Inspection on 26/06/07 for Hugh Myddelton House

This inspection was carried out on 26th June 2007.

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

Other inspections for this house

Hugh Myddelton House 05/05/09

Hugh Myddelton House 27/05/08

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Hugh Myddleton House 25 Old Farm Avenue Southgate London N14 5QR Lead Inspector Susan Shamash Key Unannounced Inspection 26th and 27th June 2007 10:00 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 Hugh Myddleton House DS0000069400.V336515.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 and Care Homes for Adults 18 – 65*. 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. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hugh Myddleton House Address 25 Old Farm Avenue Southgate London N14 5QR 020 8886 4099 020 8882 9824 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) Barchester Healthcare Homes Ltd Mrs Helen Nicola Matthews Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (38), Physical disability (18) of places Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The second floor will only accommodate up to nine service users of either sex aged between eighteen and sixty five with a physical disability and in need of nursing care. The second floor will be known as the YPD (Young Physically Disabled) Unit. This floor is to provide care for nine service users of either sex aged between eighteen and under sixty five with a physical disability, some of whom may have a sensory impairment (SI) ; be terminally ill (TI) and in need of nursing care. There will be a total of eighteen YPD service users Service users should not be admitted where the primary need is that they are sensory impaired and/or are terminally ill. The home must not admit service users who are in need of acute care, that requires intensive medical management. 7th December 2006 3. 4. 5. Date of last inspection Brief Description of the Service: Hugh Myddelton House is a care home owned and managed by Barchester Healthcare Ltd and registered to provide nursing care for up to forty-seven people. The home provides nursing care to up to thirty-eight people over the age of sixty, and up to eighteen people with physical disabilities aged between sixteen and sixty-five. The service is provided in a purpose built building which provides modern facilities for people. All of the bedrooms are single rooms and have en suite facilities. There are five communal areas as well as a dining room. There are communal areas on each of the floors including two large areas on the ground and first floor. Bedrooms are provided on the ground, first and second floor and all three floors are served by two shaft lifts. There is a pleasant garden area to the side of the home. The home is located in a quiet residential area of Southgate close to shops, amenities and transport links. The stated aim of the home is to create circumstances in which residents can maintain their dignity, identity and independence and also to provide an environment for individuals that supports their physical and mental well being. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 5 Weekly fees to the home (as of June 2007) are £501.73 - £1780 depending on need. Extra charges are made for hairdressing, chiropody and newspapers. Current CSCI inspection reports are available from the manager’s office or from the CSCI website (www.csci.org.uk). Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place over two days and lasted approximately fourteen hours in total. The first day was primarily spent in the YPD unit of the home, and the second day was spent in the remainder of the home. I spoke to approximately fifteen people living at the home, and twelve staff members. The manager cooperated fully with the inspection process and enabled me to move freely about the home. A tour of the home was conducted, and staff, residents’ and a range of other records maintained at the home were inspected. What the service does well: The furnishings, decoration and cleanliness in the home are maintained to a high standard, the home is well equipped with attractive external grounds. The younger adult facilities at the home are particularly bright and inviting. The garden is maintained to a very high standard and the home is commended for involving people living at the home and their relatives in maintaining and enjoying the garden area. Most recently peas, courgettes, butternut squashes, tomatoes, runner beans, radishes and coriander had been planted by people living at the home and these were being used in meals prepared at the home. Comprehensive systems are in place for recording assessments of residents’ needs and their care plans. A thorough recruitment system is in place to protect residents and staff are generally well trained, with more than 50 trained to at least NVQ level 2 in care, exceeding the national minimum standard. Residents are encouraged to maintain contacts with their friends and relatives. Health and safety records are maintained to a high standard at the home so that residents are protected appropriately. The home is well managed with clear policies and procedures regarding its operation and clear systems in place to protect residents from abuse. The majority of people living at the home enjoy the food provided and a range of activities that are available to them. The manager makes a conscious effort to be available to residents, relatives and staff members who have concerns that they wish to discuss regarding the home. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 7 Efficient financial procedures are in place at the home and clear records are maintained of residents’ financial accounts with the home and any monies that the home keeps at their request for safekeeping. What has improved since the last inspection? What they could do better: Improvements should be made in the recording of consultation with people about their care plans, provision of photographs of any pressure ulcers/sores being treated by nurses, recording of people’s appointments with health care professionals and the recording of prescribed medicines carried forward each month. The use of the first floor YPD lounge should be reviewed so that all people have equal opportunities to access it and further options should also be available for people to go out in the local area with staff support in addition to organised group outings that are arranged. A clear and complete log of all complaints received must be maintained. The cause of the damp problem in two bathrooms on the first floor must be addressed and these bathrooms must be redecorated, for the comfort of people living at the home. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 8 A review of security and reception arrangements for the home must be conducted for the safety of people living at the home. All relevant staff must be provided with training in dealing with challenging behaviour, and in working with people who have learning disabilities and person centred planning, mental health problems e.g. bipolar disorder and schizophrenia, and specific disabilities e.g. blind awareness etc. It remains recommended that a selection of staff, including the activities coordinator, be provided with training in multi-sensory work to meet the needs of people living at the home. More regular staff supervision sessions must be provided and more detailed records of induction training for new staff must also be maintained. It remains recommended that there be an increase in the frequency of residents meetings arranged at the home. A current satisfactory gas safety certificate must be obtained for the home and the fire risk assessment for the home must be reviewed at least six-monthly to ensure the safety of people living and working at the home . 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. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): OP 3 and 5 (6 is not applicable) YA 2 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People and their advocates have the opportunity to visit the home, and their needs are assessed before they move in. Assessments indicate nursing, care and support to be provided to individuals, to ensure that their needs are addressed appropriately. However the needs of people admitted to the YPD unit are not always assessed in sufficient detail to ensure that they receive all necessary support. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 11 EVIDENCE: Assessments in residents’ files indicated that a full assessment of their needs including physical, social, cultural and emotional needs, takes place prior to their admission, this was confirmed by staff and people living at the home, that I spoke to. People living at the home indicated that there had been opportunities to visit the home prior to admission, although in some cases this was a visit by the relative due to the poor health of the prospective resident at the time. One person told me that they had visited several places before deciding to move into this home. They said that on entering this home ‘I felt the warmth’ straight away and ‘I thought that’s it, no need to go anywhere else.’ Inspection of the initial assessments of people admitted to the home with pressure sores, or developing these whilst at the home, indicated that there had been an improvement in the level of detail being included within care plans regarding the type of dressings to be used, frequency for when they should be change, turning regimes and types of pressure sore mattress to be used etc. However a number of recent concerns had been raised by the local authority regarding the care and support provided to a small number of people with learning disabilities admitted to the YPD unit. This indicates that insufficiently detailed assessments and communication with other agencies are in place to ensure that the needs of people with complex learning and physical disability needs are fully met. Staff and the manager confirmed that staff do not necessarily have training or experience of working with people with learning disabilities. A requirement is made accordingly under Standard 30 (Standard 35 of the National Minimum Standards for Adults 18-65). Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs have been assessed and care plans are in place. However people living at the home and their relatives (where appropriate) are not always consulted with, to ensure that their preferences are respected. Significant improvements had been made in the recording and delivery of pressure sore care provided by the home to ensure that people receive Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 13 appropriate care at all times to minimise the risk of pressure sores developing or deteriorating. Administration of medicines is generally appropriately recorded however improvements are needed to ensure that prescribed medicines are accurately recorded at the start of each new medication administration record to ensure that people are not placed at risk. People feel that they are treated with respect by the staff team, and are consulted about any limitations placed upon them. EVIDENCE: Care plans inspected were generally detailed and were reviewed monthly as appropriate. Upon speaking to people living at the home, most indicated that they were consulted in choosing preferred care routines. However, possibly due to the implementation of a new care plan recording format, their consultation was not always included on care plans. At the previous inspection a significant improvement had been noted in the recording of consultation with people or their relatives/advocates, regarding their preferences. It is therefore recommended that this issue be addressed, so that people’s consultation is recorded as appropriate. Evidence was seen confirming that peoples’ health needs are generally being met, through consultation with a variety of health care professionals. At the previous inspection a noticeable improvement was noted in staff support in carrying out prescribed physiotherapy exercises with people. Staff confirmed that they have regular training with the physiotherapists working at the home. Staff indicated that they felt more confident in carrying out prescribed exercise regimes, and people spoken to indicated that they were being supported to carry these out regularly. However, although it was required at the previous inspection, current recording of appointments with relevant health care professionals such as dentists, chiropodists, opticians etc, was still not always adequate to ensure that regular follow up appointments were being attended. Recording was variable, better in some care files than others. This requirement is therefore restated. Following investigation of concerns raised about the home’s pressure sore care in 2006, the registered manager had carried out a detailed audit of pressure sore care at the home identifying a number of areas requiring improvement. Discussion with the manager, staff and people living at the home and inspection of care plans indicated that undertakings made following this audit Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 14 were being fulfilled as appropriate. Pressure sore monitoring was also being included as a category to be inspected during monthly monitoring visits by the responsible individual for the provider organisation. There were clear records of nursing care provided to people who have pressure sores, including photographs on admission/development of a pressure sore, dating and signing of all documentation. However in some care files there were no current photographs of some pressure ulcers/sores being treated by nurses at the home. This must be addressed. The manager also advised that the new clinical matron who had recently been appointed to work at the home, had considerable experience and relevant training in pressure sore care and tissue viability, and was in the process of providing nursing staff with relevant supervision regarding the treatment of pressure sore care within the home. Medication records within the home were generally satisfactory, with no gaps noted in the medical administration record (MAR sheets). The Nursing and Midwifery Council’s guidance regarding medication and records had been distributed to all nurses, and the manager advised that monthly audits of medication continue to be undertaken at the home. Whilst medicines received at the home were being recorded, the quantities of medicines carried forward i.e. already in stock from the previous month, were not always being recorded on the MAR sheets. This is necessary to ensure the protection of residents through adequate stocks of their prescribed medication. Storage temperature of medicines stored at different sites within the home were being recorded, with refrigerated medicines stored appropriately and other medicines stored at room temperature. No residents required covert medication on medical grounds, and controlled drugs, were being stored appropriately, with double signatures and totals matching those stored in the relevant compartment. A recent problem had come to light, when prescribed medicines were not being accurately transferred onto new MAR sheets, resulting in a person not receiving a prescribed PRN ‘as and when’ medicine as it was not recorded on their MAR sheet. The manager advised that she had conducted a full investigation into the matter, which involved communication problems between the home and the medication supplier. The clinical matron was in the process of carrying out detailed medication assessments with all the nurses working at the home, and I observed nurses undertaking two such assessments during the course of the inspection. People spoken to confirmed that their privacy and dignity were respected, and I observed staff knocking on bedroom doors and waiting for a response prior to Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 15 entering. My observations of care practices within the home indicated that staff treated people appropriately and spoke to them, and about them, with respect. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. YA Standard 11 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff encourage people to participate in a range of activities with people both within and outside of the home. However some people living at the home still feel frequently bored. People are encouraged to maintain contact with their family members and friends and are given choices about the way in which their care and support is provided. People have generally noted a continued improvement in the quality of food provided at the home. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 17 EVIDENCE: An activities timetable for the week was available to people living at the home, including activities relating to both older people and younger adults. However a significant number of people spoken to indicated that there were still not always sufficient activities provided for them and that they were often bored. I remained concerned about the people who were confined to their rooms due to ill health, and the possibility of insufficient provision of activities and stimulation for them. Although the activities coordinator, with help from other staff at the home, is very proactive in arranging a variety of activities for people in the home, this is made difficult by the large number of residents living in the home and the presence of both older people and younger adults with differing preferences for activities. It remains recommended that a second activities organiser be appointed to the home to ensure that the social, recreational, intellectual, religious and cultural needs of all residents can be met as far as possible. As recommended, care plans inspected specified ways of providing stimulation for specific people in addition to organised activities e.g. reading to them, assisting them to listen to the radio or accessing library books, magazines or knitting materials, but did not always include details of when this support was provided. However although I did witness staff engaging in some informal activities with people on the YPD unit, it was not possible to ascertain whether all people living at the home receive appropriate stimulation. The inspector met with the activities coordinator employed by the home, who remains very enthusiastic about her role, with many ideas for activities for both the older and younger adults living in the home including cooking, gardening, cinema trips, photography, themed tea parties, clothing shows, sherry mornings, seaside trips and sailing. She advised the inspector that she received significant support from the manager, making staff available to assist with particular activities scheduled both inside and outside of the home. The home is commended for its involvement of residents and relatives in transforming the garden area under a Venetian theme and planting a bed of sensory plants within the garden. Several residents are involved in planting peas, courgettes, butternut squashes, tomatoes, runner beans, radishes and coriander in the garden, and I was impressed to see that their produce was being used in dishes served at the care home. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 18 A monthly newsletter continues to be produced for the home including news about the home, peoples’ celebrations and activities. The format is inclusive for residents of all cultures and religions. The dining area on the ground floor at the home was decorated for Wimbledon (underway at the time of the inspection). A group of residents went out to pick strawberries on the one day of the inspection and these were served to all people living at the home with cream for their afternoon tea. I was concerned to note, from discussion with staff and people living at the home, in addition to my own observations, that the YPD first floor lounge, is primarily used by one particular resident. This resident does not tolerate many other people using the lounge at the same time, and therefore almost all people living in this area of the home, spend most of their time in their bedrooms. Whilst it is acknowledged that this is a complex issue to address, it is required that the use of this room be reviewed so that all people have equal opportunities to access it. Trips continue to be arranged to places of interest including garden centres, the coast, local parks and the cinema. Some of the younger adults told the inspector that they attend college courses or day centres on a part time basis. Several others told me that they would welcome the opportunity to go out within the local area, with staff support, on a regular basis. People living at the home told me that visitors were encouraged to visit the home. In addition to friends and relatives, and health and social care professionals, a mobile library, Church of England and Catholic Church members visit the home regularly. Care plans inspected clearly identified the cultural and religious needs of each person living at the home, and consider ways in which these can be addressed. The majority of people spoken to indicated that there had been a sustained improvement in staff communication regarding choices about their care and any concerns that they might have. I had the opportunity to eat lunch with people living at the home and there was a noticeable improvement in residents’ accounts of the food provided at the home. Some of the improvements that had been made included more baking, table service on a course-by-course basis and homemade soups. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People can be sure that their complaints about the home will be addressed appropriately. Procedures are in place and staff are trained appropriately to ensure that the risk of people being abused is minimised. EVIDENCE: The home’s complaints procedure is posted in the reception area. Seven complaints had been received at the home in the last twelve months, one of these was fully substantiated and the others were partially substantiated. Inspection of records and discussion with the manager indicated that these had been dealt with appropriately. However the home’s records of these complaints was not complete and a requirement is made accordingly. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 20 Through observation in addition to accounts from people living at the home, I noted that the registered manager continued to form good relationships with relatives visiting the home so that concerns were brought to her early rather than escalating to become complaints. It is recommended that informal concerns expressed by people living at the home or relatives/visitors should be recorded, alongside information about how they are addressed, to demonstrate that the service is responsive. I also saw thirteen letters or cards from people living at the home or their relatives which had been received since the last inspection, complimenting the home regarding its practices. The home has an appropriate procedure regarding the protection of vulnerable adults, and has arranged a number of adult protection training sessions for staff. Over the last year during a number of cases in which adult protection strategy meetings have been called, the manager had taken appropriate action to address the issues raised. She had provided all relevant information required and taken necessary actions to safeguard people living at the home without delay. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a pleasant environment that is well furnished, clean and hygienic and purpose built to meet their needs. The home is generally decorated to a high standard, although two bathrooms required redecoration. They have access to a range of comfortable communal areas both inside and outside of the home. The home is commended for the work undertaken to make the garden inviting and encouraging participation in gardening activities from a number of people living at the home. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home is decorated and furnished to a high standard, and has good hygiene procedures, with no offensive odours detected on both days that I visited. Bedrooms had been personalised as appropriate and during the inspection, approximately twenty bedrooms were seen. Feedback from people living at the home indicated that a high standard of housekeeping was provided. Bedrooms and communal areas are comfortable and well furnished. The home has adequate communal areas and a sufficient number of toilets and bathrooms. Two bathrooms on the first floor of the home still require redecorating, however the manager advised that the cause of damp in these bathrooms had now been determined. This issue has been restated twice, and must be addressed without delay. The showerhead on the first floor YPD bath must also be repaired. The garden is maintained to a high standard with a range of shady areas and activities available for residents and their visitors. Most recently it was being transformed using a Venetian theme, involving participation by people living at the home and their relatives. A bed of sensory plants had also been planted, and a number of people living at the home were involved in planting peas, courgettes, butternut squashes, tomatoes, runner beans, radishes and coriander which were served in the home. The home is commended for its performance in this area. Observation of security procedures within the home and discussion with staff, residents and health care professionals, indicated that the security and reception arrangements for the home are not adequate to ensure the safety of people living at the home. A review of security and reception procedures is therefore required. There is no monitor available for the intercom system on the 2nd floor of the home, and one faulty intercom was identified on another floor, emitting a loud noise. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home operates safe recruitment practices to protect people from abuse, and staff are generally experience and competent at meeting people’s needs. Staff need training in challenging behaviour, mental health issues and learning disability to ensure that people’s needs are met effectively. EVIDENCE: Satisfactory Criminal Record Bureau Disclosures were available for new workers who had commenced employment since the previous inspection, as appropriate. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 24 Staff files also contained application forms, two references, proof of identity documents and the other records specified under Schedule 4(6) of the Care Homes Regulations 2001. Detailed separate training files were available for each staff member, and as noted at the previous inspection the manager confirmed that the home was meeting the standard of over 50 of care staff trained to at least NVQ level two in care or equivalent. Staff spoken to were knowledgeable about their roles and responsibilities within the home. The manager advised that a Gujarati speaking worker had been identified to work with a particular resident for several hours each week. I was pleased to see that the resident in question appeared to have improved social relationships with staff on the unit, and was participating in more activities. In 2006, the manager had increased the number of staff working on early and late shifts by an extra carer in both the younger adults’ and older persons’ units. Residents and staff spoken to indicated that this continued to make a positive difference, with staff having more time to spend with residents during the day. As described under previous Standards, it is recommended that a second activities organiser be appointed to the home. Arrangements had been made to ensure that staff from a neighbouring home deputise for the maintenance person when he is on leave. It remains recommended that some