Please wait

Inspection on 29/01/08 for Magdalen House

Also see our care home review for Magdalen House for more information

This is the latest available inspection report for this service, carried out on 29th January 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Magdalen House Magdalen Square Gorleston Great Yarmouth Norfolk NR31 7BZ Lead Inspector Jenny Rose Unannounced Inspection 29th January 2008 09:30 X10015.doc Version 1.40 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 Magdalen House DS0000034568.V358641.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 Older People. 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. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Magdalen House Address Magdalen Square Gorleston Great Yarmouth Norfolk NR31 7BZ 01493 661598 01493 444432 ssdmagdalen.house@norfolk.co.uk www.norfolk.gov.uk Norfolk County Council-Community Care 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) Manager post vacant Care Home 38 Category(ies) of Dementia - over 65 years of age (38) registration, with number of places Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That the home should be registered to accommodate older people who have dementia. That the home should be registered to accommodate up to 38 Service Users. 12th February 2007 Date of last inspection Brief Description of the Service: Magdalen House is a care home providing personal care and accommodation for 38 older people who have dementia. The home is owned by Norfolk County Council and is located in a residential area of Gorleston-on-Sea. The fees for the home are £368.72p per week. The home provides single occupancy accommodation on two floors. There are two passenger lifts serving different areas of the home. The home is in the process of refurbishment and this will improve the environment for service users. Magdalen House has large gardens including a secure area suitable for safe usage for people with dementia. Magdalen House DS0000034568.V358641.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 stars. This means the people who use this service experience good quality outcomes. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This was a key, unannounced Inspection carried out over 7.5 hours on 29th January 2008. A partial tour of the premises was undertaken. Care plans, staff files and records for regulation were examined. The Manager was available throughout the day. Discussions took place in private with two residents, three members of staff on duty as well as three groups of two members of staff, two visitors, a community health worker and several residents in passing. The Annual Quality Assurance Assessment (AQAA) had been returned to the Commission. Eight comment cards from relatives/friends and four from residents, (three completed with support), had also been returned prior to the Inspection, all of which provided useful information and which is reflected in this Report. What the service does well: • The ground floor environment has been greatly improved, particularly the large communal area outside the dining room which provides a comfortable, inviting area in which residents can sit on their own or in small groups. The dining room has also been refurbished and attractively decorated. The system for food service has been changed to a flexible ‘restaurant style’. Hot and cold drinks are readily accessible for both residents and their relatives, as well as fresh fruit, snacks and finger foods available. The downstairs bathrooms and toilets have been greatly improved and are pleasantly hygienic and practical. However, the first floor facilities are awaiting improvement. • • Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 6 • • • • There is clear signage and good use of colours to guide residents to the different areas of the Home, which inform and empower residents. The majority of relatives speak of the staff team as being cheerful, helpful and caring and this was observed on the day of the Inspection. There are good training opportunities for staff. Training in dementia care is already taking place. Staff are regularly supervised and there are career development appraisals, although further training in managing Challenging Behaviour would assist staff in meeting the needs of all the residents. Relatives and friends are able to visit whenever they wish. They are made welcome and able to take meals with residents if they so wish. Relatives are invited to provide information with regard to hobbies, interests and past occupations of residents in order to enable staff to better involve residents in the activities which most interest them. All residents have their nutritional needs assessed (Malnutrition Universal Screening Tool (MUST) and their weight and general health monitored. All residents’ monies are held on an individual basis, correctly recorded and audited. • • • • What has improved since the last inspection? • The Manager and a Care Coordinator have recently undertaken an intensive course in Dementia Mapping and a staff training audit has taken place. Further training in dementia is in place for night staff as well as those on day shifts. An Annual Quality Assurance and Annual Development Plan have been carried out. The Manager has undertaken a fire risk assessment on the building in conjunction with a fire safety expert and approved by the County Council. A plan for the enclosed, safe garden is in place and work is scheduled to start in February 2008. Work is due to start March/April 2008 on enlarging the upstairs toilets to include wash hand basins, as well as improvements in bathrooms to create a walk-in shower area. • • • • Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 7 • • Medication procedures have been adapted to suit the more flexible meal times by extra daily audits, including liquid medication. There is a display stand