methilhaven home care home service adults

Methilhaven HomeCare Home Service AdultsMethilhaven RoadMethilLevenKY8 3HSTelephone: 01592 583326

Inspected by: Carol Ambrose

Type of inspection: Unannounced

Inspection completed on: 9 May 2013

ContentsPage No

Summary 31 About the service we inspected 52 How we inspected this service 73 The inspection 124 Other information 315 Summary of grades 326 Inspection and grading history 32

Service provided by:Fife Council

Service provider number:SP2004005267

Care service number:CS2003006837

Contact details for the inspector who inspected this service:Carol AmbroseTelephone 01383 841100Email [email protected]

Inspection report continued

Methilhaven Home, page 2 of 34

SummaryThis report and grades represent our assessment of the quality of the areas ofperformance which were examined during this inspection.

Grades for this care service may change after this inspection following otherregulatory activity. For example, if we have to take enforcement action to make theservice improve, or if we investigate and agree with a complaint someone makesabout the service.

We gave the service these grades

Quality of Care and Support 6 Excellent

Quality of Environment 6 Excellent

Quality of Staffing 6 Excellent

Quality of Management and Leadership 6 Excellent

What the service does wellMethilhaven continues to benefit from rigorous checks, carried out by themanagement, on all aspects of the service.Staff continue to learn from examples of care or areas identified as needingimprovement and applying new knowledge to benefit other people living here and/ortheir own practice.The environment continues to be a very pleasant place to live and enhances the careand support enjoyed by people with memory difficulties.Methilhaven achieves high levels of care and support, with the co-operation ofcommunity health care professionals. This provides very good outcomes for peoplewith ever changing care and support needs.Methilhaven has created and sustained a climate of care that promotescommunication, encourages people to express their views and get them involved.

What the service could do betterThe service must maintain very high standards and continue to explore how tocontinue improving the quality of life enjoyed by the people living in Methilhaven.



What the service has done since the last inspectionThis inspection visit confirmed that Methilhaven has continued to develop theirperson centred approach to care for the benefit of people living here.Staff training has been a consistent strength here. This has been further supported bya focus on training relating to health and safety.A programme of refurbishment is now complete.The manager reported great effort has been made to maintain standards.

ConclusionMethilhaven has maintained very high standards in all aspects of the service. Peopleliving here are very well supported to enjoy a good quality of life. They and theirrelatives continue to experience a high level of satisfaction.

Who did this inspectionCarol AmbroseLay assessor: Mrs Sheila Nimmo



1 About the service we inspectedThe Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, thisfunction was carried out by the Care Commission. Information in relation to all careservices is available on our website at www.careinspectorate.com.

The Care Inspectorate will award grades for services based on findings of inspections.Grades for this service may change after this inspection if we have to takeenforcement action to make the service improve, or if we uphold or partially uphold acomplaint that we investigate.

Requirements and recommendationsIf we are concerned about some aspect of a service, or think it could do more toimprove its service, we may make a recommendation or requirement.

-A recommendation is a statement that sets out actions the care service providershould take to improve or develop the quality of the service but where failure to doso will not directly result in enforcement.

-A requirement is a statement which sets out what is required of a care service tocomply with the Public Services Reforms (Scotland) Act 2010 and Regulations orOrders made under the Act, or a condition of registration. Where there are breachesof the Regulations, Orders or conditions, a requirement must be made.Requirements are legally enforceable at the discretion of the Inspectorate.

Methilhaven is a purpose built local authority care home. It is registered to provide 24hour care and support to a maximum of 32 older people, including 4 respite.

The manager was available to support the inspection and people using the serviceand staff were very willing to contribute to the process of inspection.

Methilhaven aims to provide a "homely environment" with the highest standards ofcare for residents. The principles supporting the care provision include; respect,dignity and maintaining independence and identity. There is emphasis onconsultation and involvement as the route to ensuring these principles are sustained



Based on the findings of this inspection this service has been awarded the followinggrades:

Quality of Care and Support - Grade 6 - ExcellentQuality of Environment - Grade 6 - ExcellentQuality of Staffing - Grade 6 - ExcellentQuality of Management and Leadership - Grade 6 - Excellent

This report and grades represent our assessment of the quality of the areas ofperformance which were examined during this inspection.

