Inspection on 27/05/08 for Hugh Myddelton House

This inspection was carried out on 27th May 2008.

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 26/06/07

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 28/09/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Hugh Myddelton House 25 Old Farm Avenue Southgate London N14 5QR Lead Inspector Susan Shamash Unannounced Inspection 27th and 29th May 2008 12:00 X10029.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 Hugh Myddelton House DS0000069400.V363865.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 Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hugh Myddelton House Address 25 Old Farm Avenue Southgate London N14 5QR 020 8886 4099 020 8882 9824 helen.matthews@barchester.com www.barchester.com Barchester Healthcare Homes Ltd 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) Vacant position Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (38), Physical disability (18) of places Hugh Myddelton House DS0000069400.V363865.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. 23rd November 2007 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 Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 5 Weekly fees to the home (as of May 2008) are £800 - £1300 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 Myddelton House DS0000069400.V363865.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 twelve hours in total. The first day was an unannounced afternoon visit, spent in all areas of the home, during which I was assisted by the Acting Manager for the home. The second day was an announced morning visit during which I fed back to the two Sisters in charge of the home. I spoke to approximately twelve people living at the home, and eight staff members. All staff cooperated fully with the inspection process and enabled me to move freely about the home. A tour of the home was conducted, and care plans, staff files and a range of other records maintained at the home were inspected. Information provided in the Annual Quality Assurance Assessment for the home was also taken into account. 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. 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. A significant number of people living at the home enjoy a range of activities that are available to them. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Up to date photographs should be available within people’s pressure sore records to ensure that pressure sore care is monitored appropriately in the interests of people living at the home. Clear guidelines should be recorded for addressing challenging behaviour from relevant individuals living at the home so as to ensure that this behaviour is addressed appropriately and consistently by all staff members. Daily records for people living at the home should still include greater detail of health and social care provided, including staff support to provide social and intellectual stimulation, to evidence that they are receiving holistic support. Use of the first floor YPD lounge must be further reviewed to ensure that all people have equal opportunities to access a communal living room. A recent increase in residents’ levels of dissatisfaction with food served at the home must be addressed to ensure that the quality of life for people living at the home is raised. A record must be maintained of all complaints made by people living at the home and how they are resolved to evidence that all complaints made by or on behalf of people living at the home are taken seriously. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 8 The number of care staff on duty in each part of the home, should be reviewed to ensure that people living at the home are provided with high quality care and attention at all times. Staff must be provided with relevant training in working with people who have mental health problems e.g. bipolar disorder and schizophrenia, and specific disabilities e.g. blind awareness etc. to ensure that they receive appropriate support. Communication regarding changes in the management arrangements for the home must be improved to ensure that the home is run smoothly in the best interest of residents. Accident and incident records must be available at the home in the absence of the manager, for monitoring purposes, to prevent similar, and the fire risk assessment for the home must be reviewed at least six-monthly to ensure the safety of people living, working or visiting at the home. It is recommended that a record be maintained of all concerns raised and how these are addressed, that a refrigerator for storage of medicines be provided in the second floor medical room, that a portable call bell be provided for people wishing to sit outside in the garden area, that the spare hoist in the home should be repaired for more efficient running of the home. 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 and that some staff be provided with training in multisensory work to meet the needs of people living 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 Myddelton House DS0000069400.V363865.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 Myddelton House DS0000069400.V363865.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 good 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. 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. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 11 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. Inspection of the initial assessments of people admitted to the home with pressure sores, or developing these whilst at the home, indicated that improvement in the level of detail being included within care plans had been sustained, e.g. specifying 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. Hugh Myddelton House DS0000069400.V363865.