in the front hall with a list of the names of staff on duty on the day, as well as activities for the day and other items of interest. What they could do better: • The complaints procedure should be extended to include ‘minor’ complaints and a facility for anonymous concerns in the form of a suggestions box. Key-workers could be more involved in recording in care plans in order to ensure that care plans are even more person centred. Radiators at present covered in wire mesh could be replaced with more homely covers, less ‘institutional in nature. Encouragement could be given to relatives to participate in care plans and reviews, as appropriate. Consideration should be given to staff being trained in managing Challenging Behaviour. The Activities programme and recording should be further developed and staffing hours dedicated accordingly. Consideration should be given to a plan of replacements for metal windows and measures taken to reduce condensation in some areas. The wearing of jewellery by staff should be further reviewed, as it could place residents at risk of skin abrasions and infection. A review of the serving of meals on the current two-plate system could be undertaken. It is not satisfactory that staff have to ‘lift’ wheelchairs in order to manoeuvre them into the lift. Staff recruitment documents for long standing members of staff, for whom these documents did not exist originally, need to be obtained from County Hall The majority of the areas seen, especially those which had been refurbished, were clean, well presented and free of unpleasant odours. However, despite a rolling programme of regular carpet cleaning there were problems with unpleasant odours on the first floor. DS0000034568.V358641.R01.S.doc Version 5.2 Page 8 • • • • • • • • • • • Magdalen House • The comparatively new dining room carpet is proving difficult to keep clean looking, despite being vacuumed several times a day and spot cleaned each day. This matter is under review by the Local Authority. The new procedure for emergency, short-term admissions should be closely adhered to. The leaflets on Magadalen House planned in the AQAA should be implemented so that new residents and their relatives feel they are receiving sufficient information regarding Magdalen House and to include the procedures for notifying concerns and complaints. Reorganisation of part of the laundry area would be advantageous to staff in caring for residents’ clothes, once the steam ironing equipment arrives. • • • 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. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People looking to live in the Home have their individual needs assessed, but new systems have been put in place for emergency, short term, residents in order to ensure that these people’s needs can be met within the Home. The Home does not provide intermediate care. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 11 EVIDENCE: It was clear from the care plans examined that the Home receives information from health and social services workers before residents are admitted. However, three comment cards from residents stated that they had not received sufficient information before being admitted to the Home. The Manager explained that there had been difficulties with emergency admissions in recent weeks, in that incomplete information had been forthcoming from healthcare professionals. Problems had also occurred with the established resident group by the influx of residents needing short-term care. The Manager said that he had recently visited a resident at Home for assessment before admission and as a result it had been decided that the Home could not meet this particular person’s needs. Where possible two members of staff visit prospective residents in order to assess their needs. In addition, the Manager said a senior member of staff ,where possible, will visit a resident in hospital before the resident is discharged back to the Home. There was also evidence from the Team Meeting Minutes of 15th January 2008 that following two recent complaints new systems had been put in place for the admission of residents needing short-term care. There is therefore a recommendation that these new systems should continue to be followed to ensure that the Home is able to meet the assessed needs of the prospective residents. In addition, there is a recommendation that the leaflets for relatives planned in the AQAA should be put in place to ensure that both residents and relatives feel they receive sufficient information before coming to live in the Home to include the procedure for notifying and raising concerns and complaints. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are detailed care plans in place to ensure staff have the information to deliver the necessary care, respecting the privacy and dignity of those people living in the Home. However, further attention to detail in completing and cross-referencing daily notes would further ensure that more person-centred care is delivered. EVIDENCE: Four care plans seen included detailed information which was easy to read and for staff to follow. They all contained a photograph of the respective resident with relevant contact details and two of these residents were spoken with. Personal care needs were identified including mental well being and comprehension, manual handling needs medical information and details of social history and interests which had been gathered from relatives. Care plans were seen to be reviewed monthly and fully reviewed annually. Risk assessments were seen. There was one resident who preferred not to have Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 13 information such as social history in the care plan and this was clearly stated, which is good practice. Two relatives spoken with said that they visited their relatives regularly, one