Grades for this care service may change following other regulatory activity. You canfind the most up-to-date grades for this service by visiting our websitewww.careinspectorate.com or by calling us on 0845 600 9527 or visiting one of ouroffices.



2 How we inspected this service

The level of inspection we carried outIn this service we carried out a low intensity inspection. We carry out theseinspections when we are satisfied that services are working hard to provideconsistently high standards of care.

What we did during the inspectionThis report was written following an unannounced inspection visit which took placeon Friday 3rd May 2013. A follow up visit was carried out on Sunday 5th and feedbackwas given to the manager on 9th May 2013. The inspection was carried out by CarolAmbrose, Inspector and with the support of Sheila Nimmo from our Lay Assessorscheme.

The views of people using the service were gathered informally throughout theinspection visit.

During the inspection evidence was gathered from a number of sources including thefollowing:*A sample of policies and procedures,*Minutes of meetings,*A sample of service user personal care and support plans,*Activity information,*Examination of training and other staff records*Examination of the home's own audits and external visits,*Examination of staff rotas*Physical check of the environment*Information from the manager and staff*Information from residents*Information from relatives and carers*Observation of practice

Grading the service against quality themes and statementsWe inspect and grade elements of care that we call 'quality themes'. For example,one of the quality themes we might look at is 'Quality of care and support'. Undereach quality theme are 'quality statements' which describe what a service should bedoing well for that theme. We grade how the service performs against the qualitythemes and statements.

Details of what we found are in Section 3: The inspection



Inspection Focus Areas (IFAs)In any year we may decide on specific aspects of care to focus on during ourinspections. These are extra checks we make on top of all the normal ones we makeduring inspection. We do this to gather information about the quality of these aspectsof care on a national basis. Where we have examined an inspection focus area we willclearly identify it under the relevant quality statement.

Fire safety issuesWe do not regulate fire safety. Local fire and rescue services are responsible forchecking services. However, where significant fire safety issues become apparent, wewill alert the relevant fire and rescue services so they may consider what action totake. You can find out more about care services' responsibilities for fire safety atwww.firelawscotland.org



The annual returnEvery year all care services must complete an 'annual return' form to make sure theinformation we hold is up to date. We also use annual returns to decide how we willinspect the service.Annual Return Received: Yes - Electronic

Comments on Self AssessmentEvery year all care services must complete a 'self assessment' form telling us howtheir service is performing. We check to make sure this assessment is accurate.The service submitted an electronic self assessment as requested by The CareInspectorate. The self assessment was completed to a very high standard, reflecting awide range of evidence and examples of service strengths as well as areas forimprovement.

Taking the views of people using the care service into accountWe provided 20 Care Standards Questionnaires (CSQ) and received 2 completed CSQsbefore our visit. These people were very satisfied with all aspects of this service.I spoke with a number of people informally. Comments included:"It's just like home"

From our Lay Assessor Inspection Report:I had conversations with 9 residents in the Care Home all of whom were in communalareas. I observed 5 residents in a sitting area involved in a reminiscence type activity.I observed a total of 15 residents having lunch.

Residents made the following comments regarding food -'There is plenty of good food - you get as much as you want''Food is good - we get choices, but I like pasta''Food is 'no' bad''I enjoyed lunch - it was 'awfy' good but I don't remember what it was'At lunch time I observed a relative supporting their ... to take food. That relative saidthat they come in regularly at lunch time for that reason.



