Care Home: Mythe End House

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What the care home does well The home provides a safe and secure environment with large grounds and spacious living accommodation. The home has a number of experienced staff that know the service users well and have worked at the home for several years. Staff are provided with good opportunities for training including accredited training in the managing of challenging behaviours. The staff team liaises and communicates well with relatives of the service users. The home provides good quality care and support with evidence of good and excellent practice. What has improved since the last inspection? The home has increased the variety of daytime activity options for service users. Some service users are being supported to be more confident in the community and spend increased time there. The care planning process and documentation has been improved to be more person centred and goal orientated. What the care home could do better: No specific areas requiring improvement were identified in relation to the care and support of the service users but there is a need to improve and update the kitchen area and fittings. CARE HOME ADULTS 18-65 Mythe End House Mythe Road Tewkesbury Gloucestershire GL20 6ED Lead Inspector Mr Simon Massey Key Unannounced Inspection 12 & 14th February 2008 10:00 th Mythe End House DS0000061857.V348729.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 Mythe End House DS0000061857.V348729.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. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mythe End House Address Mythe Road Tewkesbury Gloucestershire GL20 6ED 01684 299272 01684 299273 mytheend@kentwoodsupport.co.uk 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) Kentwood Ltd Mrs Jennifer Jillian Harvey Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the two bedrooms on the upstairs floor with their own staircase are only accommodated by service users that have been risk assessed as being able to safely access this accommodation. 14th September 2006 Date of last inspection Brief Description of the Service: Mythe End House is a care home for seven adults with learning disabilities that have complex needs. The home is set in large grounds approximately a mile from the town of Tewksbury. The accommodation is spacious and is spread over three floors. The home is annexed to another registered home that is run by the same organisation, Kentwood Care. Both have their own grounds and entrance. Information for prospective service users is available in the home’s Statement of Purpose and Service User Guide. The current scale of charges are between £1400 and £1750 per week. Mythe End House DS0000061857.V348729.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 two days on 12th and 14th February 2008. The Inspector met with the Registered Manager, Deputy and various members of the care staff team. All of the service users were also met and observed. Feedback was also received from some of the relatives and visiting health professionals who have involvement with the home. Records relating to care planning, daily recording, health and safety, medication, staff recruitment and training were examined. An inspection of the environment was also carried out. What the service does well: What has improved since the last inspection? The home has increased the variety of daytime activity options for service users. Some service users are being supported to be more confident in the community and spend increased time there. The care planning process and documentation has been improved to be more person centred and goal orientated. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 6 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. Mythe End House DS0000061857.V348729.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 Mythe End House DS0000061857.V348729.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose provides accurate and accessible information to service users and prospective admissions to the home. EVIDENCE: There have been no admissions to the home since the previous inspection and there are currently no vacancies. The home has an admissions policy that complies with the regulations. All new service users would have an assessment of needs completed before their admission and would be provided with the opportunity of informal visits and a trial stay at the home. The Statement of Purpose and Service User Guide were reviewed and updated in 2007 and these documents provide an accurate and informative guide to the services the home can offer and what prospective admissions could expect if they were placed at the home. Copies have been supplied to the Commission. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed care plans ensure that the service user’s needs are documented and guidance is available to staff. The home takes action to encourage service users to make choices and supports them to take appropriate risks. EVIDENCE: All service users have care plans in place and records showed that these are regularly reviewed with as much involvement as the service user is able to give. The home have improved the care planning format to be more person centred and to identify clear goals and objectives that will meet the needs of the service users. Some people have limited communication skills and understanding of the care planning process due to their disability and efforts are made by the staff, and particularly the relevant key-worker, to ascertain the wishes of the person. Relatives and other professionals can also be invited to review meetings and feedback from relatives evidenced that they generally feel well informed and consulted when this is appropriate. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 10 The care plans contain details about a variety of areas that reflect the complex needs of several of the service users. These provide advice and guidance to staff on how to manage certain behaviours as well as basic information about likes and dislikes. Records showed evidence of good regular recording being completed and of staff being aware of how to meet particular needs. People are encouraged to make choices and decisions about their daily lives, activities and daytime occupation. There was recording that showed people reflect upon the success and impact of activities and feed this information back to the rest of the staff team. Comments from relatives were very positive about the outcomes for service users. One person said, “they have given him what he needs…….the home has achieved a great deal and we are sure it will continue”. Other comments included, “they always make sure they are cared for and will seek advice that will make sure the care is properly administered”, and, “ they teat my son as an adult and a human being…….the staff at Mythe End House do a great job” A sample of risk assessments were seen and these were up to date and had been reviewed at appropriate intervals. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are supported to pursue their interests and hobbies, develop their own individual routines and are able to access the local community with staff support. EVIDENCE: All service users have daily and weekly routines that are individualised and organised around their particular needs. People undertake trips and activities into the community such as horse riding, college courses, walks, shopping and bowling. Some are done as a group and others are individual sessions. Within the house people are supported to do some artwork, enjoy music therapy and watch television and DVDs. People who wish to, have personalised their bedrooms and have a variety of equipment such as computers, video games, televisions and music centres. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 12 On both days of the inspection people were observed going to and returning from activities, and appeared to have thoroughly enjoyed themselves. People appeared keen to go and also relaxed upon their return. One person has continued to develop their ability to venture into the community with staff support. This has been progressed on a gradual scale and now this person with opportunities to experience the wider community on a regular basis, which something they have not been able to do for several years. The home employs a cook to provide the majority of the food but care staff perform this role at the weekends. Service users help with food preparation with staff support, and depending upon their ability and interest. Guidance is provided on people’s preferences and staff explained how a varied diet is provided and healthy eating is encouraged. The kitchen was well stocked with fresh and packaged food and all items were correctly labelled and stored. Service users have a choice as to where they choose to eat their meals. People were observed making snacks and drinks with staff support. Due to the needs and behaviours, the kitchen is kept locked when staff are not available to supervise this area. Staff were observed helping people to make choices about how they were going to spend their time. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health needs are closely monitored and appropriate professional input provided to meet the needs of the service users, and provide advice and guidance for the staff team. EVIDENCE: The care plans contain information about the personal care that is required and how this should be delivered. All service users have en-suite accommodation, which means their privacy and dignity is easier maintained. Good records are kept of health appointments and information is transferred to the daily recording to ensure all staff are aware of any relevant changes or issues. A recommendation is made that the home consider introducing Health Action Plans for the service users, which is a format of person centred health care planning. People have had regular checks ups and visits to the Dentist, Opticians, Doctors and Chiropody department. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 14 The home accesses the services of the Community Learning Disabilities Team and there is records of advice given and evidence of regular liaison taking place. All medication and administration was found to be in order at the time of the inspection. All medication has been appropriately reviewed with the relevant health professional. This has resulted in some changes which have been of benefit to service users. All staff must complete medication training before undertaking this task. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe environment for service users in which they are respected and treated with dignity. There are arrangements which help to protect service users from the risk of harm and abuse and efforts are made by the staff team to communicate with people and act upon their wishes. EVIDENCE: The home has a complaints procedure in place and there have been no complaints made to the home since the previous inspection. Relatives said they were aware of how to raise concerns and were happy about taking issues to the Manager, who people described as approachable. The Manager and staff have completed training in Adult Protection, attending a course that is provided by the local authority. Staff spoken to demonstrated a good awareness of the practice issues, and their importance to the safety and protection of the service users. The home provides all staff with accredited training in the managing of challenging behaviours. All but the most recently appointed staff were up to date with this training. Staff were observed relating to and interacting with service users in a professional and positive manner and it was evident that people felt relaxed and confident with the staff on duty. Due to the needs of the service users it would be difficult for them to personally make a formal complaint, but staff showed an awareness of how Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 16 individuals express their wishes and display their unhappiness at anything within the home. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is well maintained and decorated and provides a comfortable homely environment. Service users are supported and encouraged to personalise their living space to meet their individual needs. EVIDENCE: The home is large and spacious and also has a large garden that surrounds the property. This is a secure and safe area, with access to the grounds being gained through an intercom that has been located at the front gate. The home was well decorated and maintained at the time of this visit, and appeared to be clean and hygienic throughout. All the bedrooms have been personalised by the service users with help form the staff. The rooms all reflect the individual taste and needs of the occupants, with some people choosing to spend a lot of time in their rooms. One of the bedrooms had considerable amounts of electrical equipment, using several electric extension cables. It was recommended that the home check the safety of this set-up. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 18 The home has moved the main office up from the basement to the ground floor following flooding during 2007. Repairs have now been carried out to the basement area, but it is planned to keep the office on the ground floor as it has been seen as a positive move to have the office located more centrally. The kitchen is used to prepare food for the adjoining home as well. The kitchen is in need of updating and repair. Several of the kitchen units are damaged and some of the work surface is very worn. The cooker was not working properly and it was stated that this was being replaced. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are supported by a staff team that relates well to them and has a positive approach to their care and support. Service users benefit from having a staff team that is motivated and provided with good training opportunities. EVIDENCE: The home currently has three vacancies, with interviews for these posts planned for the days following this inspection. The home has maintained the staffing levels required and the records show that there has been limited use of agency staff over the previous months. The home has a group of its own relief staff and these have been able to provide the necessary cover. Additional cover can also be provided by accessing some of the staff from the adjoining home, run by the same Provider. These staff are familiar with the service users and the routines of the home. The home has generally had a consistent staff group with limited turnover and relatively low rates of absence. This has helped the team to work consistently, which is of particular benefit to service users who have an autistic spectrum disorder. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 20 Staff training is well organised, with courses and updates being co-ordinated by the Provider’s training manager. All staff undertake various training during their initial induction period and also must complete training in the managing of challenging behaviours. This is accredited provision and once completed staff must also attend annual updates. Staff were very positive about the training and considered it relevant to their role. The majority of staff have completed their NVQ training and new staff are enrolled onto NVQ when they have successfully finished their induction. All staff have been having regular recorded supervision with a member of the management team. Staff said they felt well supported and that they worked well as a team, with good peer support and communication within the staff team. There have been regular staff meetings. Staff appeared to be motivated towards providing a good service and demonstrated a good awareness of the ethos of care within the home. Staff commented that they worked well as a team, supporting and communicating well with each other. Service users appeared comfortable and relaxed with the staff on duty and feedback from relatives was very positive about the staff, saying they were caring and able to interact well with people. Two service users spoken to expressed their satisfaction with the staff. Relatives were also positive about the communication between themselves and the relevant key-workers and felt they were kept informed of important issues. Relatives also made various positive comments about the good standard of care delivered by the staff team. Staff were described as hardworking and caring and having a good understanding of the needs of the service users. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is well managed and organised and committed to providing high quality care and support EVIDENCE: The Manager is qualified and experienced, and along with the Deputy, provides leadership and direction to the home. Staff and relatives said that the management was approachable and responsive to any issues or concerns raised. The home is administered in an efficient and effective manner with evidence of good monitoring and supervision being in place. The Manager is provided with regular supervision and support, with regular Regulation 26 visits being completed by the Provider. The Provider has also recently completed an annual Quality Assurance audit on the home and a copy of this report will be supplied to the Commission Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 22 The home has recently had an Environmental Health inspection and a Health and Safety inspection. Copies were seen of the reports and the home will be implementing the recommendations made. All fire safety testing was completed and up to date and all servicing had been completed. All staff have undertaken fire safety training. All other health and safety testing had been completed and recorded. Staff are also required to undertake health and safety training, which is provided by the Provider. Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 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 4 13 3 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 24 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 YA24 Regulation 23(2)(b) Requirement The home must update or repair the kitchen cupboards/cooker and work surfaces Timescale for action 30/05/08 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. 2. Refer to Standard YA42 YA19 Good Practice Recommendations The home should safety check the arrangement of electric cables in one service user’s bedroom. The home should consider introducing Health Action Plans as part of their health monitoring and planning system Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mythe End House DS0000061857.V348729.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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