every day, and were closely involved with the details of their care. They were appreciative that the Home kept them informed of any changes in their relatives’ health. However, three care plans examined were not signed by residents or relatives and although the Manager said that sometimes this was not possible, there is a recommendation that it would be good practice to state the reason for a signature being absent on the relevant signature sheet. One care plan seen contained a dementia care plan which had been reviewed and was electronically recorded. The Manager said that this would enable care plans to be more easily updated with new information regarding residents’ needs which would be gathered particularly by key-workers (and putting into practice the knowledge gained by senior staff from the training in Dementia Mapping). This had been discussed at the Team Meeting on 15 January 2008 and will apply to all care plans in future and that this is intended to make the plans more person-centred. Nutritional screening (MUST) is completed for all residents. This identifies those residents who may be at risk and there are action plans to improve their diets by encouraging snacks and finger foods, fortified drinks etc. This information is cross-referenced in the care plans making it readily available for staff. One relative spoken with was pleased that her mother’s health and weight had improved since being in the Home. The District Nurse visits at least weekly and said that staff are good at reporting issues which they felt needed attention, such as possible pressure areas. She found that the senior staff team in particular were open to suggestions in carrying out instructions from the nursing team. From time to time District Nurses carried out training in the Home on such issues as the care of pressure areas, infection control and a guide for dry dressings. In her opinion this and the training within the Home had increased staff confidence and consequently improvements in the delivery of care. As a result of the relatives’ response to the quality assurance questionnaire in 2007 regarding the delay in NHS chiropody appointments, it was agreed by the majority of residents and relatives that a private chiropodist visit the Home on a regular basis. However, if specialist advice is needed, there are still delays in waiting for the local NHS chiropodist to visit. The medication round was observed at lunchtime. The medication records appeared to be well recorded and contained a photograph of each resident. The medications are now dispensed at a time convenient for the residents who have a choice of flexible mealtimes. The Care Coordinator administering the medication showed the ‘end of round audits’ the Home have put in place for Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 14 double checking the accuracy of the medication and the four hourly gap between administering pain relief medication. There is regular daily stock auditing of those medicines that are not supplied in the monitored dosage system. The member of staff administering the medication on the day of the Inspection was seen to be discreetly asking residents whether they needed pain relief medication. The Home has built on improvements brought about following the Pharmacy Inspection on 16 February 2007. Two Care Co-ordinators are responsible for the ordering of medication, checking it in and organising returns. Liquid medication was seen to be clearly labelled for individual residents, together with the opening date. The ordering of liquid medication was calculated according to the GP’s instructions, which also provided a clear audit trail. There was no one self-administering their own medication other than one resident administering her own cream and medication for indigestion. There were MAR sheets for both these in the resident’s room and risk assessments where appropriate. No residents were prescribed controlled medications, although there are appropriate storage facilities for these. Some medication was being held correctly for a resident in hospital. All staff administering medication have received training and the Care Cocoordinators have devised their own communication book as a further check, together with a record book for those homely remedies that have been approved. Staff were observed treating residents respectfully, speaking in a kind good humoured way. One resident spoken with, confirmed by staff, said that residents could choose where they spent their days, where they ate their meals and now had more flexible choice in the time meals were taken. Training as Dignity Champions was being encouraged amongst the staff. This training has been undertaken by the Manager. Staff were observed asking residents discreetly whether they wished to wear an apron to protect their clothes at lunchtime, thus respecting their dignity. Residents could have a key for their lockable bedroom door if they wished. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 15 Health Professional’s Comments “The residents are always clean and well groomed.” Relatives’ Comments “My ‘relative’ is looked after very well…I am involved with her care plan.” In response to how do you think the care home can improve? “Making it more private when we come and visit”. “Privacy is often invaded by other people in the room removing and tampering with personal possessions.” Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the Home have choice in their lifestyle, including well-balanced meals served in a “restaurant” style of service. EVIDENCE: Relatives and staff spoken to said that the Home was looking forward to the realisation of the plan for the redesign of the garden in time for the summer months with work due to commence February 2008. On the day of the Inspection residents were observed playing a large domino game in small groups and one to one board games with a member of staff. There are several communal sitting areas for residents, with one area where a flat screen TV with surround sound and videos and DVDs were available. Newspapers are available in the Home everyday. There are contacts with local Churches who provide individual services if requested. There is a new display board in the hall with details of activities taking place, such as entertainers or the Library service and some photographs for “reminiscence”. Some staff have attended an 8-day training course around reminiscence. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 17 One of the Care Co-ordinators is the designated activities organiser who has begun a new system of recording activities in a file which contains good detailed individual life histories gained from relatives, with residents’ consent. This needs to be developed further. However, there has been some difficulty in achieving this and developing a more structured activities programme pertinent to the life histories and interests of the people living in the Home as the Care Co-ordinator has been engaged in covering for other senior staff seconded temporarily to another Home. Although there is an end date for this secondment on 31 March 2008, there is a requirement elsewhere in this Report (see Staffing) that the staffing hours should be dedicated to this in order to ensure more person centred care. Two visitors spoken with visit the Home regularly, one every day. They both, together with several relatives’ comment cards, confirmed that visitors were welcomed into the Home at any time. The AQAA states that a room has now been identified for use by relatives should they wish to stay overnight. A resident, relatives and staff spoken with commented favourably on the range of various choices open to residents. One resident spoken with chooses not to join in activities within the Home, as she prefers to listen to the radio in her room, or to go shopping or to church with the aid of her walker. Care plans demonstrated that detailed information was taken as to the preferred personal routine of each resident. Staff spoken with also confirmed that as key-workers they were familiar with the preferred choices and wishes of the residents with whom they were involved. Residents can choose to take their meals in the attractively decorated, light dining room or in their own room. The system for serving meals has been changed to enable more flexibility and for residents to be able to take their meals when they wished within a certain time period. An individual menu is displayed on each table. A fruit bowl, snacks and finger food as well as coffee/tea and water dispensers are readily available for those able to help themselves. The evening meal menu includes sandwiches, as many residents find these easy to eat as finger food, but there are at least two other choices. Staff were observed assisting discreetly or encouraging residents to eat if necessary. The staff have undergone MUST nutritional training and this “restaurant” style project is the subject of ongoing UEA research into its effect on nutrition and health of the residents. The Manager had recently purchased a wooden trolley for the Home for the service of drinks for those who cannot help themselves from the machine. It was considered that the trolley would act as a visual clue to those residents who needed encouragement to take drinks. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 18 One relative spoken with said that the new arrangement in the dining room meant a more relaxed atmosphere at meal times with staff having more time to focus on individual needs and that her mother now took her meals there, which had not been the case before the changes. It was evident from observation in the dining room that staff were aware of residents’ likes and dislikes and one resident said she was pleased with her choice of meal. However, one resident was seen to be having difficulty in managing a meal because of the method of serving the vegetables separately on a crescent shaped dish on the dinner plate. There is a recommendation that this method of serving the vegetables should be reviewed in order to assist residents to eat their meals independently. Relatives’ Comments “They always try to make my relative feel like an individual. They let him be as independent as he is able.” “My relative is very well looked after and I feel she is happy here.” “Families are welcome and can make drinks.” “Meals are very good”. “They even have kippers on the menu occasionally.” “It’s a shame that staff have to be politically correct all the time…they (residents) love terms of endearment and I think it should be encouraged.” “More magazines, books….packs of playing cards….maybe a dance afternoon occasionally.” Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home has a clear complaints procedure, but a clearer procedure for more minor ‘concerns’ would further ensure that people living in the Home could feel that all concerns were listened to and acted upon. The Home’s policies, procedures and staff training ensure that residents are safeguarded as far as possible from abuse. EVIDENCE: The Home has a complaints procedure, which is included in the Service User Guide. It is also displayed in the Home. The AQAA states that there are complaints leaflets in various areas of the Home. At the time of the AQAA two complaints had been received in the Home. These, together with two complaints received in December 2007 had been resolved, the latter two having been investigated by Social Services. Although the two visitors spoken with and four of the comment cards received said that they would know how to make a complaint, there were four comment cards which stated that they were uncertain and two stated they did not know how to make a complaint, but that they did not wish to speak to an Inspector. In addition, one comment card raised several issues and these are being dealt with directly by Social Services. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 20 Because of the uncertainty of the procedure for making a complaint, or expressing a concern there is a recommendation that there should be a suggestions box positioned in the Home, where concerns could be raised anonymously if required. It is intended that a notice of the names of staff on duty each day should be posted on the new display board in the front hall, which is good practice. It is also noted that following two complaints new systems had been put in place to stop similar incidents occurring again and this has been minuted in the Team Meeting Minutes of 15th January 2008. (see elsewhere in this Report Choice of Home) The Local Authority has robust policies and procedures in place for the protection of vulnerable adults. The policies include a whistle blowing policy, which all staff are made aware of through their induction training and in their staff handbook. Those staff spoken with were clear on what action they would take if they witnessed or suspected any form of abuse. There had been one adult protection issue since the last inspection which had been correctly reported and resolved. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the Home have a safe well-maintained environment in which to live, but when the second phase of the planned refurbishment is completed they will enjoy a more comfortable environment in all areas of the Home. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 22 EVIDENCE: There have been major improvements to Magdalen House over the past year. Two new lifts have been installed, although there is little room in these lifts for the manoeuvring of wheelchairs. Curtains have been replaced and several bedrooms have been redecorated and new carpets fitted. Most of the downstairs area has been completely refurbished and decorated. The corridor and communal seating area outside the dining room is a most inviting area in which residents can sit. On the day of the Inspection residents were seen sitting in small groups around occasional tables, participating in games or sitting quietly together and chatting to visitors. Plans are in place for the relandscaping of the garden specifically to meet the needs of people with dementia with work due to begin in February 2008. When completed it will afford views from this sitting area, therefore partly fulfilling a requirement made at the last inspection. There are other communal areas where residents can also sit if they wish, including a smoking room for residents. Stirling University, who have been conducting research into care for people with dementia, provided advice to the Local Authority on the colour scheme for the furniture, walls and carpets to create a calm environment. Communal and private areas are clearly identifiable by colour differences in the paintwork on the doors and walls. In addition, the signage in the Home offers clear instruction to residents, enabling them to retain as much independence as possible. There are clear signs to identify toilet facilities in both writing and pictures. Bedroom doors also have signage personal to the resident. Downstairs toilets have been refurbished and have been made comfortable and homely by the good use of pictures, vases and new curtains. The laundry area at present does not have the equipment to provide full satisfactory service, particularly for residents’ shirts and trousers. The Manager has recently ordered a steam press for this purpose. There is therefore a recommendation that the necessary storage and hanging facilities should be provided to assist staff in caring for residents’ clothes. There is an existing requirement from the previous inspection for the refurbishment of the first floor in keeping with the standard on the ground floor, particularly in the redesign of toilets, in order to make them more accessible for residents with frames or wheelchairs and to incorporate hand washing facilities within them. This requirement is therefore repeated that a date is set for the second phase of the improvement plan to be completed. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 23 The improvement of the toilet and bathroom facilities on the first floor has now become a matter of urgency. One of the baths, sited against a wall, with access only on one side for staff assisting residents, is too low from the point of view of manual handling. In addition, staff report that the hoist attached to this bath is continually failing and is therefore not ‘fit for purpose’. There is also an existing recommendation from the previous inspection that the “institutional” looking metal mesh radiator covers in corridors on the first floor and in all bedrooms could be replaced with the good quality, homely covers which have been installed in the corridors on the ground floor. There is therefore a repeated recommendation for this work to be considered. Included in the planned improvements are plans to change what was a dining room and lounge on the first floor, which is at present used as a store room, into an activities area, with cooking facilities as an additional activity for residents. All areas of the Home to which residents have access appeared to be free from hazards on the day of inspection and most were clean and tidy. However, despite a rolling programme of carpet cleaning (which was taking place on the day of Inspection) there was one particular area in the upstairs corridor where there was an odour. There is evidence from a Regulation 26 Report of 4th June 2007 that there had been a problem in one particular room which had been addressed by changing the flooring. The Manager said that it was hoped that the refurbishment of the upstairs corridor would