Regarding activities, residents commented thus -'I get lots of visitors and I have my own mobile phone''I like watching TV''I like reading, chatting and watching TV''I don't go to bed until until after 11pm''We get activities like skittles, cards, dominoes and exercisesfor the arms and upper chest which help my breathing''We get pampered - I get my nails done, hands massaged andhair done once per week''The optician comes to check our eyes''I like reading - I've just read 3 books by an author from Crieff -I just wish I could meet and talk to her''I just like to sit down and think''I used to knit and sew''I like talking to people'

Residents made the following comments about their accommodation -'We like it here - people are very friendly''I was told that this was the best care home''I have a nice room with my own TV and pictures''It's alright here''My bed is comfy - I'm really comfy when I'm in it''It's comfortable - I'm quite happy''It's a wonderful place to stay - I wanted to come here''I am happy - it's very homely and you are made to feel welcome'

Quality of Staffing:Residents comments included -'Staff are very kind and very helpful''Staff are all very good''Staff are good''Staff are nice''They are really good to us''They are just ordinary people''I have no complaints''Care is very good - staff discuss my care needs'



Taking carers' views into accountWe provided 20 Care Standards Questionnaires (CSQ) and received 2 completed CSQsbefore our visit. They reflected a high level of satisfaction with all aspects of thisservice and confidence in standards being maintained.Written comments included:"I have nothing but praise for the staff that look after my (relative), the care home isvery well run and hygiene is first class. Everyone is very friendly and all people aremade very welcome."

I spoke with one visiting relative. Their comments included:"This is the best home I've seen - no smells.""It's good that it's the same staff you see."

From our Lay Assessor's report relatives' comments included:'My ...'s accommodation is fine but new units in the room wouldmake it great'Another relative said they had made the right choice by bringing their relative toMethilhaven.'I am very happy with the standard of care. I cannot fault anyof the staff - they have been brilliant. I can go to the key workerif I have a problems - but none so far'Another relative said they were involved in the 'care planning and review'



3 The inspectionWe looked at how the service performs against the following quality themes andstatements. Here are the details of what we found.

Quality Theme 1: Quality of Care and SupportGrade awarded for this theme: 6 - Excellent

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the care and support provided by the service.

Service strengthsFollowing discussion with residents and staff, a review of a sample of documentationand observation of practice, Methilhaven was found to have sustained an excellentperformance in relation to the involvement and participation of people using theservice. The grade awarded is as a result of sustained improvements and thedevelopment of a dementia friendly service which has had a sustainable positiveimpact on the climate of care.The grade awarded at our last inspection has been re-confirmed.Methilhaven continues to use a wide range of well established ways to gatherpeoples' views. These include meetings, questionnaires and reviews. Staff continue todemonstrate their awareness of how individuals need a variety of ways to confidentlyexpress their views. People using the service confirmed that they could talk to staff,get information, make choices and that they were very happy with their involvementin their care and support.

This service demonstrates excellent outcomes for individuals. The use of alternativetherapy and the investment of time and space to promote improvements has resultedin sustained improvements in communication, maintaining independence and a senseof identity and reducing agitation and distress. One example of innovative careplanning was the inclusion of a sensory sheet within one person's care file. This wasa simple practical aid to communication.

This service has a short film involving service users and staff that summarises someof the ways people here are supported to experience an improved quality of life. Theyhave added another, in response to enquiries about why they feel they have beenawarded 6s. This is one way in which very good performance is shared.



As recorded in our last report, the staff here also recognise the importance ofmaintaining activities that relate to normal life and links with the community. There isa high level of involvement of family and friends. This results in people maintainingrelationships that support their identity.

The manager's commitment to staff training, the development of person centred careand robust quality assurance is vital to the atmosphere, attitude of staff and valueplaced on the views gathered from people. This in turn has supported the involvementand participation of everyone with an interest in the service.

Throughout the inspection, a strong culture of inclusion within the service wasevident. Observation of practice showed that everyone working in the servicecontinues to promote a strong, positive value base with choice and opportunity beingoffered to all residents.

Minutes from meetings confirmed service user involvement in choices made regardingredecorations and menus. Discussions with visitors and people living here, confirmeda high level of satisfaction.

Areas for improvementThe challenges of maintaining and developing staff knowledge, skill and commitmentto maintaining and developing the involvement of people using the service inassessing and improving the quality of the care and support experienced, remain.

Grade awarded for this statement: 6 - Excellent

Number of requirements: 0

Number of recommendations: 0



Statement 3We ensure that service users' health and wellbeing needs are met.