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. Improvements have been sustained in the recording and delivery of pressure and medication administration, to ensure that people receive appropriate health care at all times. People generally feel that they are treated with respect by the staff team, and are consulted about any limitations placed upon them, however there remains room for improved guidelines on addressing challenging behaviour to ensure that people receive consistent support in this area. EVIDENCE: Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 13 Ten care plans were inspected, and these 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, and this was recorded on care plans. People spoken to said that their health needs were being met, through consultation with a variety of health care professionals. Clear records were available of all appointments with relevant health care professionals such as dentists, chiropodists, opticians etc. Discussion with staff and people living at the home and inspection of care plans indicated that there had been a sustained improvement in pressure sore care monitoring within the home. Clear records were maintained of nursing care provided to people who have pressure sores, including photographs on admission/development of a pressure sore, and dating and signing of all documentation. There was also written evidence of regular contact with the local Tissue Viability Nurse as appropriate. The most recent photographs of pressure sores were not available on people’s files, the nurses explained that this was because they were awaiting a new cartridge in order to print the most recent photographs from the home’s camera. This is an area that should be addressed, with spare cartridges available to aid printing if necessary, to ensure that pressure sore care is monitored appropriately in the interests of people living at the home. Medication records within the home remained at a high standard, with no gaps noted in the medical administration record (MAR sheets) and clear records of medicines received at the home including medicines carried forward i.e. already in stock from the previous month. 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. In cases where people were self-medicating, risk assessments were in place as appropriate. 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. 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 entering. At the previous inspection it was required that clear guidelines be put in place for addressing challenging behaviour by identified individuals in the home. Although staff had undertaken training in working with people who have challenging behaviour, as appropriate, there were still no guidelines in place for individuals to ensure consistent support by the staff team. Discussion with staff and residents, and observations of interactions in the home indicated that this can lead to some residents feeling isolated and confused, and other residents feeling that their rights are infringed upon by those with challenging behaviour. This requirement is therefore restated. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 14 Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 15 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 adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are encouraged to participate in a range of activities both within and outside of the home, but those who are unable to do so are not provided with sufficient stimulation to meet their social and intellectual needs. 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. There is a high level of dissatisfaction with the food provision at the home, which affects the quality of life of people living at the home. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 16 EVIDENCE: An activities timetable for each week remains available to people living at the home, including activities relating to both older people and younger adults. 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. I had the opportunity to meet with the activities coordinator on the first day of the inspection, and she remains enthusiastic about her role, with many ideas for activities for both the older and younger adults living in the home. She advised that there had been a recent trip to Southend-on-Sea and told me about other popular events held recently including entertainers such as an accordion player, pianist, viola performance, Frank Sinatra night and hot chocolate and muffins event. Regular groups continue such as cooking, gardening, themed tea parties, clothing shows, sherry mornings and arts and crafts groups. Although many residents told me that they were happy with the activities provided, some residents still told me that they frequently feel bored. I remained particularly concerned about the people who were confined to their rooms due to ill health, and the possibility that they were receiving insufficient provision of activities and stimulation, as documentation within care files remains unclear about the social, emotional and intellectual support provided to 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. Care plans inspected specified ways of providing stimulation for specific people in addition to organised activities e.g. reading to them, accessing library books, magazines or knitting materials, but more often than not, did not include details of when this support was provided. Although I did witness staff engaging in some informal activities with people on the YPD unit in particular, it was not possible to ascertain whether all people living at the home receive appropriate stimulation. There appeared to have been some improvement in describing stimulation provided to residents living on the first and second floors, whilst this area was less well documented on the ground floor. Staff told me that they have been getting in Indian movies for a resident who enjoys these, and I observed the resident watching one such movie with Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 17 another resident in the lounge. However, I noted, from discussion with staff and people living at the home, in addition to my own observations, that the YPD first floor lounge, remains primarily used by one particular resident, and a small number of other residents who this person tolerates. The acting manager advised me that he had received a letter of complaint from three residents who are unhappy with this arrangement, feeling that they are unable to access the lounge when they wish to. The identified resident does not tolerate many other people using the lounge at the same time, and therefore the majority of people living in this area of the home, spend most of their time in their bedrooms. The nursing staff advised that action was being taken to address this issue with healthcare professionals, and practical steps such as arranging for this person to spend periods of time in their bedroom. Whilst it is acknowledged that this is a complex issue to address, it remains required that the use of this room be reviewed so that all people have equal opportunities to access it. 