also include some better ventilation in order to eliminate such odours. There was also evidence from the same Regulation 26 Report and on the day of the Inspection that the comparatively new carpet in the dining room, despite being vacuumed three times a day and spot scrubbed when necessary, proves a disheartening task for the domestic staff who are anxious to keep the Home clean and well presented. This matter is being kept under review by the Local Authority. The bedrooms seen were comfortable and furnished with resident’s own possessions as desired. However, in one room where a resident has a large collection of ornaments and memorabilia, the windowsill, (where these items are displayed), was found to be wet with condensation. The condensation over a long period from the metal window frames had caused a mould to form on the windows and curtains, which was a potential health risk to the occupant of the room. There was also a noticeable draught from the metal window frame, which was pointed out by the resident. There are therefore two requirements regarding the issues of the metal window frames. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 24 All other areas of the Home were clean and tidy and 15 members of staff had received training in Infection Control at the time of the AQAA. However a healthcare professional spoken with pointed out that some staff were inclined to wear jewellery such as rings and bracelets which could put residents at risk of skin tears and infections. There is, therefore, a recommendation that the Home’s policy for staff wearing personal jewellery should be reviewed. Those residents unable to comment appeared happy and relaxed in both the downstairs lounge areas and in the dining room. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the Home are having their needs met by staff who have or are being trained to meet those needs. However, the staffing hours dedicated to developing a more structured individualised activities programme would ensure more holistic care. EVIDENCE: The majority of comment cards, visitors spoken with, including a healthcare professional, were positive about the care delivered by the staff team. Members of staff spoken with were enthusiastic about their work, although they would like more time to be spent one-to-one with residents. Observation provided evidence that staff worked with residents in a caring, discreet and respectful way, promoting the individual’s dignity and choice. Although the AQAA states that the staff rota has been revised and staffing levels have increased, long term sickness, delays in filling vacancies as well secondment of senior staff to an adjacent home, have meant that there is a need to employ agency staff (there was evidence of this on the day of the Inspection) which neither the Manager nor the existing staff team find satisfactory. On the day of the Inspection the 11.00 am to 7.00 pm shift, which is usually given over to organising activities, was also being used as cover for a care shift. There is therefore a requirement mentioned elsewhere Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 26 in this Report (see Daily Life and Activities) concerning this issue. Although, it is clear from the AQAA that the Manager is aware of what plans of improvement are needed. It was evident on the day of the Inspection, including talking privately with staff that there is an enthusiastic staff team who enjoy working with residents. Several said that staff morale had improved considerably since the Manager had been in post. Staff members undertaking kitchen and laundry tasks were enthusiastic about their tasks and took pride in performing them well. The staff spoken with confirmed that they enjoyed their keyworker role, looking after individual resident’s needs and communicating with relatives. From examination of files Induction training is completed by all staff and all are offered various training opportunities, such as MUST training and training in Dementia and Dementia Mapping. Several night staff will be attending the next training session in dementia care. The Manager and the Care Coordinator, whose special area of responsibility is training, confirmed that over 67 had gained NVQ2 qualifications or above and four staff were undertaking this level at present. However, there is a recommendation that staff should receive training in managing Challenging Behaviour in order to better meet the needs of all the people living in the Home. The documents and information needed prior to making staff appointments were seen to be in place in three staff files, but there is a requirement that the relevant CRB reference information is obtained from the Local Authority for a member of staff who was originally employed before CRB information was required for recruitment. From the files and staff spoken with it is evident that staff receive regular supervision. Senior staff are trained in giving annual appraisals. There are regular staff meetings which members of staff said they found helpful. They also confirmed that there was time at the beginning and end of shifts, which enables them to carry out their work in a competent manner. Relatives’ Comment Cards: “Always listen to what I ask.” “The staff keep my ‘relative’ clean and comfortable and also keep a clean and comfortable room for her.” “The care staff are very sympathetic….” Staff are “cheerful helpful, caring, talk and interact with residents well. Patient, persistent if necessary and listen to their needs. Even whilst alterations have been going on the residents did not seem distressed.” “Better training for the younger carers and better pay for them all.” Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager and the staff team work hard to ensure people living in the Home receive a good standard of care. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 28 EVIDENCE: The Manager has been in post since the last inspection, when he was the temporary manager. In accordance with a recommendation from the previous inspection he relinquished his responsibilities in respect of a previous position and his post has now been made permanent, but he has not yet registered with the Commission. The Manager has several years experience in managing Care Services and has an NVQ4 in Management and Care. His main area of interest in his NVQ3 qualification was in Dementia Care. He, together with a Care Co-ordinator, have recently undertaken a three-day course in Dementia Mapping. In the near future this will mean that the Home will have four senior staff who have undertaken such training and this knowledge will be used in reorganising the care plans to be more person centred. The senior staff team and a part time administrator assist him. All staff spoken with were positive about the Manager, saying that he was open and approachable and that after many changes of management he had raised the morale of staff. The Local Authority monitors the quality of the service which includes questionnaires to residents, their relatives, staff and other interested parties. There is an Annual Development Plan in place and the Manager has completed the AQAA. As referred to elsewhere in this Report, (Health and Personal Care) the practice of employing a private chiropodist was as a result of quality assurance monitoring, which is good practice. Issues arising from these surveys were discussed at regular staff and relatives’ meetings. Regular Regulation 26 visits take place by the Local Authority and copies of these are sent to the Commission. The financial records and a sample of monies held on behalf of three residents were examined and all were seen to be in order and correct. The administrator audits these records weekly. All staff receive regular training in areas of safe working practice, including moving and handling training, fire safety, first aid, food hygiene and infection control. Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 29 A recommendation from the last inspection that risk assessments for the Home were brought up to date had been complied with. The Manager had completed a Fire Risk Assessment with a fire prevention expert and the Local Authority had approved this. Weekly fire tests were seen to be recorded as well as Legionella tests. Accidents and incidents are recorded and audited and Regulation 37 forms are completed as appropriate and copies sent to the Commission. Relatives’ Comment Cards “This is a very well run, ‘happy’ home, but it’s always good to look for ways to improve places.” Staff Comment: “The Manager is very fair.” Magdalen House DS0000034568.V358641.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 Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 X X X 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES 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 OP19 Regulation 23 Requirement That the organisation ensures the second planned phase of the improvement plan for the first floor is fulfilled, by setting a start date. An improvement plan to replace ill fitting and draughty metal window frames should be submitted to the Commission to ensure that the Home meets the environmental needs of the people living there. The condensation emanating from one particular metal window frame should be investigated and the possible health risks eliminated. Staffing ratios should be determined according to the assessed needs of residents and that additional staff are on duty at peak times of activity during the day. This will ensure that the needs of people living in the Home come first. (This refers to the development of an individualised activities programme) DS0000034568.V358641.R01.S.doc Timescale for action 01/04/08 2. OP19 23.2(b) 30/04/08 3. OP26 4(c) 29/02/08 4. OP28 18(1)(a) 01/02/08 Magdalen House Version 5.2 Page 32 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 OP3 Good Practice Recommendations It would be good practice to follow the new systems as stringently as possible for the preassessment of residents requiring short term care in order to ensure as far as possible that the Home can meet the needs of the prospective resident and that all the necessary details are in place in the case of emergency admissions. It would be good practice to follow through with the plans in the AQAA to produce information leaflets on Magadalen House to further ensure that both prospective residents and their relatives receive sufficient information before coming to live in the Home. It would be good practice to state the reason for a signature being absent on the relevant signature sheet in the care plan. Consideration should be given to reviewing the two-plate system of serving meals in order to facilitate residents to eat their meals independently. Consideration should be given to positioning a suggestions box where concerns could be raised anonymously if required. Consideration should be given to the necessary storage and hanging facilities to be provided in the laundry area in order to assist staff in caring for residents’ clothes. It would be good practice to cover all radiators in a way that was cosmetically pleasing and homely and not with wire mesh, including in bedrooms. Repeated Consideration should be given to reviewing the Home’s policy for staff wearing personal jewellery, which may put residents at risk of skin abrasions and infections. Consideration should be given to staff receiving further training in managing Challenging Behaviour in order to meet the needs of all the people living in the Home. 2. OP3 3. 4. 5. 6. 7. 8. 9. OP7 OP15 OP16 OP19 OP19 OP26 OP28 Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Magdalen House DS0000034568.V358641.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!