Service strengthsFollowing discussion with staff, a review of a sample of documentation andobservation of practice, Methilhaven was found to have maintained an excellentperformance in relation to meeting the health and wellbeing needs of people usingthe service.

There are excellent working relationships with community health care professionals.Community Nursing Staff confirmed that improvements made over time, regardingthe way staff manage health care needs, have been sustained. This, staff training,management and the environment have resulted in Methilhaven successfullysupporting people with higher dependency relating to dementia than would beexpected in a care home not claiming to provide specialist dementia services. Thisservice also has a solid history of successfully supporting the few people who havecare needs that can no longer be met within Methilhaven, until suitable alternativearrangements are made. Since our last visit, this has continued. The managerrecognises the need to ensure extra resources are available to support individual'swho require extra supervision.A comprehensive range of policy documents is in place to support staff practice. Theprovider has a robust system for reviewing these. Staff confirmed they had awarenessof the policies and had ready access to them.New or reviewed policies are routinely displayed and discussed at meetings and/orsupervision. The provider has continued to focus on safety, cascading training anddevelopments as a result of an awareness of issues affecting other services. Oneexample is regarding end of life record keeping. Another is with regard to fire safety.

A record of accidents and incidents was maintained and the manager evidenced arobust system for auditing outcomes for people living in Methilhaven.

The manager demonstrated commitment to providing good quality care through on-going staff training and an annual training plan is in place. The plan includedmandatory and non statutory training to meet the needs of the service user group.Training records identified training had been provided and an SVQ training programmeis in place for care staff. The provider has a centralised training plan which themanager can access and tailor individual staff training to meet the health care needspresented by people living here.



All care records sampled were appropriate, complete and current. All care was basedupon assessment and a review of the effectiveness of any action taken. Records alsoreflected that staff could easily access support from community health care services.The care records seen confirmed that support from community health care serviceshad been accessed and that the health and well-being needs of service users werethoroughly assessed and met. Records reflected good detail and were generallyperson centred.

Care staff interviewed reported the importance of training and support frommanagement, in improving their ability to meet the health and wellbeing needs ofpeople living here.

The provision of activities has been identified as essential to maintaining the healthand well-being of service users. People were observed participating in group activitiesand reported their satisfaction with the provision of activities. Our observationsconfirmed meaningful activity and good rapport/relationships are elements of everyaspect of care.

People confirmed a high level of satisfaction with meals provided. The cook hasreceived national recognition for her cooking, repeatedly. People living here confirmeda high level of satisfaction with meals. Records reflected good management of foodand fluid management. Staff demonstrated flexibility and very good knowledge ofpeoples' likes and dislikes. They provided very good support for people at meal times.

From our Lay Assessor Inspection Report:I had conversations with 9 residents in the Care Home all of whom were in communalareas. I observed 5 residents in a sitting area involved in a reminiscence type activity.I observed a total of 15 residents having lunch.

Quality of Care and Support:In each of the 3 dining areas in the Care Home I noted tables each with 4 places setfor lunch.Lunch being served that day comprised leek and potato soup, fish with chips orquiche with salad or baked potato with beans or salad.Residents made the following comments regarding food -'There is plenty of good food - you get as much as you want''Food is good - we get choices, but I like pasta''Food is 'no' bad''I enjoyed lunch - it was 'awfy' good but I don't remember what it was'At lunch time I observed a relative supporting their ... to take food. That relative saidthat they come in regularly at lunch time for that reason.



Regarding activities residents commented thus -'I get lots of visitors and I have my own mobile phone''I like watching TV''I like reading, chatting and watching TV''I don't go to bed until after 11pm''We get activities like skittles, cards, dominoes and exercises for the arms and upperchest which help my breathing''We get pampered - I get my nails done, hands massaged and hair done onceper week''The optician comes to check our eyes''I like reading - I've just read 3 books by an author from Crieff - I just wish I couldmeet and talk to her''I just like to sit down and think''I used to knit and sew''I like talking to people'

During the inspection I observed 5 residents participating in an activity where theytried to remember things they collected as a child. The activity person had a large ballwhich was tossed to each resident. The ball was marked with lots of differentquestions which could be asked, depending on how it was caught.

