Inspection on 18/08/09 for Middlesbrough Intermediate Care Centre

This is the latest available inspection report for this service, carried out on 18th August 2009.

CQC found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Middlesbrough Intermediate Care... 04/10/06

Middlesbrough Intermediate Care... 16/01/06

Middlesbrough Intermediate Care... 30/08/05

Middlesbrough Intermediate Care... 15/02/05

Middlesbrough Intermediate Care... 27/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Middlesbrough Intermediate Care Centre Homerton Road Pallister Park Middlesbrough TS3 8PN     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tanya Newton     Date: 1 8 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Middlesbrough Intermediate Care Centre Homerton Road Pallister Park Middlesbrough TS3 8PN 01642513120 01642513126 margaret_mett@middlesbrough.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Middlesbrough Council care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Age on admission 40 years and over. The maximum number of service users who can be accommodated is: 23 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following catgories: Old age, not falling within any other category - Code OP, maximum number of places: 23 Physical disability - Code PD, maximum number of places: 23 Date of last inspection Brief description of the care home Middlesbrough Intermediate Care Centre is a large detached two-storey purpose built home that has been completely refurbished to provide personal care and accommodation for 23 older people and older people with physical disabilities, up to 10 of whom could be 40 years plus. 0 23 Over 65 23 0 Care Homes for Older People Page 4 of 25 Brief description of the care home The home provides intermediate care; physiotherapy and occupational therapy are available as part of the rehabilitation process. The home is located near to a shopping complex which enables service users to have access to a wide variety of shops, a public park, post office, leisure centre and public transport. Middlesbrough Intermediate Care Centre has an enclosed garden, at the back of the building, part of the garden has a lawn and there are trees and plant pots. It provides a safe seating area during warm weather. All bedrooms are for single occupancy and there are two flatlets, to provide for the monitoring of independent living. All bedrooms have an en-suite with bath or shower, toilet and washbasin. The home has communal bath/shower rooms and toilets. There are also lounges, dining rooms, meeting/training rooms, a therapy room, a main kitchen and two domestic training kitchens. There is separate access to the office accommodation for: the domiciliary care service, therapists and associated staff, the Stroke Association, mobile response team, Carelink (community alarm call service) and the re-enablement officer. On the date of this inspection there was no fee for care at Middlesbrough Intermediate Care Centre. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced. We carried out a site visit on the 18th August 2009 which lasted five and a half hours. Prior to the inspection, the home were asked to complete their annual quality assurance assessment (AQAA). This provides CQC with information about the service. We also received eight questionnaires which people living, working and visiting the home had completed. During the visit the premises were looked at, records were examined and feedback was gained from staff, visitors and people staying at the home. Comments from these discussions have been included throughout the report. The area manager was also in attendance for the majority of the inspection. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had their needs assessed prior to moving into the home and there were clear plans in place detailing what people wanted to achieve prior to them moving back home. Evidence: Contracts are provided and set out the terms and conditions of residence. The contract forms need updating as they reflect NCSC which is CQCs predecessor. Most people were admitted to the home immediately after being discharged from hospital. People could be admitted from their own home if they had been assessed as needing some form of rehabilitation. Prior to being admitted people would be assessed to ensure that the service would be able to meet their needs. Once admitted a further assessment would be carried out to identify the persons care needs and to plan a programme of rehabilitation. The service provides an intense programme of occupational therapy and physiotherapy, to help people be as independent as possible. Care Homes for Older People Page 9 of 25 Evidence: There are dedicated health care professionals who carry out the therapy treatment. The home had plenty of equipment in physiotherapy room, two domestic kitchens and a bathroom. In those rooms people were supported and supervised with all activities of daily living and were supported to achieve maximum mobility. People are given support and plans are in place for people to return home. This included identifying any specialist support or equipment that may be required prior to them being discharged. From the surveys returned, two surveys said yes to always being given sufficient information before moving in and six said usually. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were being met and were recorded within their individual care plan. There were good systems to support people in managing their medication and people were treated with dignity and respect. Evidence: Three care plans were looked at. Care plans provide written information stating how peoples health and personal care needs would be met by the home. These plans are reviewed regularly to reflect any changes in the persons care. They include risk assessments which reflect how risks can be minimised. People staying at the home are encouraged to be involved in all aspects of care planning. Care files also included detailed information about the therapy being delivered at the home as well as a record of all health care visits and appointments. The records included the progress being made with any therapy as well as any input from other health care professionals which may be required such as district nurses. Any equipment required is accessed via a referral to the physiotherapy or occupational therapy staff. Comments from people at the home included, I am being discharged Care Homes for Older People Page 11 of 25 Evidence: today, I have had excellent health care whilst here, the staff have spent time talking to me about rehabilitation, I help out in the kitchen as part of my rehabilitation and use the gym. Medication systems were looked at. The home has good systems for the storing, recording and administration of medicines. People are assessed for their ability to manage their own medication. The staff monitor peoples progress to ensure that this is managed safely. A pharmacist visits the home each afternoon and is able to provide support and advice to staff as well as monitoring the medication. Checks are carried out on the medication twice weekly, this is important due to the high number of admissions and discharges taking place at the home. All staff who administer medication have been trained in doing so. People staying at the home said that they were treated with dignity and respect. