Inspection on 05/05/09 for Hugh Myddelton House

This inspection was carried out on 5th May 2009.

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

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 27/05/08

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 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Hugh Myddelton House 25 Old Farm Avenue Southgate London N14 5QR Lead Inspector Susan Shamash Unannounced Inspection 5th – 19th May 2009 12:00 DS0000069400.V375658.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hugh Myddelton House DS0000069400.V375658.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 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) 020 8886 4099 020 8882 9824 helen.matthews@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Manager post vacant 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.V375658.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. 27th May 2008 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.V375658.R01.S.doc Version 5.2 Page 5 Weekly fees to the home (as of May 2009) are £850 - £1300 depending on need. Extra charges are made for hairdressing, chiropody and newspapers. Current CQC inspection reports are available from the manager’s office or from the CQC website (www.cqc.org.uk). Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection visit took place over approximately eleven hours, including an afternoon/evening spent at the home, and some information provided by telephone (as the acting manager was not present on the day of the visit). I spoke to approximately ten people living at the home, and seven 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 most recent Annual Quality Assurance Assessment for the home was also taken into account, alongside completed surveys received by CQC. Three surveys were received from people living at the home, five from staff members, and one from a healthcare professional in contact with people living at the home. 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. The home generally has a cheerful and very welcoming atmosphere, with staff making new residents, and visitors feel at ease. 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. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 7 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. What has improved since the last inspection? Up to date photographs were available within people’s pressure sore records ensuring that pressure sore care is monitored appropriately in the interests of people living at the home. Use of the first floor YPD lounge had been reviewed to ensure that all people have equal opportunities to access a communal living room. There had been some improvement in the level of satisfaction with food served in the home, with a ‘Cook off’ involving residents, between the leading two candidates for the recruitment of new chefs, now being part of the recruitment process. A clear record of formal complaints made by people living at the home and their representatives, was being maintained, including details of how they are resolved to evidence that all complaints made by or on behalf of people living at the home are taken seriously. Staff had been 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 had been improved to ensure that the home is run smoothly in the best interest of residents. Accident and incident records were available at the home in the absence of the manager, for monitoring purposes, and the fire risk assessment for the home was being reviewed at least six-monthly to ensure the safety of people living, working or visiting at the home. A refrigerator for storage of medicines had been provided in the second floor medical room, and a new hoist had been provided for more efficient running of the home. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 8 A second activities organiser (on a part time basis) had been appointed to the home, so that people living at the home have more opportunities to engage in organised activities. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): OP 3 and 5 (6 is not applicable) YA 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of 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 people’s 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 in confirmation with staff and people living at the home. People living at the home and their representatives indicated that there had been opportunities to visit the home prior to admission, although frequently Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 11 this was a visit by a relative due to the poor health of the prospective resident at the time. Residents and relatives spoke positively about staff approachability, including that of the receptionist, who made them feel very welcome within the home. Inspection of the initial assessments of people admitted to the home with pressure sores, or developing these whilst at the home, indicated sustained improvements in the level of detail within care plans 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.V375658.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of 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 sore care. However issues relating to the changeover to a new pharmacy provider have resulted in a small number of improvements needed in the administration of medication, 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. EVIDENCE: Nine care plans were inspected, and these were detailed and were signed to indicate that they were being 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. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 13 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 appointments with relevant health care professionals such as consultants, chiropodists, tissue viability nurses, opticians etc. Fewer records were available for dentist appointments, and it was unclear whether this was a result of people’s preferences, or whether regular dentist appointments were being made available. It is therefore recommended that clearer records be maintained to evidence that people are provided with the opportunity to attend regular dentist appointments, including appointments offered but refused. Discussion with staff and people living at the home and inspection of care plans indicated that good practices remained in place regarding 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. Feedback from a healthcare professional in contact with people living at the home indicated that staff are aware of people’s needs, and telephone for advice/visits as they arise. They noted, in a completed questionnaire, that ‘In my experience the individual patients are cared for by the staff with their individual needs/likes and dislikes taken into consideration.’ Also ‘patients are considered individuals first’ and good communication with medical staff was noted as a strength of the home. It was suggested that the home should consider improved access to Physiotherapy, due to long waiting times for Community Physiotherapy. Inspection of the medication administration and storage arrangements was complicated by the fact that the home had commenced receiving all prescribed medicines from a new pharmacy supplier, with new administration recording put in place, on the week of the inspection. Storage arrangements and administration records relating to all parts of the home were inspected. There were some gaps noted in the medical administration records (MAR sheets) whereby these medicines appeared to have been administered but not signed for. Clear records were in place for 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. However I was concerned to learn that as a result of the changeover to the new pharmacy supplier a small number of residents had not received particular medicines on the changeover day due to the late supply by the new pharmacy supplier. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 14 There is therefore a need for increased monitoring of gaps in the recording on medication administration records, and action must be taken to ensure that no residents miss out on medication prescribed to them due to pharmacy provider issues. 