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. 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. The home remains commended for its involvement of residents and relatives in making the garden area a pleasant and stimulating area to visit. Several residents are involved in gardening with a sensory area cultivated, and several vegetables grown including peas, courgettes, butternut squashes, tomatoes, runner beans, radishes and coriander. I had the opportunity to eat lunch with people living at the home and noted that there was a high level of dissatisfaction with the food served. This appeared to be predominantly due to the home’s chef leaving and the use of agency chefs in the interim period, who do not know the likes and dislikes of people living at the home. The interim manager advised that a new head chef and second chef had been appointed for the home, following a ‘Cook Off’ between the two leading candidates for the position, with several residents participating and choosing their preferred candidate. The home is commended for this practice of including residents in the decision. Some individual issues were relayed to the nursing staff, to be addressed with the new chef. Clearly it is required that people’s level of satisfaction with food served at the home be addressed without delay, to ensure that the quality of life for people living at the home is raised. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 18 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. Most recently people have not been certain that their complaints about the home will be addressed promptly. 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. The interim manager provided me with the complaint records for the home. These indicated that the most recent complaints had been received in January 2008, and addressed as appropriate. There were also a large number of compliments received. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 19 However the record did not include a recent letter received by the interim manager concerning the use of the first floor YPD lounge. Nor a complaint made by a resident regarding money going missing, which they advised had also been made verbally to the interim manager, and also to several other members of staff including at least one of the Sisters. The new interim manager who commenced work at the home shortly after the inspection visit, assured me that this complaint would be addressed and has since provided me with an update on progress made so far. However I was concerned at the lack of a handover between interim managers, clearly leading to the possibility of complaints remaining unaddressed. Speaking to a number of staff and people living at the home, it was clear that there was some confusion over management arrangements, and who was to be contacted in the event that a resident wished to make a complaint. It remains recommended that informal concerns expressed by people living at the home or relatives/visitors should also be recorded, alongside information about how they are addressed, to demonstrate that the service is responsive. The home has an appropriate procedure regarding the protection of vulnerable adults, and has arranged a number of adult protection training sessions for staff. The home has a good track record of addressing adult protection issues appropriately, attending strategy meetings when appropriate, and taking appropriate action to address the issues raised. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 20 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 and decorated, clean and hygienic and purpose built to meet their needs. Residents 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 Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 21 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. Most recently, two bathrooms on the first floor of the home had been redecorated for the comfort of people living at the home. Observation of security procedures within the home and discussion with staff and residents, indicated that the security and reception arrangements for the home had sustained improvement as noted at the previous inspection. The garden is maintained to a high standard with a range of shady areas and activities available for residents and their visitors. A bed of sensory plants is included, 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. Following discussion with staff, it is recommended that a refrigerator for storage of medicines be provided in the second floor medical room to enable easier access to these medicines for people living on this floor. I noted that one service user who was sitting outside in the garden according to their wishes, was unable to call a staff member when it started to rain (albeit lightly). It is recommended that a portable call bell be provided for people wishing to sit outside in the garden area to ensure that they can call for assistance. Staff told me that they were experiencing difficulties due to a portable hoist being out of order, necessitating them sharing the hoist with another floor at the home, and I passed this information on to the administrator and Sisters in charge of the home. However staff also noted that there was one spare hoist which had not been service, but might otherwise have been used in this interim period. It is recommended that the spare hoist in the home should be repaired so that it may be used in the event of another hoist being out of order. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 22 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 experienced and competent at meeting people’s needs. Staff need training in working with people who have mental health issues and sensory impairments to ensure that people’s needs are met effectively. EVIDENCE: Staff told me that they generally worked well as a team. However during the evening shift on the first day of the inspection, one member of staff went home due to feeling unwell, whilst another member of staff on the same floor, did not know that they had gong. This indicated to me that communication within the staff team was not strong, and this is addressed under Standard 33. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 23 A number of staff and residents told me that they did not think sufficient staff were available to provide social and intellectual stimulation for people who are unable to leave their bedrooms. My observations of people in the home confirmed that this did appear to be the case. It is required that the number of care staff on duty in each part of the home, be reviewed to ensure that people living at the home are provided with high quality care and attention at all times. I inspected eight staff files, training records and supervision files on this occasion. Satisfactory Criminal Record Bureau Disclosures were available for new workers who had commenced employment since the previous inspection, as appropriate. 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. As described under previous Standards, it is recommended that a second activities organiser be appointed to the home and it remains recommended that some staff, including the activities coordinator, be trained in multi-sensory work. Training files indicated that all staff are provided with appropriate mandatory training in fire safety, first aid, food hygiene, protection of vulnerable adults and health and safety in their first year of work at the home. Other training including communication skills, care skills, medication administration, venepuncture, male catheterisation, continence and bowel care, dementia and care of the dying training are also provided by the organisation. Induction records were not available for all new staff, although the home’s Sisters advised that this was because they were still being worked on by individual staff members. Detailed separate training files were available for each staff member, and as noted at the previous inspection records 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. As required at the previous inspection, the majority of relevant staff had undertaken training in dealing with challenging behaviour from residents. However staff had not yet undertaken training in working with people who have mental health problems e.g. bipolar disorder and schizophrenia, and specific disabilities e.g. blind awareness etc. and this remains required. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 24 The home’s Sisters advised that nursing staff had been trained in the Mental Capacity Act 2005. They advised that they would be cascading some of this learning to the care staff at the home so that they are aware of how this affects their role, to ensure that the rights of all people living at the home are protected appropriately. Hugh Myddelton House DS0000069400.V363865.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 adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Management arrangements, since the home manager left, have been confusing for people living at the home, with inadequate communication to ensure that they feel adequately protected. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 26 Appropriate quality assurance procedures are in place to ensure that the home is run in the best interest of residents. Provision of staff supervision sessions has improved to ensure that people living at the home are provided with appropriate support. Residents are protected by efficient financial procedures and there is a high standard of practice in health and safety at the home. EVIDENCE: Due to personal circumstances the registered manager had left employment at the home since the previous inspection. She was very popular with staff, relatives and residents, and people that I spoke to were clearly very disappointed that she was no longer working at Hugh Myddelton House, although wishing her well. I was introduced to Benet Ormerod, as the interim manager on the first day of this inspection. He had only been working at the home for a few weeks, and told me that a new manager had been recruited for the home. That very day she was coming in for an interview with four residents from the home, and I had the opportunity to meet her. The home is commended for involving residents in the recruitment procedure. The new manager will commence work at the home in early August 2008. Benet told me that he worked some weekends, and also carried out some spot checks at night, both of which I considered to be very positive. He advised that he was increasing domestic and laundry support by two positions, and was looking to set up a dining committee for the home. However on the same day, Benet told me that he had received a phone call advising him that that would be his last day at the home. He had not yet been made aware of what the management arrangements would be in his absence. This was clearly very confusing for staff and particularly residents at the home, many of whom had only just learned his name. I expressed my concerns to the two Sisters who were managing the home in the interim period. They advised that they did feel supported by the provider organisation and that there was always somebody available to contact should the need arise. However the remainder of the staff team seemed more confused by the change, with many not even aware that Benet was no longer working at the home, on the second day of my inspection. Residents that I spoke to were predictably more confused, some saying that they were waiting to here back from Benet on particular matters. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 27 Shortly after the inspection I received a telephone call from another manager who advised that she would be working at the home in the interim period prior to the new manager starting, although she would be away for two weeks in June. This was later confirmed in writing by the home’s head office advising that for those two weeks, three other managers would oversee the home. As noted under Standard 16, there did not appear to be any handover between interim managers for the home. A requirement is therefore made that all stakeholders should be notified of changes in the management arrangements for the home, and that communication procedures amongst the staff team must be improved to ensure that the home is run smoothly in the best interest of residents. Records showed that one staff meetings and one resident meeting had been held in 2008. More regular staff and resident meetings must also be undertaken to ensure appropriate communication procedures within the home. As required at the previous inspection, records indicated that there had been an improvement in the regularity of staff individual supervision sessions to comply with the National Minimum Standard of at least six times annually. This was confirmed by the Sisters and staff spoken to. Several quality assurance audits had been undertaken for the home including audits on nutrition and dining, infection control and health and safety, and I was able to view a summary of the results. Regular regulation 26 visits (unannounced monitoring visits by the registered provider) were being undertaken to the home with copies sent to the CSCI. The home’s administrator advised that all residents now manage their own finances with support, where appropriate, from their family or solicitors. It was not possible to view the home’s accident and incident records in the absence of the registered manager, as these are only maintained on computer, and the interim manager and Sisters did not have access to this record. I had the opportunity to meet with the maintenance person for the home. Health and safety checks continue to be maintained to a high standard. 