In my opinion, having used care services as a carer, all residents whom I spoke with inthe Care Home were very nicely dressed in colour co-ordinated outfits and worecomfortable foot wear. A relative informed me that if ... noticed clothes becomingworn ... took them home to throw out.I observed 2 residents having lunch whilst still wearing night attire and dressinggowns.



Areas for improvementThe manager has identified the continuing need to provide staff with training, accessto best practice guidance and up-to-date policies and procedures. This will involve thecontinuing monitoring and discussion with all staff to ensure that the necessarytraining and resources are in place to meet the changing health and well being needsof people using the service.

The provision of activities has been identified as essential to maintaining the healthand well-being of service users. This is an area identified by the service as at risk as aresult of deployment of staff to cover absence.

Grade awarded for this statement: 6 - ExcellentNumber of requirements: 0Number of recommendations: 0



Quality Theme 2: Quality of EnvironmentGrade awarded for this theme: 6 - Excellent

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the environment within the service.

Service strengthsEvidence in support of this statement can be found in Quality Theme 1, QualityStatement 1.

Areas for improvementSee Quality Theme 1, Quality Statement 1.




Statement 2We make sure that the environment is safe and service users are protected.

Service strengthsThis service has maintained an excellent performance with regard to this statement. Itis run in a way that protects people without avoidable restraint. Any restraints inplace are fully supported by risk assessments and subject to review.

The provider has demonstrated swift action to notifiable events and the manager hasprovided all relevant information including action taken by third parties. This supportsconfidence in systems in place to manage the environment safely. As recorded withinTheme 1, Statement 3, the provider has focused staff training on safety issuesidentified in other services.

A comprehensive range of policy documents is in place to support staff practice. Theprovider has a robust system for reviewing these. This promotes good practice with abasis in good practice guidance. The provider has risk assessments and audit systemsin place to support staff in ensuring an environment suitable to the individual needsof people living here and/or the early detection of areas for improvement. Staffconfirmed they had awareness of the policies and had ready access to them. New orreviewed policies are routinely displayed and discussed at meetings and/orsupervision.

A record of accidents and incidents was maintained and the manager evidenced arobust system for auditing outcomes for people living in Methilhaven.

Discussions with people living here confirmed that they felt safe and secure withoutbeing overprotected. The atmosphere is very relaxed and homelike.

Records of risk management and safety checks were complete, up-to-date andreflected consultation with external agencies. Staff could report procedure in theevent of emergencies.

All areas of the home were observed to be clean and well maintained. Refurbishmentwork is complete and has been carried out in a systematic, managed manner. Peopleliving here reported feeling well informed and that there had been minimal disruptionby way of room changes and noise.

Good recruitment and induction procedures are in place to protect people using theservice. Files are held centrally but individual files seen verified good induction andsupervision processes. This allows for early identification of individual learning needsand training opportunities.



The manager demonstrated commitment to providing good quality care through on-going staff training. An annual training plan is in place. The plan includes mandatoryand non statutory training to meet the needs of the service user group. An SVQtraining programme is in place for care staff.

A visitor's policy is also in place and staff members were observed to be diligent inwelcoming visitors. External doors are fitted with alarms and secure entry. Theinternal main door has power assisted push panel door opening and it is worth notingthat people who chose to wander around the home were not looking to leave. Theenvironment was seen to promote wandering "for pleasure" or purpose and oftenwith company. This has the overall effect of creating a very settled atmosphere.People confirmed that they could get around the home and out into the garden quiteeasily.

Specialised equipment to meet the assessed needs of people using the service hadbeen provided. Good moving and handling practice was observed.

Review of duty rotas identified staffing levels complied with the staffing schedule.Staff confirmed that they generally felt able to support and supervise people livinghere and that resources were made available if there were exceptionalcircumstances.

Areas for improvementOngoing monitoring of staff members understanding and implementation of trainingdelivered.




Statement 3The environment allows service users to have as positive a quality of life as possible.

Service strengthsFollowing our observations, discussions with people using the service andexamination of records, this service was found to have an excellent performance withregard to this statement.

