Inspection on 07/12/06 for Midtown House

This inspection was carried out on 7th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Midtown House Caldbeck Wigton Cumbria CA7 8EL Lead Inspector Mrs Margaret Drury Unannounced Inspection 10:30 7 December 2006 th 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.V309421.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.V309421.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.V309421.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th March 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.V309421.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit that forms part of the key inspection took place over one day in December. A pre-inspection questionnaire was not received by The Commission for Social Care Inspection prior to the visit, so information was gathered from previous inspections and questionnaires sent to residents and visitors/relatives. One questionnaire was received from a resident and two from relatives of residents living in Midtown House. All the comments were positive and complementary about the care provided During the visit the inspector spent time with the registered manager and her husband discussing the operation of the home and looking at the administrative procedures. A tour of the building looking at the environment was undertaken. During the visit, time was spent speaking to staff residents and visitors to the home. Comments from residents confirmed that the staff provided an extremely high level of care. “They are wonderful” and “the staff are so caring, nothing is too much trouble” were comments received from residents. Visitors remarked on the caring attitude of the staff and the patience they showed when providing support. What the service does well: Residents and visitors spoke very highly of the staff and praised the level of care and support provided. The inspector observed warm interaction between staff and residents and visitors said they were “always made welcome and offered tea and biscuits”. The home provides a warm and homely atmosphere with staff supporting residents in their daily life and ensuring the routines within the home are applicable to the needs of the residents. The home is in the centre of the village and this allows residents access to the local community facilities if they wish. The home is family run and the registered manager and her husband are very much involved in its operation. This is very much appreciated by the residents who told the inspector that “Julie is lovely is lovely and so caring”. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 6 Care plans are well kept with all the monthly reviews up to date. Information on them was relevant and provided sufficient detail for the care staff to meet the assessed needs. Residents are given choice about how they spend their days and one resident told the inspector she “loved living in the home as the atmosphere was so relaxed and she could have a lie down after lunch”. Medication records were up to date and correctly completed, with details of all prescribed medication recorded on the care plans. What has improved since the last inspection? 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. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 7 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.V309421.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, & 5 Quality in this outcome area is good. This judgement was made using available evidence including a visit to this service. Care needs assessments are completed prior to admission, which ensures the care given is appropriate to meet the needs of the residents. EVIDENCE: Admissions to Midtown House do not take place until the manager has completed a full assessment of needs. The dependency levels of those already living in the home are also taken into consideration when assessing prospective residents. This ensures that the staffing levels within the home are able to meet the needs of all those living there. Family members are encouraged to be present during the assessment visit as this ensures all concerned know that the home is able to meet the needs of those hoping to move in. Prospective residents and their families are encouraged to visit the home prior to admission to meet the staff and the other people living in the home. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement was made using available evidence including a visit to this service. An effective and efficient care planning system is in place showing that personal, social and healthcare needs are being met effectively. EVIDENCE: Each resident has a care plan that is used as a working tool and is understood by all staff. It is written in clear language with resident and/or family member involvement wherever possible and is used to ensure the correct level of care is provided. Each care plan includes a comprehensive risk assessment. Management of risk takes into account the needs of residents and demonstrates a balanced view in maintaining safety while also offering choice. The rights of others living in the home are also considered when drawing up an assessment of risk. The care plans are updated each month by manager and evidenced that all the assessed needs are reviewed to ensure they are all met. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 10 Discussions with the manager confirmed that the staff have an excellent working relationship with the healthcare professionals that visit the home on a regular basis. Medication is received from the pharmacy in a monitored dosage system and checked in by the manager who is also responsible for any that has to be returned. The manager ensures a regular audit of the medication records is completed. This ensures the safety of the residents and is a protection for those responsible for giving the medication. Residents who spoke with the inspector said that the staff always treat them with respect and kindness and that any personal care required is given in the privacy of their own rooms with doors and curtains closed. They are always asked how they wish to be addressed when coming to live at the home. Visitors also confirmed they were impressed with the caring and polite attitude of the staff. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement was made using available evidence including a visit to this service. The routines of the home are planned around the residents’ needs and wishes and are flexible enough to meet the changing needs of the individual. EVIDENCE: Routines in the home are flexible and suit the needs of the residents. Those who spoke to the inspector were pleased that they could spend their days as they wish. Some residents choose to take their meals in their rooms whilst others enjoyed talking to their friends in the dining room. Cultural needs are met by regular visits by the clergy and communion is provided for those residents who wish to take it. There is a church service held each month that all residents are invited to attend if they wish. One resident is able to go to his own church every week and told the inspector he was delighted that someone called to pick him up in the car. There are some activities organised but the manager and members of staff told the inspector it was not always possible to persuade the residents to take part. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 12 There are entertainers who visit the home occasionally to sing to the residents. The residents who spoke with the inspector said that they like living in the home because the atmosphere was so relaxed and they could spend their time “just as they wished, without being entertained all the time”. Staff said that they always had time during the afternoon to spend time talking to the residents and enjoyed listening to them talk about their life before they came into the home. One of the favourite activities is the reading group, which meets twice a week. A member of the owner’s family comes into the home and reads poetry or a short story, some of which are chosen by the residents. Visitors to the home are welcome at any time and are invited to stay for a meal if their visit coincides with lunch or tea. There was only one visitor in the home during the visit and she told the inspector that she “always received a lovely welcome.” and how much better her aunt was since she came to live in the home. The manager’s husband does most of the cooking and the residents told the inspector that the food “was great and always hot”. There is always a choice at the main meal served at lunchtime and then the residents choose whatever they like for their later meal. Teatime meals range from soup and sandwiches to toasted teacakes. Diabetic meals are prepared for those requiring them and soft diets are made available if necessary. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement was made using available evidence including a visit to this service. Residents feel confident that any issue they raise will be dealt with promptly. Residents are safeguarded by the home’s adult protection policies. EVIDENCE: The home has a complaints book in place but there have been none to record. The home encourages open dialogue and many of the residents are well able to express their opinions. Details of the complaints procedure forms part of the terms and conditions given to each resident and there is a copy on display. There are policies and procedures in place that outline the rights of those living in the home and these also form part of the terms and conditions of residency. Adult protection issues are discussed during staff induction and this area is also covered in the NVQ training course. Staff interviewed showed a good awareness of abuse issues and the process to follow should this be necessary. The home has a set of video recordings dealing with this subject that are available at all times for internal training purposes. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24 & 26 Quality in this outcome area is good. This judgement was made using available evidence including a visit to this service. Residents live in a home that is clean, hygienic and maintained to a good standard. This helps to ensure their safety and comfort. EVIDENCE: This home provides a comfortable environmental standard with good quality furniture and fittings. The manager conducts regular inspections of the home and notes any repairs that may be required. Some parts of the home have been refurbished and there is a continual programme of redecoration. There is ample communal space with two large lounges and a dining room. There are also other small sitting areas around the home that can be used by the residents. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 15 There are large, well kept gardens with ample parking facilities at the front of the building. The home is set in a quiet village location and many of the rooms have views overlooking the fields. Midtown House is a large, grade 2 listed property that has been converted and extended for its present use as a care home. This means that all the bedrooms are individual in size and design and personal to each resident. Each room has bathing and en-suite toilet facilities. There are lots of pictures and ornaments and each room has a radio and television. Access to the upper floors is via stair lifts and this ensures that residents have access to all parts of the building. Domestic arrangements in the home ensure the environment is clean and pleasant for the residents. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement was made using available evidence including a visit to this service. There is a trained and experienced staff team to care for the residents that has been recruited using the home’s robust policies and procedures. EVIDENCE: Midtown House has a stable staff team with a very low staff turnover. Many of the staff live near the home, which is helpful for travelling to work. The staffing arrangements in this home are good with 3 members of care staff on duty in the morning and two in the afternoon, plus the manager. There are also catering and domestic staff employed. The staff team is experienced and qualified, with over 50 of the care staff having already completed National Vocational Qualification (NVQ) level 2 and others working towards the award. Some of the care staff are hoping to start level 3 NVQ early next year. The inspector was able to observe the staff and found their attitude to be caring, supportive and enabling. This attitude ensures that the residents can maintain as much independence for as long as possible even though the dependency needs vary throughout the home. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 17 There is a full recruitment and selection process that ensures all the legal checks are completed prior to new staff starting work. All staff have enhanced CRB checks, which ensures the safety and security of the residents. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 36 & 38 Quality in this outcome area is good. This judgement was made using available evidence including a visit to this service. The home is run by a competent, qualified and experienced manager who ensures it is run in the best interest of the residents. EVIDENCE: Discussions with the registered manager confirmed her commitment to giving the highest level of care to the residents. She works closely with the staff team to ensure all the assessed needs are met. She is well qualified, and has considerable experience in the care and support of older people. During the inspection she demonstrated clear lines of responsibility and delegation to the staff team but also provided a “hands on approach” when necessary. She is very involved with the care of the residents and this is very much appreciated. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 19 Discussions with the residents and staff evidenced that she ensures the home is run in the best interest of the residents and that all appreciated the fact that that could enjoy a laugh and joke with her. All staff supervision and appraisals are up to date with records held on staff files. There are procedures in place to ensure that residents’ personal finances are safeguarded even though the families are ultimately responsible for residents’ personal monies. The home has a full set of policies and procedures in place and the manager is always looking at ways to ensure these are kept completely up to date. Record keeping is of a high standard, which safeguards the residents. The manager is responsible for health and safety and all fire safety procedures are in place. She ensures that fire drills and fire safety equipment are tested on a regular basis. All risk assessments are in place and reviewed at the same time as the care plans. Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 20 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 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 3 3 3 X 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Midtown House DS0000022609.V309421.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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.V309421.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 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. 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