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, with further work being undertaken to meet the requirements of the electrical installation inspection. Likewise works had been completed to meet the requirements of the last gas safety inspection for the home. A fire risk assessment had been undertaken and an emergency plan had been produced in July 2007, although these need to be reviewed at least six-monthly. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 28 Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 29 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 3 4 X 5 3 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 2 34 X 35 3 36 3 37 2 38 3 Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 30 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 OP8 Regulation 12(1) Requirement The registered person must ensure that up to date photographs are available within people’s pressure sore records, (with spare cartridges available to aid printing from the home’s camera) to ensure that pressure sore care is monitored appropriately in the interests of people living at the home. The registered person must ensure that clear guidelines are recorded for addressing challenging behaviour from an identified individual and other relevant people living at the home so as to ensure that this behaviour is addressed appropriately and consistently by all staff members. (Previous timescale of 08/02/08 not met). The registered person must ensure that daily records for people living at the home include greater detail of health and social care provided, including staff support to provide social and intellectual stimulation e.g. chatting with or reading to people, assisting them to listen DS0000069400.V363865.R01.S.doc Timescale for action 04/07/08 2. OP10 13(6) 15 01/08/08 3. OP12 16(2mn) 18/07/08 Hugh Myddelton House Version 5.2 Page 31 4. OP14 16(2mn) 5. OP15 16(2i) 24(1) 6. OP16 22 7. OP27 18(1a) 8. OP30 18(1ci) to the radio or access books, to evidence that they are receiving holistic support. (Previous timescale of 22/02/08 not fully met). The registered person must ensure that the use of the first floor YPD lounge is further reviewed to ensure that all people have equal opportunities to access a communal living room. (Previous timescales of 31/08/07 and 22/02/08 not met). The registered person must ensure that a recent increase in residents’ levels of dissatisfaction with food served at the home is addressed to ensure that the quality of life for people living at the home is raised. The registered person must ensure that a record is maintained of all complaints made by people living at the home and how they are resolved to evidence that all complaints made by or on behalf of people living at the home are taken seriously. The registered person must ensure that the number of care staff on duty in each part of the home, is reviewed to ensure that people living at the home are provided with high quality care and attention at all times. The registered person must ensure that staff are provided with relevant training in working with people who have mental health problems e.g. bipolar disorder and schizophrenia, and specific disabilities e.g. blind awareness etc. to ensure that they receive appropriate support. (Previous timescales of 28/09/07 DS0000069400.V363865.R01.S.doc 11/07/08 18/07/08 20/06/08 29/08/08 29/08/08 Hugh Myddelton House Version 5.2 Page 32 and 04/04/08 not met). 9. OP31 8 24 The registered person must ensure that all stakeholders are made aware of changes in the management arrangements for the home, and that communication procedures amongst the staff team are improved to ensure that the home is run smoothly in the best interest of residents. The registered person must ensure that regular staff and resident/relative meetings are held at the home as part of quality assurance procedures for the home to ensure that it is run in the best interest of residents. The registered person must ensure that accident and incident records are available at the home in the absence of the manager, for monitoring purposes to prevent similar reoccurrences for the safety and comfort of people living at the home. The registered person must ensure that the fire risk assessment for the home is reviewed at least six-monthly to ensure the safety of people living, working or visiting at the home. 27/06/08 10. OP33 24 04/07/08 11. OP37 37 04/07/08 12. OP38 23(4) 18/07/08 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 OP16 Good Practice Recommendations It is recommended that a record be maintained of concerns raised and how these are addressed in addition DS0000069400.V363865.R01.S.doc Version 5.2 Page 33 Hugh Myddelton House 2. OP19 3. 4. 5. OP19 OP19 OP27 6. OP30 to formal complaints to demonstrate that the service is responsive to people’s views. It is recommended that a refrigerator for storage of medicines be provided in the second floor medical room to enable easier access to these medicines for people living on this floor. It is recommended that a portable call bell be provided for people wishing to sit outside in the garden area to ensure that they can call for assistance. It is recommended that the spare hoist in the home should be repaired so that it may be used in the event of another hoist being out of order. 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. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. Hugh Myddelton House DS0000069400.V363865.R01.S.doc Version 5.2 Page 35 - 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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