The building is very well maintained and has undergone a long and substantialprogramme of up-grading facilities. This has included the provision of large, wellappointed en-suites which supports service user privacy and choice.The freedom to personalise bedroom space is also evident in the on-goingconsultation process regarding communal areas. Staff are enthusiastic about thecontribution made by people living here in improving the units.

The service has successfully provided a respite service within one of the units, despitethis unit also being the permanent home for others.

This service has introduced signage that assists people with memory difficulties, findtheir way. One example was with doors having distinct pictures or designs displayedas well as names and room numbers. Staff were visible and available to supportpeople find their way.

The small unit design provides a positive climate of care. Small groups of peopleenjoying activities, meals and quiet time were seen throughout the visit. Staff skillfullymanaged socialising either by direct involvement and prompting or simplycontributing to the general discussions.

People described how they enjoyed the opportunity to get out and about. Theyreported easy access to the various outdoor spaces and garden, and their anticipationof outings and entertainment.

The location of the home is important to a lot of the people living here. They canmaintain links and keep up-to-date with their family, community, clubs or old haunts.Again staff have the local knowledge to support this.

The home continues to have it's own "Haven" providing a more private dining room.There remains also some flexibility within the environment to provide space tosupport new initiatives or service developments. This is currently a staff areaproviding a quiet space to review records.



As previously recognised by us, the memory walls with their old local photographscontinue to encourage people to walk about the home and find things to talk about.The bus stop was back in position too, providing a place to sit, but also a focus ordistraction allowing people to communicate a purpose. For example if they feel lost orthe urge to be somewhere else.

From our Lay Assessor's report:Throughout the care home I was aware of a very friendly and relaxed homelyatmosphere. Corridors were wide, uncluttered and decorated in soft pastel shades.I was not invited to visit any of the occupied residents' rooms although I was showninto an empty one which was nicely decorated and had a small wash hand basin/vanity unit in one corner.Whilst being shown around I noted a small room with a table and chairs which, I wastold, was available to provide 'special dining in a romantic setting'. I commented thatit appeared to be more like a 'store cupboard' as there were several boxes lining onewall. A short time later I was asked to take another look. All boxes had been removedand it was now beautifully laid out. The table was set with napkins, glasses and aposy of flowers.Residents made the following comments about their accommodation -'We like it here - people are very friendly''I was told that this was the best care home''I have a nice room with my own TV and pictures''It's alright here''My bed is comfy - I'm really comfy when I'm in it''It's comfortable - I'm quite happy''It's a wonderful place to stay - I wanted to come here''I am happy - it's very homely and you are made to feel welcome'

Areas for improvementThe manager has identified the need to :Encourage volunteers to work within the home to enhance/support person centeredactivities and increase activities, as this has been affected recently due to activitiesorganiser working elsewhere.




Quality Theme 3: Quality of StaffingGrade awarded for this theme: 6 - Excellent

Statement 1We ensure that service users and carers participate in assessing and improving thequality of staffing in the service.

Service StrengthsEvidence in support of this statement can be found in Quality Theme 1, QualityStatement 1.





Statement 3We have a professional, trained and motivated workforce which operates to NationalCare Standards, legislation and best practice.

Service strengthsFollowing discussion with staff, a review of a sample of documentation andobservation of practice, staff have maintained an excellent performance in relationto this statement.The people living in Methilhaven benefit from the continuity that low staff turnoverprovides and continue to hold staff in high regard.

Staff are motivated and continue to demonstrate a willingness to try something new.Discussion with staff illustrated that better outcomes for people living here wererecognised and valued. A reflection of their genuine desire to improve the quality oflife for people living here and their families.

The manager is continuing to review systems such as key champions and key worker.These approaches can promote better outcomes for people using the service as staffdevelop expertise, access good practice guidance and apply their knowledge to thereview and application of policies and procedures.

Our observations confirmed person centred practice is embedded in the day-to-dayactivities of staff. There is a holistic approach to the routines of people living here andthe day-to-day tasks completed to support them.

There is evidence of practice being guided and supported by staff knowledge ofpolicies and procedures.

