of the people concerned, this was also documented. Records and discussions showed that those who were able had been involved in planning for their lives. Staff showed by their comments and practice that they were familiar with the content of peoples’ care plans. The manager told us a review was planned of Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 12 all support plans and risk assessments acknowledging there may be some shortfalls. She reported the intention to introduce more care plans around enablement including achievable goals and aspirations that people can do. Care plans were developed around each person’s specific needs and wishes. Examples included drinking hot drinks, personal hygiene, dietary intake, seizures, inappropriate sexual behaviour, accessing the community, obsessive behaviours, access to the kitchen, negative comments directed at staff, epilepsy and bed time routines. The care plans identified goals for individuals and details of the actions staff needed to take to support the person to achieve their identified goal. The last section of each care plan indicated when it was next due to be reviewed. One care plan we looked at did not indicate that the scheduled review had taken place. Discussion with the person’s key worker told us that the review had taken place albeit later than scheduled. Computer records confirmed this but due to computer problems the reviewed care plan had not been printed off and placed in the service users’ file at this time. In this instance there had been no changes to the care plan so this did not have a negative impact on the person’s care and support. Each person had been provided with their own folder, which they kept in their rooms containing a copy of their agreed weekly programmes, care plans and risk assessments, copy of service user meetings and information about their rights and how to complain. A professional involved with the care and support of one of the people living at Myland House told us “They are doing their best to meet X’s needs. I have no worries, X is well looked after and seems happy there”. We noted there were weekly minuted meetings held between each resident and their key worker. These records showed us that they discussed things such as college attendance, holiday plans, staff issues, the menu, and forthcoming care reviews. One person’s meeting notes included information that the person chooses inappropriate clothing such as a jacket in hot weather. The notes stated ‘the wardrobe will have to be locked if this continues’. This was not an appropriate management strategy for this issue as it indicated a restriction of the person’s choice. These notes also showed us that the person would like an aviary in the garden to keep budgies. The manager was able to report they were waiting the ‘go ahead’ from Health and Safety’ to comply with this request. Residents were going to be involved with constructing the aviary. The manager told us that residents always had some of their own monies in their purses/wallets, and they were asked twice weekly, Monday and Friday, if Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 13 they would like to have any of their spending money. Funds were available outside those times by asking staff who had access to the petty cash fund to facilitate this. A ledger was kept for each person showing records of funds in and out together with receipts. These records were checked monthly by the manager and one other staff member when the bank statements came in so that they could be reconciled. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 14 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): This is what people staying in this care home experience: 12, 13, 15, 16 and 17. People using the 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 routines and lifestyles people experienced at Myland House suited them and they enjoyed a healthy diet. EVIDENCE: The service offered a flexible structure to the day, with no rules other than those required for safety. People had unrestricted access around the home, with the exception of other people’s rooms. People confirmed they were able to spend time on their own in their room, if they chose to do so, and that staff respected their privacy. Staff members were observed knocking before entering people’s rooms. The interaction between people living in the home and staff was friendly and appropriate, chatting about day-to-day events and interests. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 15 People living at Myland House were encouraged to be involved, according to their capacity, in a range of day-to-day domestic activities including the twice weekly grocery shop at a local supermarket. Individual weekly activity charts confirmed that people living in the home were supported to attend adult education classess at local colleges and reflected their chosen leisure activities, including regular visits to the pub, cinemas, Gateway club, church and personal shopping trips. Examples of leisure participation we saw in the daily records included: Visit to an Owl Sanctuary, home visits, drive out, shopping in Chelmsford, trip to the Pub, telephone call with family, attending College and receiving visitors. We saw a diary for each person that was used to record detail of their day and the support provided including the level of prompting needed for people to participate in activities of daily life. Examples included: Ate lunch outside, Interacted with staff well, Doing laundry, spending time outside pottering, talking to a cat. Had evening drink, socialised in lounge and retired to bed. On the day of this visit some staff members and service users visited a day centre facility where people were supported to become involved in jobs such as packing teaspoons, plastic cups, build garden furniture, working in a café etc. This