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, and generally treating residents with patience and respect. Issues relating to addressing challenging behaviour by identified individuals had also been dealt with appropriately as required at the previous inspection. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. YA Standard 11 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to participate in a range of activities both within and outside of the home, although there remains room for improvement in the provision of social and intellectual stimulation for those unable to join in group activities. 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 are varying levels of satisfaction with the food provision at the home. 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 also continues to be produced for the home including news about the home, peoples’ celebrations and activities, with a format inclusive for residents of all cultures and religions. I had the opportunity to meet with the activities coordinator during my visits, and she remains enthusiastic about her role, with many ideas for activities for Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 16 both the older and younger adults living in the home. She described recent trips out, entertainers booked, parties and themed nights, in addition to regular groups continuing such as cooking, gardening, tea parties, clothing shows, sherry mornings and arts and crafts groups. She also advised that a new part time activities assistant would be commencing shortly to provide residents with additional support in this area. This was confirmed by the interim manager, indicating that the plan would be for increased provision of support to residents who are unable to leave their rooms, as required at the previous inspection. The majority of residents told me that they were happy with the activities provided, although some still felt that they were frequently bored. 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 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. A survey received from one person living at the home advised: ‘I am one hundred percent dependent, and would like to see more of the outside world – trips to parks, around the block etc.’ Despite being required at two previous inspections it remains required 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 to the radio or access books, to evidence that they are receiving holistic support. Staff continue to provide Indian movies for a resident who enjoys these, and had resolved the issues regarding use of the YPD first floor lounge, so that it is not monopolised by one particular resident. 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. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 17 I had the opportunity to eat lunch with people living at the home and noted an increase in levels of satisfaction since the previous inspection, although some residents remain unhappy with the food served. The interim manager advised that new chefs were now being appointed following a ‘Cook Off’ between the two leading candidates for the positions, and some residents spoken to confirmed that they had been present for the most recent ‘Cook Off’ event. The home is commended for this practice of including residents in the decision. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although an appropriate system remains in place to address formal complaints, people are less certain that their informal concerns about the home are addressed promptly. Procedures are in place and staff are trained appropriately to minimise the risk of people being abused as far as possible. EVIDENCE: The home’s complaints procedure is posted in the reception area, and the interim manager provided me with the complaint records for the home. These indicated that formal complaints received in the home were being addressed appropriately. A significant number of compliments had also been received. Speaking to a number of people living at the home, and their relatives it was clear that there was some dissatisfaction regarding the way in which informal concerns were addressed within the home. People were concerned at the amount of time taken for issues to be addressed, and described a lack of confidence in the abilities of nursing staff on duty in the absence of the acting manager, in addressing issues brought to their attention. Particular issues were raised regarding practicalities of feeding an identified resident, and giving tablets to people with swallowing difficulties. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 19 I observed that folders for recording informal concerns were in place at each nursing/staff station in each unit of the home. However inspection of these records indicated that they remained largely unused, and where concerns were recorded, there was no evidence that these had been followed up. In addition these were also frequently being mistakenly used to record maintenance problems, for which there is an alternative record available. A requirement is therefore made that informal concerns expressed by people living at the home or their relatives/ representatives, must be recorded alongside evidence that they are addressed swiftly. The home has an appropriate procedure regarding the protection of vulnerable adults, and has arranged 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.V375658.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a 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 continuing to encourage participation in gardening activities from a number of people living at the home. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home remains decorated and furnished to a high standard, and has good hygiene procedures, with no offensive odours detected during the inspection. Bedrooms have been personalised as appropriate and during the inspection, approximately twenty bedrooms were seen. Feedback from people living at the home and their relatives generally indicated that a high standard of housekeeping continues to be provided. One completed survey indicated that there was a problem with inadequate dusting, and the smell of urine in a particular room, however I was unable to confirm this during the inspection visit. Bedrooms and communal areas are comfortable and well furnished, and the home has adequate communal areas and a sufficient number of toilets and bathrooms. Observation of security procedures within the home and discussion with staff relatives and residents, indicated that the security and reception arrangements for the home remain at an improved standard, as noted at the previous inspection. The garden continues to be 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 have been served in the home. The home remains commended for its performance in this area. As recommended at the previous inspection, a refrigerator for storage of medicines was provided in the second floor medical room to enable easier access to these medicines for people living on this floor. It remains 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. Discussion with the manager and maintenance person within the home indicated that a solution to this issue was being researched. A new hoist had been provided within the home, but some staff felt that they would benefit from a spare large sling being provided for the hoist on the first floor YPD unit, for when the other is being laundered, so that they do not need to borrow a sling from other units within the home. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home operates safe recruitment practices for the protection of residents, and staff are generally experienced and competent at meeting people’s needs. Improvements had been made in training provision for staff regarding particular physical or mental health impairments experienced by people living at the home to ensure that their needs are met effectively. EVIDENCE: 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. The majority of residents and relatives felt that staff provide them with sensitive care and support. However a number of staff, relatives and residents told me that they did not think sufficient staff were available to meet people’s social and healthcare needs within certain areas of the home, particularly at night. One completed survey received by CQC indicated that ‘sometimes there are not enough staff around to help (for example to put my coat on). It is Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 23 therefore 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. As recommended previously, a second activities organiser had been appointed to work at the home on a part-time basis. It remains recommended that some staff, including the activities coordinators, be trained in multi-sensory work. The acting manager advised that it had been difficult to locate relevant training in this area. Staff spoken to generally felt well supported by the management within the home, one completed staff survey received by CQC compared the staff, residents, relatives and their friends, to a family, supporting each other, and felt proud of this family. All staff confirmed that they had been given appropriate induction training. One person noted ‘The sister of the unit did my induction and she made sure I knew how to do everything properly before I started..’ Training files indicated that all care/nursing staff are provided with appropriate mandatory training in fire safety, first aid, food hygiene, protection of vulnerable adults and health and safety with other training provided relevant to specific roles including communication skills, care skills, medication administration, vene-puncture, male catheterisation, continence and bowel care, dementia and care of the dying. As noted at previous inspections, records confirmed that the home is 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 previously, the majority of relevant staff had undertaken training in dealing with challenging behaviour from residents. Staff had also been provided with some training in working with people who have mental health problems e.g. bipolar disorder and schizophrenia, and specific disabilities e.g. blind awareness etc. Nursing staff confirmed that they had had training in the Mental Capacity Act 2005. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate management arrangements are in place, to ensure the smooth running of the home. Appropriate quality assurance procedures are in place to ensure that the home is run in the best interest of residents. However insufficiently regular provision of staff supervision sessions may mean that residents are not provided with support in line with best practice. Residents are protected by efficient financial procedures and there is a high standard of practice in health and safety at the home. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager employed shortly after the previous key inspection, had left employment at the home shortly before the current visit. However an interim manager, Benet Ormerod, well known to the home, was providing cover whilst a new manager was being recruited. Staff and service users generally felt confident under the management of Mr Ormerod, however they understandably had some worries about having a prospective new manager again, after such a short time. In the case of the last manager the home involved residents in interviewing her as part of the recruitment procedure. The interim manager advised that this procedure was to be followed once again in the recruitment of the next manager. The home is commended for involving residents in the recruitment procedure in this way. Mr Ormerod advised that the recruitment of a deputy manager, following one of the home’s Sisters being promoted to work at another Barchester home, would be the responsibility of the new manager. Mr Ormerod was able to confirm that he would be able to give a full week’s handover to the new manager once appointed. Records showed that regular staff meetings, and residents/relatives meeting were being held at the home. This was confirmed by staff, residents and relatives spoken to, and the minutes of these meetings indicated that people were encouraged to speak up about issues of concern to them. However records indicated that there the regularity of staff individual supervision sessions (particularly following one of the Sisters leaving the home) had decreased, so that it did not comply with the National Minimum Standard of at least six times annually for all nursing and care staff. Supervision frequency appeared to be variable, with some receiving more regular sessions than others. This was confirmed by staff spoken to. A requirement is therefore made in this area. The home continues to undertake regular quality assurance audits 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) also continue to be undertaken, with reports maintained within the home. The home’s administrator advised that all residents continue to manage their own finances with support, where appropriate, from their family or solicitors. Appropriate records were available of accidents and incidents taking place within the home. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 26 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 gas and 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. The fire risk assessment and emergency plan had been updated within the last six months as appropriate. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13(2) Requirement Timescale for action 22/06/09 2. OP12 16(2mn) 3. OP16 22 The registered person must ensure that there is increased monitoring of gaps in the recording on medication administration records, and that no residents miss out on medication prescribed to them due to pharmacy provider issues, to ensure that people’s medication needs are met safely. 17/07/09 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 to the radio or access books, to evidence that they are receiving holistic support. (Previous timescales of 22/02/08 and 18/07/08 not met). The registered person must 03/07/09 ensure that informal concerns expressed by people living at the home or their relatives/ representatives, are recorded alongside evidence that they are DS0000069400.V375658.R01.S.doc Version 5.2 Hugh Myddelton House Page 29 4. OP27 18(1a) 5. OP36 18(2) addressed swiftly. Recent concerns raised regarding practicalities of feeding an identified resident, giving tablets to people with swallowing difficulties, and confidence in nurses abilities to address concerns raised, must be addressed swiftly, to ensure that the views and interests of people living at the home are taken into account. 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, and particularly at night. The registered person must ensure that all care and nursing staff receive individual supervision sessions at least six times annually, to ensure that they work in line with best practice in the interests of people living at the home. 17/07/09 17/07/09 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 OP8 Good Practice Recommendations It is recommended that clearer records be maintained to evidence that people living at the home are provided with the opportunity to attend regular dentist appointments, including appointments offered but refused, to ensure that people receive appropriate dental healthcare. The home should also consider improving access to physiotherapy due to the long waiting lists for referrals to the community physiotherapy team. DS0000069400.V375658.R01.S.doc Version 5.2 Page 30 Hugh Myddelton House 2. 3. OP19 OP19 4. OP30 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 a spare large sling be provided for the hoist on the first floor YPD unit, for use when the other is being laundered, for the convenience of staff and people living at the home. 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 certain people living at the home. Hugh Myddelton House DS0000069400.V375658.R01.S.doc Version 5.2 Page 31 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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