All staff continue to demonstrate their personal knowledge, experience and skillregarding the way people living here wanted to be cared for and what their supportneeds were.

The manager demonstrated commitment to providing good quality care through on-going staff training and an annual training plan is in place. The plan includedmandatory and non statutory training to meet the needs of the service user group.Training records identified training had been provided and an SVQ training programmeis in place for care staff. The provider has a centralised training plan which themanager can access and tailor individual staff training to meet the health care needspresented by people living here.

Community Nursing Staff confirmed that improvements made over time, regardingthe way staff manage health care needs, have been sustained.



Areas for improvementThe provider should continue to evidence staff are trained to carry out all aspects oftheir role.




Statement 4We ensure that everyone working in the service has an ethos of respect towardsservice users and each other.

Service strengthsOur observations and feedback from people using the service and visitors, confirmedthis service successfully ensures everyone working in the service has an ethos ofrespect towards service users and each other.

Everything we heard said reflected staff knowledge of the people in their care andvery good team work. All staff clearly value the individuals living here. All records ofcare seen confirmed the caring positive tone demonstrated verbally.

Staff confirmed they had a copy of the Social Services Code of Practice. This is part ofthe provider's induction training. Staff receive 5 days induction training, thisincorporates sections on person centered care, values, attitudes, discrimination,diversity, whistle blowing, safeguarding and abuse. Other areas look at team working,communication and valuing each other, this is a theme which is threadedthroughout.

There is access to SVQ training for staff which uses our National Care Standards as aworking tool.Staff confirmed the emphasis placed on respect when supporting person centred careand that there are values underpinning every aspect of their training and discussionswith management. For example at team meetings, or when new guidance is madeavailable, including policies.

Methilhaven aims to promote a no blame culture and staff are encouraged to be openand honest. They confirmed their satisfaction with the support their manager gives.

Everything in place to support service user participation reflects the value placed onthe views of people living here and those of their family or representatives.

Areas for improvementThe manager has identified developing staff questionnaires to gather their views andassess learning needs as one area for development.Another is promoting service user confidence in expressing their views.




Quality Theme 4: Quality of Management and LeadershipGrade awarded for this theme: 6 - Excellent

Statement 1We ensure that service users and carers participate in assessing and improving thequality of the management and leadership of the service.

Service strengthsEvidence in support of this statement can be found in Quality Theme 1, QualityStatement 1.





Statement 3To encourage good quality care, we promote leadership values throughout theworkforce.

Service strengthsFollowing discussion with staff, observation of practice and examination of records,this service was found to perform well with regard to this statement.

Staff confirmed they have a personal training and development plan.The manager uses discussions with staff to identify gaps in training or areas forimprovement. Staff practice is monitored to inform these discussions too.

Staff demonstrated a very good awareness of the service's aims and objectives.Staff are encouraged to make informed decisions about the care they provide on aday-to-day basis.They are encouraged to arrange and record their key service users'reviews.Staff confirmed that they are listened to and are valued members of the team.Every aspect of the service relies on a process of assessment and they are involvedat a level their role and responsibilities supports.Examples of where staff have influenced service developments have been recorded inpast reports. Examples where staff have researched care approaches that they believewill benefit the individual and that have had a ripple effect throughout the team withpositive consequences for other service users.They include doll therapy and baking asmeaningful activity, enhancing communication and appetite.

When asked why they were able to provide high standards of care, staff gave a verygood account of the impact of lots of training, increased delegation of responsibilitiesand support from their manager, as key.

Testimony from a supporting community nurse confirmed staff have sustained goodknowledge and communication. Ensuring appropriate support or intervention fromcommunity health care professionals is accessed.

Areas for improvementThe manager recognises the need to maintain the training and support staff need, ifthey are to continue to take the lead on service developments.




Statement 4We use quality assurance systems and processes which involve service users, carers,staff and stakeholders to assess the quality of service we provide.

Service strengthsMethilhaven has maintained consistently high standards with regard to thisstatement.