would provide people living at the home with a social experience as well as giving them meaningful tasks to do that would potentially provide them with new skills. The needs of a prospective resident were also considered during this exercise. All people living at the home were supported to take an annual holiday that they paid for themselves. The organisation provided one staff member for their allocated contracted hours. It was reported that residents were responsible for the holiday cost and staffing hours over and above the contracted hours. The organisation did not have a policy in place in relation to service user holidays. The deputy manager told us that annual holidays were still under discussion for this year. Last year one resident went to a holiday camp for a 70’s weekend as that era of music was their favourite. The manager reported she felt the menu had become institutional as far as residents chose what they wanted to eat from week to week and this involved the same choices continuously. People were encouraged to go shopping with staff to purchase their food, and the manager told us of plans involving people in looking at the supermarket shelves and deciding what they wanted to eat rather than devising the menu for the week ahead on Sunday evening and just buying the ingredients to meet the list. The manager also wanted to provide more flexibility by continuing with the current system of residents deciding the meals for the week ahead but giving the people the opportunity to pick meals from the weekly selection on a daily basis so it became less regimented and Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 16 gave people more control of their daily lives. The manager told us she wanted people to be encouraged to help more with meal preparation and that the current practice was not inclusive, it was reported that one person often offered to help but staff did not have the confidence to allow this. Minutes of the last team meeting acknowledged this. Evidence in people’s care plans showed us that individual menu plans were devised weekly. An example we looked at showed us that a person was offered toast and cereal daily, there was never an option of a cooked breakfast and there was no menu to choose from. Examples of lunches were as follows: Cheese salad, bacon sandwich, bagel and cream cheese, scrambled egg on toast. Examples of evening meals were as follows: Shepherd’s pie, Chicken Kiev’s and chips, Tuna Pasta Bake, Sausage Plait, Fish pie and vegetables, Chicken Tikka Masala and rice and Roast lamb with all the trimmings. The deputy manager told us “The food has improved dramatically over the past 6 months. People get more choice now and a better quality”. A resident told us “The food is good, alright I suppose. There is always enough of it”. Family members told us “X really enjoys the food they have at Myland House; it is like home from home”. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the support they need to maintain good personal hygiene and health in a manner which promotes their independence and privacy. Medication practices and recording in the home may not always protect peoples’ health, safety and well being. EVIDENCE: Observation on the day of this visit and information from the staff and management indicated that people were supported to maintain a good standard of personal hygiene and appearance. It was evident on the day of the visit, and from records, that people were encouraged to shower frequently and, where necessary, provided with support in a manner that respected their privacy and dignity whilst maintaining their independence. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 18 A professional person, involved with people living at the home that we spoke with subsequent to this visit, indicated that peoples’ individual health care needs were ‘always’ properly monitored and attended to. Records showed us and the manager was able to give examples of where external support had been obtained for individuals such as Occupational Health and Physiotherapy. The manager indicated she felt the needs of some of the people living at the home had increased and had the potential to have a negative impact on the other people living there. A professional we spoke with confirmed that the manager had requested a review of one person’s support needs with a view to securing additional funding for ‘one to one’ support for individuals. There was a comprehensive medication policy and procedure in place for ordering, storing, and administering medicines. Medication was locked in a storage cupboard to which only senior staff held the key. During our visit we looked at Medication Administration Record (MAR) charts and blister packed medication belonging to people living in the home. MAR charts were completed correctly, with no gaps. Medication that was dispensed from boxes as opposed to the blister packs were not dated to indicate when the box had been opened and any remaining medication in the box at the end of the month was not carried forward on the MARs from month to month. This meant there was no audit trail of these medications held within the home. There was no system of recording where people had taken homely remedies or ‘as required’ medications such as Paracetamol or Ibuprofen. There had been a pharmacy audit the month prior to this visit. We saw that each person’s medication records had a front sheet with their name and photograph to avoid mistakes with people’s identity. As at the previous inspection of this service there were no people currently prescribed controlled drugs. As advised at the last visit the management needs to be aware that should controlled drugs be prescribed for one or more persons it is a legal requirement that the home has a separate metal cupboard of specified gauge with a double locking mechanism, which is fixed to a solid wall, with either rawl or rag bolts. The manager and deputy reported a medication error that had occurred the day before this visit where one person was given their evening medications in the morning. This was not discovered until the evening, staff contacted their line manager and then NHS direct for advice. There was no negative impact on the service user resulting from this error. The staff member concerned had recently attended medication training. There was a general policy within the home for all medication administration to be checked and signed for by another member of staff on duty; however this had not taken place in this instance. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 19 Where people had refused or dropped their medication staff stored the tablets in a glass jar in readiness for return to the pharmacy monthly. Records showed us that this had not taken place last month. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People could expect their views to be listened to and acted on however staff may not always have the skills and knowledge to keep people safe from harm. EVIDENCE: The service had a complaints policy available in an ‘easy read’ format that was contained within the Service User Guide in peoples’ rooms. These documents needed to be updated to reflect the current management arrangements and update the regulatory body contact details. The manager indicated that the service had not received any complaints and no issues had been raised with the Commission about this service since the last inspection. People we spoke with subsequent to this site visit expressed confidence in being able to approach the home, if they had issues to discuss, and of always receiving an appropriate response. People living at the home appeared relaxed in the company of staff during the inspection and there was lots of positive interaction taking place. Staff had access to updated policies and procedures on safeguarding adults and new staff had undertaken external training on the protection of vulnerable adults as part of their induction programme. Bank staff undertook the home’s basic environmental induction but there was Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 21 no evidence to indicate they had undertaken Skills for Care induction training nor did they routinely receive the training necessary to promote and protect the health, safety and well being of the people living at the home. For example on the day of this visit a bank carer was to undertake a ‘sleep in duty’ at the home but had not received the necessary training in fire awareness or adult safeguarding etc to keep people safe. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People using the 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, people living at Myland House experienced a comfortable and homely environment. EVIDENCE: Myland House was a two storey home located in an established residential area of Colchester. The house was in keeping with others in the local community, nicely decorated throughout and was appropriate for the needs of the people living there. Communal rooms consisted of a kitchen, a dining room, conservatory and a lounge. These were well furnished with modern equipment and domestic style furniture, carpets and curtains. The premises were bright, cheerful, clean, airy and free from any unpleasant odours. The home had five bedrooms, each with en-suite toilet and shower facilities, one of which had been made into a wet room. Four bedrooms were on the first floor, the fifth Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 23 bedroom was on the ground floor providing accommodation to an individual with impaired mobility. People’s rooms were nicely decorated and furnished in the colour schemes of their choice. All rooms had appropriate lighting and personal effects, which reflected the individual’s hobbies and interests. All bedrooms doors had locks for privacy and the occupants had the choice to hold their own key. Staff could override these in an emergency. A partial tour of premises showed us that the home was in a satisfactory state of repair and decoration. Staff told us that the kitchen had been redecorated at the end of last year however some of the kitchen units were showing signs of wear and tear, specifically one cupboard door had been broken off when a resident had fallen on it, this had not been replaced. We noted there was a dedicated staff toilet, there was no was wash hand basin in this facility. The nearest available wash hand basin was across the hallway in the manager’s office. If the door was shut due to interviews, one to one supervision or private phone calls for example, the staff would then need to go downstairs and wash their hands in the kitchen sink. This does not promote good infection control practice. A recent monitoring visit from Essex County Council identified that a step in one person’s room could pose a trip hazard. The person was not prone to falls. The manager had developed a risk assessment to cover this possible eventuality. We noted that the carpet on the communal stairway was stained and in need of cleaning. The manager and deputy reported issues remaining with the ground floor bedroom en suite facility. The previous report identified that the room smelt ‘musty’, due to the use of the wet room and water seeping out into the individuals bedroom carpet. Since then the wetroom and bedroom had been refurbished and the bedroom carpet had been replaced with wood effect floor covering. However the musty aroma prevailed. The wet room had no direct outside ventilation other than via an extractor fan that was on constantly. Staff told us that they thoroughly cleaned this facility daily. As noted at the previous inspection visit to this service, the utility room was situated at the side of the property, meaning staff