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Contact with family and friends is encouraged and people are supported in making choices and decisions in all aspects of daily living. The home provides an adequate diet. Evidence: Although there is not a structured activities programme in place, activities are provided by staff working at the home and include bingo, quizzes, dominos and cards. Most of the activities focused around peoples individual rehabilitation programmes and were provided by the OTs and physios. Comments from people include, the staff take me out to the park and I get visitors every day. There is a two week menu in place and people are offered a choice. As a lot of people accommodated may stay for up to six weeks a four week menu should be considered so that there is more choice in terms of the menu available. The food is bought into the home ready prepared and just requires heating. If alternative meals are required, for example for cultural or religious reasons, then they could be ordered from the Womens Royal Voluntary Service (WRVS). On the day of the inspection meal choices were either a roast chicken dinner with vegetables or beef curry and rice, followed by sago pudding or treacle sponge. Care Homes for Older People Page 13 of 25 Evidence: There was no fresh fruit or salad available, fresh produce should be available. Comments from people included, the food varies, on the whole its decent and there is always a choice, I am diabetic so I dont get much of a choice when it comes to food. Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were clear systems in place for managing any complaints or allegations. Evidence: The home has clear policies in place for managing complaints and adult protection. The home has received four complaints since the last inspection. A record of all complaints is maintained which includes any action taken by the home in response. Comments from people include, If you have any problem, you just tell the staff. The policy for protecting vulnerable adults was displayed in the entrance foyer of the home. All staff receive training in adult protection which helps to protect people staying at the home. Comments from staff include, If I saw or heard anything inappropriate, I would report, definitely. Care Homes for Older People Page 15 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, safe and well maintained environment, which is free from offensive odours and furnished and equipped to a high standard. Evidence: The home and gardens are fully accessible to wheelchair users and all rooms have a loop system which enables people with hearing impairments to listen to their television. All bedrooms have en-suite facilities which include a bath or a shower, W.C and hand basin. The home also has a number of communal areas which include lounges, dining rooms, bathrooms and a laundry. There are two training kitchens for people to make themselves meals and drinks with supervision from staff where needed. There is also an assessment bathroom which is an ordinary domestic bathroom, with equipment so that people can see how they will be able to manage once they return home. The home also has a physiotherapy room which contains lots of equipment to support and encourage people to improve their mobility as part of the process to get them rehabilitated and back at home. The centre has an enclosed garden to the rear of the property,which had both walkways and steps with handrails so that those with mobility problems could still go outside. There was a seating area for people to sit out during the warmer weather. The building complies with the requirements from the local fire service and environmental health department. A new call alarm system (Telecare) had been Care Homes for Older People Page 16 of 25 Evidence: installed, in addition to the standard nurse call already in situ. There is hand sanitizer available in every room to promote good hygiene practices. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The skill mix and numbers of staff on duty was satisfactory, to care for people at the home. Staff were competent to do their jobs and people were protected by the homes recruitment procedures Evidence: The number and skill mix of staff on duty in the main was satisfactory. There were four carers and a senior carer on duty throughout the day and there were three carers on duty during the night. The home must ensure that at all times there are suitably experienced and qualified staff on duty, which includes making sure that there is someone able to take charge in the absence of the manager. Three recruitment files were looked at, all contained an application form, two references and a CRB (police check). This helps to protect people. Training records were also viewed, mandatory training included first aid, food hygiene, moving and handling, fire and infection control. Additional training which was specific to meeting the needs of the people accommodated was also provided. Thirty of the fifty one staff working at the home have an NVQ at level 2 or 3. Comments from staff include, rehabilitation works well, we get good feedback from families, morale is good and we get loads of training, something most weeks. comments from people accommodated include, the staff are excellent, I just press my buzzer if i need them, I am well looked after, the staff are perfect, there are loads of them downstairs and I am here for convalescence, I am well supported by Care Homes for Older People Page 18 of 25 Evidence: the staff, they are all very caring. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for covering the home in the absence of the manager need to be reviewed. In the main, there are good management systems in place, which encourage peoples feedback on the quality of the services provided. Evidence: The current manager of the service is experienced and qualified to run a care home. The manager was not available on the day of the inspection and there were no clear management arrangements in her absence. Relatives were heard asking for updates on peoples care and were told that staff working at the home were bank staff so could not provide responses to their questions. The home must ensure at all times that there is a designated person in charge who is able to manage the shift and deal with any queries from people visiting the home. One of the staff on duty said, its chaotic. We looked at quality assurance systems, these include staff meetings, audits on care plans and medication, questionnaires to seek the views of people using the service and Regulation 26 visits by the provider. Quality assurance systems should be further developed and should include feedback from other professionals. It would also be Care Homes for Older People Page 20 of 25 Evidence: beneficial to summarize the findings of any surveys carried out. The home does not hold meetings for people staying at the home due to the short stay involved. Health and safety records were viewed. In the main these were up to date, however the gas safety was last carried out on the 11/07/08 and the portable appliance testing on 24/06/08. Copies of up to date certificates should be forwarded to CQC after the inspection. The home keeps suitable records of all accidents and risk assessments are carried out to safeguard the staff working and people staying at the home. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 The home must ensure that 30/09/2009 at all times there are suitably experienced and qualified staff on duty, which includes making sure that there is someone to take charge in the absence of the manager. To ensure that the home is appropriately staffed and run. 2 31 18 The home must be 30/09/2009 appropriately managed at all times. The home must ensure that at all times there are suitably qualified, competent and experienced people working at the care home. 3 38 23 The gas safety certificate 30/09/2009 was dated 11/07/08 and the portable appliance testing 24/06/08. Copies of up to date certificates should be forwarded to CQC. Page 23 of 25 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure the health, safety and well being of people at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 2 15 The contracts should be updated to reflect the move from NCSC to CQC. A four week menu should be considered to offer further choice to the people accommodated. Fresh fruit and/or salad should also be made available. Quality assurance systems would benefit from further development and should include the views of other health professionals where possible. 3 33 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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