As recorded in previous inspection reports, the provider has robust quality assurancesystems in place. Audits covering all aspects of the service are carried out, records ofwhich are maintained. The audits are carried out by the management team. Theprovider has reviewed reporting systems which now provide information on keyindicators, 3 monthly. This gives a very good example of how a provider's policy andprocedures support quality assurance. The manager uses the information to identifytrends or areas for improvement. This along with satisfaction surveys, providesfeedback and information which supports the manager's measurement of/andaspirations for service developments and improvements.

The inspector checked medication systems, storage and records within one unit andevidenced very good standards were maintained.

The views of people using the service and their carers are gathered as one measure ofthe quality of the service provided and acted upon to make improvements.

Since the last inspection visit, we have continued to be well informed regarding themanagement of significant occurrences and the refurbishment of the home.

Review of action taken by the management in response to the areas for improvementidentified in the last inspection report indicated very good progress had been madeand improvements maintained.

A key strength in the management and leadership is the capacity of senior membersof the care staff to manage the service in the absence of the manager and thesupport provided by every grade of staff. They all demonstrate a commitment toensuring standards are maintained and improving the quality of life for people livinghere with the result, people using the service are highly satisfied.

From our Lay Assessor's report:Neither residents nor relatives made any specific comment about managementalthough one relative commented 'We made a lovely choice - I can't praise this placeenough'.They also said that 'This place always had a good name and I would have nohesitation in recommending this care home'.



Areas for improvementThe manager recognises the need to maintain standards and supporton-going development of quality assurance systems.

As discussed at feedback, the manager should reinstate her monthly service userdependency assessment and evidence how this informs staffing.




4 Other information

ComplaintsNo complaints have been upheld, or partially upheld, since the last inspection.

EnforcementsWe have taken no enforcement action against this care service since the lastinspection.

Additional InformationN/A.

Action PlanFailure to submit an appropriate action plan within the required timescale, includingany agreed extension, where requirements and recommendations have been made,will result in the Care Inspectorate re-grading a Quality Statement within the Qualityof Management and Leadership Theme (or for childminders, Quality of StaffingTheme) as unsatisfactory (1). This will result in the Quality Theme being re-graded asunsatisfactory (1).



5 Summary of grades

Quality of Care and Support - 6 - Excellent

Statement 1 6 - Excellent


Quality of Environment - 6 - Excellent




Quality of Staffing - 6 - Excellent




Quality of Management and Leadership - 6 - Excellent




6 Inspection and grading history

Date Type Gradings

16 May 2012 Unannounced Care and support 6 - ExcellentEnvironment 6 - ExcellentStaffing 6 - ExcellentManagement and Leadership 6 - Excellent

2 Dec 2010 Unannounced Care and support 5 - Very GoodEnvironment Not AssessedStaffing Not AssessedManagement and Leadership Not Assessed



24 Aug 2010 Announced Care and support 5 - Very GoodEnvironment Not AssessedStaffing Not AssessedManagement and Leadership 5 - Very Good

17 Feb 2010 Unannounced Care and support 5 - Very GoodEnvironment Not AssessedStaffing Not AssessedManagement and Leadership 5 - Very Good

11 Aug 2009 Announced Care and support 5 - Very GoodEnvironment 5 - Very GoodStaffing 4 - GoodManagement and Leadership 5 - Very Good

18 Feb 2009 Unannounced Care and support 5 - Very GoodEnvironment 5 - Very GoodStaffing 4 - GoodManagement and Leadership 5 - Very Good

30 Jul 2008 Announced Care and support 5 - Very GoodEnvironment 4 - GoodStaffing 4 - GoodManagement and Leadership 4 - Good

All inspections and grades before 1 April 2011 are those reported by the formerregulator of care services, the Care Commission.



To find out more about our inspections and inspection reportsRead our leaflet 'How we inspect'. You can download it from our website or ask us tosend you a copy by telephoning us on 0845 600 9527.

This inspection report is published by the Care Inspectorate. You can get more copiesof this report and others by downloading it from our website:www.careinspectorate.com or by telephoning 0845 600 9527.

Translations and alternative formatsThis inspection report is available in other languages and formats on request.

Telephone: 0845 600 9527Email: [email protected]: www.careinspectorate.com



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