needed to take dirty and soiled laundry through the kitchen area, increasing the risk of spreading infection, this does not comply with the Department of Health Guidelines (DOH). This was due to the physical layout of the home and not avoidable however the staff team made all possible efforts to protect the safety and welfare of people by securing soiled laundry in red bags before taking to the laundry room and ensuring they did not carry soiled laundry through the Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 24 kitchen area during times of food preparation. The previous inspection also highlighted that domestic style radiators were situated throughout the home and where these remained uncovered risk assessments needed to undertaken to ensure people were not at risk of receiving burns and/or scalds. We noted on individuals’ care plans there were risk assessments in place relating to slips or falls near radiators and recognising peoples’ vulnerability due to the change in their mental capacity. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People received care and support from safely recruited staff however, they may not always be protected by the staff training practice relating to bank staff employed to work at the home. EVIDENCE: Discussion with staff and looking at the rotas confirmed that 2 support staff members were on duty to provide support for the residents daily and one person was employed for a ‘sleeping’ shift at night. Due to specific one to one support needs the local authority had provided funding for an extra 3 hours per day for 1 person. The manager told us that agency staff members were only used to cover for dedicated 1:1 time and that regular agency staff were used for this to ensure consistent support for the person. The manager was on duty Monday to Friday daytimes. The manager was able to report that funding had been agreed, and the recruitment process underway, for another person for weekend hours to provide additional activity Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 26 input for the people living at Myland House. The organisation had a central trainer who provided basic core training in house in areas such as moving and handling, food hygiene, health and safety, fire awareness, safe administration of medications and supporting people with brain injuries. This training took place over one week. Evidence in staff files confirmed that this annual training session took place and who had attended. The manager told us that all staff had undertaken induction in line with Skills for Care with the exception of one person who was currently undertaking it. However, there were no records available at the home to confirm this. The deputy manager was able to report that all new staff members had induction booklets that were completed in 3 to 6 months, the completed booklets were then sent to Head Office. Discussion with the manager and a bank staff member told us that bank staff members were taken through the home’s basic environmental induction. There was no evidence of Skills for Care induction nor did they routinely receive the training necessary to promote and protect the health, safety and well being of the people living at the home. For example on the day of this visit a bank carer was to undertake the ‘sleep in’ duty at the home but had not received the necessary training in fire awareness or safeguarding vulnerable adults in order to give them the skills and knowledge to help keep people safe. The service employed 6 permanent support staff and 3 bank staff. Records showed us that four permanent staff members had achieved the NVQ level 2 in care and two of these had also achieved the NVQ 3 qualification. We looked at recruitment documentation for two staff employed since the previous inspection visit. These showed us that all the checks necessary to ensure the right staff were employed to work with vulnerable people were undertaken before people started to work at the home. There was evidence on the two staff files seen that supervision had taken place on a regular basis and detailed records of staff meetings were seen. This showed us that staff members were provided with the support they needed to undertake their duties at the home. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41 and 42. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Management team are committed to further improvements however some current shortfalls in staff training and the lack of an effective quality assurance system could adversely affect outcomes for residents. EVIDENCE: There was a new manager in post at Myland House; the new manager had joined to organisation on 1st June 2009. Since that time they had a two week induction period that included attending a manager’s meeting, two visits to head office and time spent at another project run by the disability trust. The manager had 14 years experience working with people with learning disabilities and challenging behaviours. They had achieved the NVQ level 3 in Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 28 care and had researched the Registered Manager’s Award in order to discuss this with their line manager at their next supervision session. The manager told us that they also supported a second service with 3 people living there; this was a supported living service that had an experienced team leader in post. The manager spent the majority of their time based at Myland House with approximately one day per week at the supported living service. The manager reported receiving good support from their line manager and head office. We were shown a copy of the organisation’s annual quality assurance report however we noted that this report was an internal assessment tool that did not seek the views of the people using the service, their relatives or advocates, the staff or any external stakeholder