Inspection on 25/06/08 for Midtown House

This is the latest available inspection report for this service, carried out on 25th June 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Midtown House 15/03/06

Midtown House 07/10/05

Midtown House 13/01/05

Midtown House 11/08/04

Midtown House 15/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Midtown House Caldbeck Wigton Cumbria CA7 8EL Lead Inspector Mrs Margaret Drury Unannounced Inspection 25th June 2008 09:45 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 Midtown House DS0000022609.V365991.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. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Midtown House Address Caldbeck Wigton Cumbria CA7 8EL 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) 016974 78528 Mrs Julie Ann Tickle Mrs Julie Ann Tickle Care Home 20 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (19) of places Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2006 Brief Description of the Service: Midtown House is registered with the Commission for Social Care Inspection to provide accommodation to up to twenty older people. Midtown House is owned by Mrs Julie Tickle who is also the registered manager, responsible for the dayto-day running of the home. The home is situated in the centre of the village of Caldbeck and is close all the local facilities available in the village. The premises is a large period property, which has been adapted for it’s present use as a care home. Accommodation for residents is provided on the ground and first floor of the home. There are twenty bedrooms with en-suite toilet and bathing facilities. When suitable rooms are available, arrangements may be made for two residents to share a bedroom. Short-term respite care is provided in Midtown House when accommodation is available. The home has a range of adaptations and equipment to assist residents including stair lifts, assisted bathing and toilet facilities and a call bell system. The home is set in attractive, well-maintained grounds, which are accessible to the people living there. The fees for this home are £363.00 - £422.00 per week as at the time of the inspection. There are extra charges for newspapers, magazines hairdressing and chiropody. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This site visit that forms part of the key inspection took place over one day in June and we (The Commission for Social Care Inspection) were in the home for six hours. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager • Survey questionnaires returned by residents, staff and family members. • Interviews with residents, visitors and staff on the day of the visit. • Looking at any information received from other professional agencies We looked at care planning documentation to ensure the level of care provided met the needs of those living in the home and a tour of the building to inspect the environmental standards was undertaken. Medication records were examined and staff training records and personnel files were also inspected. Discussions took place with the registered manager about the running of the home, staffing levels and the dependency of those living in Midtown House. There were 6 surveys returned by relatives, 3 surveys returned by residents and 5 returned by members of staff. There was opportunity to spend time with residents during the day and speak with relatives and friends who were in the home at the time of the visit. We spent time observing the care delivered to those living in the home and the interaction between staff and residents. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There is an annual programme of redecoration with 4 bedrooms being completely decorated and new furniture purchased. Five windows have been replaced and others will be completed in due course. New carpeting has been purchased for the landing and all the emergency lights have been updated. A new generator has been purchased that can be used during any power cuts. The home now employs a maintenance worker who is also responsible for the gardens. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 8 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 Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Midtown House undertakes comprehensive assessments prior to admission to ensure the service can properly meet peoples’ needs. EVIDENCE: Any prospective resident is fully assessed prior to a place being offered. The manager is always mindful of the needs of those already living in the home when the assessments are carried out and there is a trial period before the placement is made permanent. This is seen as a safeguard to all concerned. A comment from a relative we spoke to during the visit was, ‘The home made my mother in law’s move so very easy’. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 10 All prospective residents and/or their families or advocates are invited and encouraged to visit the home prior to admission. This gives opportunity to meet the management, staff and those already living in the home. Residents we spoke to during the visit all confirmed that they visited to look around before making the decision whether or not to move in. They also confirmed how much they appreciated the help and support of the staff during the ‘settling in’ period. Some residents told us they were happy to have been able to leave all the arrangements to members of their family. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 11 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): All NMS were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are detailed with specific needs clearly defined. This means that peoples’ assessed needs are being appropriately met and those living in the home treated with dignity and respect. EVIDENCE: We looked at the care plans for four residents and found them to be detailed and up to date with evidence that they are regularly reviewed to meet the changing needs of those using this service. The manager takes responsibility for the care plans and works with the key workers to ensure they are always up to date. Monthly reviews take place unless there is a change in needs when the plans are updated immediately. Relatives confirmed that they are always kept up to date with any changes in the level of care provided. Comments from a family member on a survey form included ‘Julie and the staff are careful to explain things to my mother in law and we discuss anything that needs Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 12 changing’, and ‘ I am aware of the high level of discussion about the care of the residents’. Staff discuss the needs of the residents at every handover period, which ensures all the staff are constantly aware of any changes in the dependency levels of those they are supporting. Information was available about individual healthcare needs with evidence that hospital appointments, doctors’ visits and consultations with other healthcare professionals took place, helping to demonstrate that peoples’ health needs are monitored and treated correctly when necessary. The manager and staff all commented on the high level of support they received from local healthcare professionals in particular when dealing with any resident who may have complex needs. There is a policy in place for staff to adhere to the procedures for the receipt, recording, storage, handling, administration and disposal of medicines. Records were examined to ensure all medication prescribed was administered in a timely and appropriate manner. Medicines were stored safely in a locked cabinet and provision is available to store any controlled drugs correctly, although there are currently none prescribed. Since the last inspection the local G P surgery has taken over the provision of medication to the home and the manager confirmed that this is proving very successful. She said the service was excellent with medication supplied weekly in a monitored dosage system. If medication is supplied mid-week it is dispensed from bottles or boxes until it can be placed in the monitored dosage system. Opportunity is given for those residents who wish to take responsibility for their own medication. Members of staff were observed demonstrating a caring, sensitive, dignified and respectful approach with residents responding in a positive way. It was evident that warm, yet respectful relationships existed between all the staff and those living in the home. Some comments made during the visit included,’ the staff are lovely’ and ‘the girls are wonderful and so caring’. Relatives’ comments on surveys included, ‘Everyone at Midtown is sensitive to peoples’ needs and requirements’ and ‘All medical matters are dealt with efficiently in co-operation with the local doctor’s surgery’. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 13 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): All NMS were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relevant and appropriate recreational and leisure activities are provided demonstrating that people are motivated and stimulated. This gives those using this service a sense of wellbeing. EVIDENCE: Although there is no activities organiser employed at Midtown House the manager and staff do provide activities for those residents who wish to join in. routines are very flexible with residents getting up and retiring exactly when they want to. Some of the ladies were busy with their knitting and crochet and most enjoy the organised quizzes. A member of the manager’s family comes in twice a week to read to the residents and this has proved very popular. The staffing levels are such that there is always staff available to spend time chatting with those living in the home over a cup of tea or coffee and this personal activity was observed during our inspection visit. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 14 Some residents are able to go out and take part in the village activities and one gentleman is taken out to church every week. Monthly Communion is provided for those wishing to take part. The mobile library visits every 3 weeks and one of the residents goes with the manager to choose books for other residents who like to read. On the day of the visit one of the carers had brought her dog in and it was obvious that he was well known to and very popular with all those living in the home. We spoke to the cook and examined the catering facilities. There is a choice at all mealtimes and all the residents we spoke to said how much they enjoyed their meals. Diabetic and soft diets are available when necessary. The kitchen area was clean and well maintained with all the required records kept and up to date. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service are confident any complaints or concerns will be listened to and acted upon. Policies, procedures and staff training in adult protection ensure residents are safeguarded. EVIDENCE: The home has a comprehensive complaints procedure in place with copies displayed around the home. Staff who spoke to us were all aware of the complaints procedure and what to do if a complaint was made. There have been no complaints made to the home and none received by CSCI. The residents we spoke to were all aware of the procedure to follow and all said they would speak to Julie (manager) There is an in-depth policy and procedure in place regarding the safeguarding and protection of vulnerable adults. An external provider has given staff training in this discipline and the adult protection policy also covers whistle blowing. When this was discussed with the staff they all knew what to do should they witness anything untoward happening. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 16 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): Standards 19, 20, 21, 23, 24 & 26 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Midtown House is clean, hygienic and well maintained, helping to ensure people live and work in a safe, comfortable and pleasant environment. EVIDENCE: We conducted a tour of the building and found it to be clean, sweet smelling and well maintained. Since the last inspection 5 large windows have been replaced and four bedrooms have been decorated and new furniture purchased. The home now employs a maintenance manager/gardener who ensures the grounds are well maintained and any small repairs are completed as soon as possible. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 17 The emergency lighting has been updated and a generator has been purchased. As Midtown House is situated in a very rural area this will ensure electricity can be provided during any disruption to the power supply. All except one of the nineteen rooms have en-suite toilet and bathing facilities and the remaining one has en-suite toilet and washing facilities. There is also a communal bathroom available. All the residents’ rooms contained personal items brought in from home and this ensures each room is personal and familiar to the individual. Midtown House has large well-kept gardens with seating available for the residents to enjoy during the good weather. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 18 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): All the NMS were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team have been correctly recruited and have the necessary training, skills and experience to provide a high standard of care to vulnerable people. EVIDENCE: We examined the staff rotas during the visit and found there to be sufficient staff on duty to meet the assessed needs of those living in the home. We took time to observe the interaction between staff and residents and staff and visitors. We found there to be a caring, sensitive, dignified and respectful approach at all times, with residents responding positively to the members of the care team. Comments from residents about the staff included, “the staff are wonderful and so caring”, “the girls are great” and “all the staff are marvellous”. The manager ensures that the shift patterns are such that staff have time to spend with the residents chatting and enjoying personal time with them. We were in the home over the lunch period and noted the staff eating their lunch with the residents, which seemed to make it an enjoyable social occasion. There is a thorough recruitment process in place, with staff files containing evidence that all legal checks had been carried out with staff only employed on the satisfactory completion of these checks. References are obtained prior to Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 19 employment starting thereby helping to ensure that those living in the home are protected and safeguarded by this robust recruitment and selection process. There is a full training programme in place with training completed in the following subjects, moving & handling, first aid, dementia awareness, personcentred care, equality & diversity, safe handling of medicines food hygiene, health & safety and the Mental Capacity Act. Over 60 of the care staff have gained their National Vocational Qualification in social care level 2 with a further 3 carers working towards the award. One senior carer is completing her level 3. Some staff training is completed ‘in house’ but the manager also uses an external professional trainer to cover some subjects and also the staff induction programme. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 20 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): Standards 31, 32, 33, 35, 36 & 38 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of this service is based on openness, respect and trust with the manager working in the best interests of those living and working in Midtown House. EVIDENCE: Julie Tickle has owned and managed Midtown House for a number of years and has in-depth experience in the care of older people. She is a qualified nurse and has completed her registered manager award. In discussion with staff, residents and visitors it was obvious that she, together with her husband, work very hard to ensure the best possible care and support is provided to both Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 21 residents and staff. Comments from residents included, ‘Julie is top of my list any day’, Julie is always around to talk to’ and ‘ Julie is the most caring person I know’. Staff were very appreciative of her support and those we spoke to all said they would not ‘choose to work in any other home’. The home has an internal quality assurance system in place with surveys sent out annually although the manager did tell us that she ensured she spoke to the residents every day to ensure the quality of care provided remained as high as possible. The residents also confirmed this and one gentleman commented, ‘Julie is here every day and is always asking if she can do anything for me’. All risk assessments are up to date and an external company, ‘Citation’ works with the manager to ensure all health and safety systems are in place. All staff have been given an up to date handbook that contains the home’s policies and procedures. All inspection certificates were in place and up to date including, electrical, lift maintenance, PAT testing and all hoists and bath aids. Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 22 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X N/A 3 X 3 Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Midtown House DS0000022609.V365991.R01.S.doc Version 5.2 Page 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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