staff, including the activities coordinator, be trained in multi-sensory work. Following discussion with staff members as well as observation of interactions within the home, it was noted that staff would still benefit from receiving training or regular input from a psychologist in dealing with challenging behaviour from residents. This remains required. As required further staff had undertaken up to date training in first aid to ensure that sufficient trained first aiders are available in the home at all times. Further training and supervision in the area of tissue viability had also been provided. The clinical matron for the home is now overseeing tissue viability practices in the home. Following several concerns raised regarding care practices for younger adults with learning disabilities, and discussion with staff about their experience and knowledge of specific conditions, I found that there is a need for relevant training in working with people who have learning disabilities and person centred planning, mental health problems e.g. bipolar disorder and schizophrenia, and specific disabilities e.g. blind awareness etc. if people with these needs are to continue living in or are to be admitted to the home, to ensure that they receive appropriate support. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 26 The home manager is appropriately qualified and experienced. Communication mechanisms within the home remain effective, providing greater protection for residents in having their needs met consistently. Appropriate quality assurance procedures are in place to ensure that the home is run in the best interest of residents. Provision of supervision sessions still needs to be improved to ensure that people living at the home are provided with appropriate support. Residents are protected by efficient financial procedures. There is a high standard of practice in health and safety at the home. EVIDENCE: Discussions with staff and people living at the home indicated that there had been a sustained improvement in communication procedures and the general atmosphere within the home. It was my impression that this is largely due to the manager’s approach to management of the home. Since the previous inspection, the two ‘Sisters’ who had been appointed to work alongside the manager had left employment at the home, and a new Clinical Matron had recently commenced work. She advised that she was working alongside the manager in improving the quality of nursing and care provided to people, and had many years of relevant experience and training. Records of supervision indicated that insufficient supervision sessions continue to be held for each staff member, to comply with the National Minimum Standard of at least six times annually, although there had been an improvement in this area more recently. Clearly this was due to the vacant posts previously held by the home’s ‘sisters’ prior to the clinical matron commencing work. More detailed records of induction training for new staff must also be maintained. As required a quality assurance audit had been undertaken for the home and a summary of the results were made available to the CSCI. In addition monthly audits are undertaken concentrating on different areas of nursing and care practice. The manager advised that approximately monthly staff meetings were held and occasional residents’ meetings were taking place. Meeting minutes indicated that a wide variety of topics were discussed in these forums, and staff and residents spoken to advised that they found these meetings useful. It is recommended that there be an increase in the frequency of residents meetings arranged at the home, these may include some informal meetings, to ensure that people are consulted about the way in which the home is run. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 27 As required at the previous inspection, tissue viability care was being included within the records inspected during regulation 26 visits (unannounced monitoring visits by the registered provider) to the home. The majority of residents manage their own finances with support, where appropriate, from their family or solicitors. In a small number of instances where the home is asked to keep residents’ funds for safekeeping, clear records are maintained and these were satisfactory. The inspector had the opportunity to meet with the maintenance person for the home. Health and safety checks were maintained to a high standard. A fire risk assessment had been undertaken and an emergency plan had been produced, although these need to be reviewed at least six-monthly. The frequency of fire drills and alarm tests was appropriate with suitable recording systems in place. Hot water temperature records were also being maintained as appropriate. Appropriate servicing certificates were available for equipment in the home, and up to date electrical installation and portable appliances testing certificates were also in place. However the gas safety certificate for the home indicated that some further work needed to be undertaken, which had not yet been addressed. Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 28 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 X 2 X 3 2 4 X 5 3 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 2 37 X 38 2 Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 29 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 YA2 Regulation 14(1) Requirement The registered persons must ensure that sufficiently detailed assessments and communication with other agencies are in place to ensure that the needs of people with complex learning and physical disabilities are fully met. The registered persons must ensure that up to date photographs are maintained of all pressure ulcers/sores being treated by nurses and that care plans are updated when details change e.g. a person refuses medication, to ensure that people are treated appropriately and responsively. The registered persons must ensure that people’s appointments with health care professionals such as dentists, chiropodists, opticians etc. are clearly recorded so that these can be tracked easily to ensure people receive appropriate healthcare. Previous timescales of 29/09/06 and 05/02/07 partially met). DS0000069400.V336515.R01.S.doc Timescale for action 10/08/07 2. OP8 12(1) 15(2c) 10/08/07 3. OP8 12(1) 13(1b) 17/08/07 Hugh Myddleton House Version 5.2 Page 30 4. OP9 13(2) The registered persons must ensure that quantities of prescribed medicines carried forward each month are recorded. A current and accurate record of all prescribed medicines must be available for each people living at the home each month, to ensure that people’s medication needs are met. The registered persons must ensure that the use of the first floor YPD lounge is reviewed so that all people have equal opportunities to access it. Further options should also be available for people to go out in the local area with staff support in addition to organised group outings that are arranged. The registered persons must ensure that a clear and complete log of all complaints received at the home is maintained to evidence that people’s concerns are addressed appropriately. The registered persons must ensure that the cause of the damp problem in two bathrooms on the first floor is addressed and these bathrooms must be redecorated, for the comfort of people living at the home. (Previous timescales of 29/09/06 and 02/04/07 not met). The showerhead on the first floor YPD bath must also be repaired. The registered persons must ensure that a review of security and reception arrangements for the home is conducted for the safety of people living at the home. DS0000069400.V336515.R01.S.doc 20/07/07 5. YA11 16(2mn) 31/08/07 6. OP16 22 03/08/07 7. OP19YA24 23(2d) 26/10/07 8. OP19 18(1a) 23(2ac) 31/08/07 Hugh Myddleton House Version 5.2 Page 31 9. OP30 18(1ci) 10. OP30YA35 18(1ci) 11. OP36 18(2) It is recommended that a monitor be made available for the intercom system on the 2nd floor of the home, and the faulty intercom identified on another floor must be repaired. The registered persons must ensure that all relevant staff are provided with training in dealing with challenging behaviour, to ensure that people receive appropriate support. (Previous timescales of 29/09/06 and 05/03/07 partially met). The registered persons must ensure that staff are provided with relevant training in working with people who have learning disabilities and person centred planning, mental health problems e.g. bipolar disorder and schizophrenia, and specific disabilities e.g. blind awareness etc. if people with these needs are to continue living in or are to be admitted to the home, to ensure that they receive appropriate support. The registered persons must ensure that at least six individual supervision sessions are held for each staff member annually, to ensure that they support people living at the home in line with best practice. (Previous timescales of 29/09/06 and 05/03/07 not met). More detailed records of induction training for new staff must also be maintained. The registered persons must ensure that a current satisfactory gas safety certificate is obtained for the home and a copy must be sent to the local CSCI area office. DS0000069400.V336515.R01.S.doc 28/09/07 28/09/07 14/09/07 12. OP38 13(4a) 23(4a) 10/08/07 Hugh Myddleton House Version 5.2 Page 32 The fire risk assessment for the home must be reviewed at least six-monthly to ensure the safety of people living and working at the home . 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 OP7 Good Practice Recommendations It is recommended that the new care plan formats should be updated to record consultation with people living at the home (or their relatives or advocates where appropriate) to ensure that their preferences are taken into account. It is recommended that records be maintained of staff support to provide social and intellectual stimulation to specific people e.g. chatting with or reading to people, assisting them to listen to the radio or access books, to ensure that they receive sufficient stimulation. It is recommended that informal concerns expressed by people living at the home or relatives/visitors should be recorded, alongside information about how they are addressed, to demonstrate that the service is responsive. It remains recommended that a second activities organiser be appointed to the home, so that people living at the home have more opportunities to engage in organised activities. It remains recommended that a selection of staff, including the activities coordinator, be provided with training in multi-sensory work to meet the needs of people living at the home. It is recommended that there be an increase in the frequency of residents meetings arranged at the home, these may include some informal meetings, to ensure that people are consulted about the way in which the home is run. 2. OP12 3. OP16 4. OP27 5. OP30 6. OP33 Hugh Myddleton House DS0000069400.V336515.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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. 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