such as professionals involved with the service. This was not an effective quality assurance and quality monitoring system based on the views of people using the service that could be used to measure success in meeting the aims, objectives and statement of purpose of the home. Staff files and records were kept in a locked filing cabinet in the manger’s office however, it was noted that the furniture was not in a good state of repair, the drawer fronts were not secure whether the cabinet was locked or not meaning that the documents stored within the cabinet were not secure. The photocopier was out of order, and had been so since prior to the 1st of June. This meant that staff had to use a public photo copying facility in order to submit the weekly therapeutic activity monitoring sheets to head office weekly. This amounted to approximately 50 sheets of personal information pertaining to the individuals living at the home being taken into the public domain weekly. There was no registration certificate on display at the home. The manager reported this was due to the change in management and that she would contact the commission to request a replacement certificate that would accurately reflect the current management registration status. Evidence was available to confirm that a representative of the provider organisation undertook regular in depth regulation 26 visits to the home in order to evaluate the quality of the services and facilities provided for the people living there. We looked at health and safety certificates, these confirmed that all checks were made that were necessary to keep people living and working at the home as safe as possible. Radiator covers were in place in all communal areas and in the bedroom of one person at risk from falls. Risk assessments were in place for peoples’ personal Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 29 bedrooms where radiator covers were not in situ. Records were available to show that water temperatures were checked regularly in the sinks and showers in residents’ en suite facilities and the kitchen sink. Records showed us that fire drills were undertaken however there were no records to indicate which staff members had been involved with these fire drills and those that had not attended. Bank staff employed to work at the home had not received any of the basic core training such as Moving and Handling, Safeguarding Vulnerable Adults, Fire Awareness or Health and Safety training. On the day of this visit a bank staff member was due to undertake a ‘sleep in’ shift meaning that, in this instance, people living at the home were receiving support from an untrained person. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 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 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 X 2 2 2 2 x Version 5.2 Page 31 Myland House DS0000017893.V376775.R01.S.doc No 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. 1. Standard YA20 Regulation 13 Requirement Arrangements for administering peoples’ medications that are not supplied in pharmacy blister packs must ensure there is a clear audit trail showing when the pack of medication was originally opened and the amount of remaining medication that is carried forward from month to month on the MAR sheets. Arrangements must be made for clear recording of administration of PRN (as required) medications. This is so there is a clear audit trail of all medications received into the home. All staff employed to work at the home, including bank staff, must receive training in Safeguarding of Vulnerable Adults. This is to ensure that people living at the home are safeguarded from abuse and their safety and well being are promoted. All staff employed to work at the home, including bank staff, must DS0000017893.V376775.R01.S.doc Timescale for action 30/08/09 2 YA23 13 30/08/09 3. YA35 18 30/09/09 Myland House Version 5.2 Page 32 YA42 receive training appropriate to the work they are to perform. This includes the basic core training such as Safeguarding Vulnerable Adults, Health and Safety, Fire Awareness, Moving and Handling, infection control, Common Induction Standards and any training specific to the needs of the people living at the home. This is to promote and protect the health safety and welfare of residents at all times. 24 An effective annual quality assurance process must be developed that involves the views of people using the service, their relative or representatives, staff and outside stakeholders. This is so that the registered provider can undertake an accurate evaluation of the services and facilities, care and support provide for the people living at Myland House. A copy of the resulting summary and action plan to address any identified shortfalls in the service provision must be sent to CQC. 30/09/09 4. YA39 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The Statement of Purpose and Service Users Guide need to DS0000017893.V376775.R01.S.doc Version 5.2 Page 33 Myland House 2. YA14 YA40 3 4 YA35 YA41 be amended to reflect the management arrangements at the home and the new contact details of The Commission via the Regional Contact Team (RCT), who are based in Newcastle. Consideration should be given to producing a policy in relation to peoples’ rights and responsibilities in relation to the option of a minimum seven-day annual holiday outside the home, which they help choose and plan. Evidence needs to be maintained at the home to confirm that the staff team have received training in line with the Common Induction Standards. Records need to be stored in robust facilities so that people may be confident they are secure. Myland House DS0000017893.V376775.R01.S.doc Version 5.2 Page 34 Care Quality Commission Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). 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