Inspection on 26/01/09 for Madelayne Court

This inspection was carried out on 26th January 2009.

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

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

Other inspections for this house

Madelayne Court 15/01/08

Madelayne Court 20/02/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Madelayne Court School Lane Broomfield Chelmsford Essex CM1 7DR Lead Inspector Deborah Kerr Unannounced Inspection 26th January 2009 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Madelayne Court Address School Lane Broomfield Chelmsford Essex CM1 7DR 01245 443986 01245 443835 manager.madelayne@runwoodhomes.co.uk www.runwoodhomecare.com Runwood Homes Plc 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) Eiluned Evans Care Home 112 Category(ies) of Dementia - over 65 years of age (112), Old age, registration, with number not falling within any other category (112) of places Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 112 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 112 persons) The total number of service users accommodated in the home must not exceed 112 persons The registered person must not admit persons subject to the Mental Health Act 1983 or the Patients in the Community (Amendment) Act 1995 Staffing levels to be reviewed within six months of date of registration Date of last inspection 15th January 2008 Brief Description of the Service: Madelayne Court is owned by Runwood Homes PLC and is registered with us (The Commission) to provide personal care and accommodation for up to 112 older people. The home is also registered to care for service users with dementia. The home is located in Broomfield, a village type locality on the perimeter of Chelmsford, Essex. It is a three-storey building that was purpose built and first opened in 2006. There are 112 single en-suite bedrooms on three floors that are accessible by stairs and three lifts. There are 41 single en-suite rooms on the ground floor, divided into three units, 50 single en-suite rooms on the first floor divided into 3 units and 21 single en-suite rooms within one unit on the second floor. Each unit has a lounge and dining room. There are six bedrooms with adjoining doors to accommodate shared accommodation for three couples if required. The gardens surrounding the property are laid mainly to lawn with established trees and are fenced. Gardens to the rear of the property have paved areas and raised beds that are accessible to wheelchair users. The home is on the main bus route. The home is accessible by car and the nearest railway station is nearby. Parking is available for staff and visitors in the large car park located to the rear of the home. The fees range from £444.57 - £750.00 per week. Additional costs apply for chiropody, toiletries, hairdressing and newspapers. This was the information provided at the time of this key inspection. People considering using this Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 5 service may wish to obtain more up to date information from the home. Madelayne Court DS0000068095.V374033.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 stars. This means the people who use this service experience good quality outcomes. This was a key inspection, which focused on the core standards relating to older people. The inspection was unannounced on a weekday, which lasted fifteen and three quarters of an hour, over two days. This report has been written using accumulated evidence gathered prior to and during the inspection, including information we (The commission) received from an anonymous caller regarding the well being of people living in the home. We also assessed the outcomes for the people living in the home against the Key Lines Of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with five people living in the home, three relatives and six staff. The manager, deputy manager and service development manager were present during the inspection and fully contributed to the inspection process. What the service does well: The home is welcoming, nicely decorated and well maintained to a good standard, providing safe and comfortable accommodation. People shared their experiences of living in the home and what it was like for them. They told us, “staff look after us very well, we have nice food and I have a nice room” and “I have settled here well, the care staff treat me well, some better than others, but on the whole they are good, I like my own company and prefer to stay in my room and watch television”. Relative’s commented, we are very happy with the service, I am able to visit my relative every day, the carers are very nice and the food is very good and “I am kept informed about my relative, the staff are very good, I am happy with the home”. Other relatives commented, “we feel our relative is well looked after, they are eating well and have nice food, we are very pleased with the home they keep us informed, the staff are nice”. Residents and relatives told us “the manager has an open door policy, they are very approachable” and “I feel able to discuss any concerns openly with the manager, who responds promptly to any concerns I may have”. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Improvements could be made to the recording on health monitoring charts, such as turning charts. On the whole these are being completed well, with a few exceptions. Some charts did not have the date at the top of the sheet, making this difficult to track regular monitoring was taking place. Examination of incident and accident records showed that there have been 77 falls recorded, in the home since December 2008. Three residents in particular appeared to have recurrent falls. Although the home have referred to the falls co-ordinator in the past, more needs to be done protect people identified as at risk from further falls and injury. For the size of the home more could be done to ensure all people are provided with regular activities. People spoken with were mixed in their views of sufficient activities being provided. The deputy manager confirmed they are plans to review the activities co-ordinators hours to provide more activities in each unit and encourage care staff to take part in more activity based care providing one to one time with individuals. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 8 The manager must investigate where body maps highlighted that a number residents had small brusies on their wrists and forward the outcomes of their findings to us. This will establish if service users are being harmed or suffering abuse or being placed at risk of harm or absue. A schedule of periodic checking of radiators needs to be implemented to ensure that radiators in corridors (and throughout the home) are working, this will ensure there is sufficient heating in the home to keep residents warm. 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. Madelayne Court DS0000068095.V374033.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 Madelayne Court DS0000068095.V374033.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6, People who use the service experience good quality outcomes in this area. People who may use this service and their representatives are provided with information needed to help them choose if this home will meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A comprehensive statement of purpose and service users guide was provided at the inspection. These clearly tell people living in the home and prospective clients about the services provided, the fees and facilities. Copies of these were also displayed in the entrance of the home for visitors’ information. Age Concern and Advocacy leaflets, NAPPA (National Association of Activities for Older People) development booklets, information about Alzheimer’s and guidance for understanding vascular dementia were also on display. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 11 The home has three floors, divided into three units on the ground and first floors and a further unit on the second floor. In total the home has seven units, one person from each unit was tracked as part of the inspection process to ascertain how well the home is meeting their needs. Information seen in the seven peoples care plans confirmed that people have been issued with a contract between them and the home, which included their fee, the roles and responsibilities of the provider and the rights and obligations of the individual. The home has detailed information and admission policies and procedures in place to support people that may consider using this service and which ensures they can meet the individuals needs. Pre-admission assessments were carried out by the manager or deputy manager, which covered all aspects of the individual’s health, personal and social care needs. For people with a dementia moving in to the home a basic dementia assessment and a dementia dependency assessment tool had also been completed to enable a more robust assessment and ensure that the home is able to meet the individual’s needs. To ensure the home can meet the specialist needs of the people living in the home, all staff are provided with training, which ensures they have an understanding of person centred care and dementia. A copy of the training programme was provided at the inspection. This has been produced in association with the Alzheimer’s Society and promotes good practice. The course is accredited by the Alzheimer’s Society, staff have to complete a multiple-choice test and a case study questionnaire. The organisation also has their own dementia care specialist who provides support and training to promote person centred care within the service. People spoken with told us they had been provided with information about the home and been given the opportunity to look around before making a decision if the home was suitable for them and would meet their needs. The home does not provide intermediate care. Madelayne Court DS0000068095.V374033.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11, People who use the service experience good quality outcomes in this area. People who use this service receive health and personal care, which is based on their individual needs and are protected by the homes policies and procedures for dealing with medicines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each of the seven care plans examined contained a pre admission assessment, assessment for elderly care with a behaviour scale to assess need and a dementia dependency assessment tool. These assessments provided the basis of the individuals care plan setting out the action required by care staff to ensure that all aspects of the individuals health, personal and social care needs are met. To ensure people receive appropriate health care, including specialist health care, where required, relevant care plans and risk assessments had been completed in regards to risk of falls, moving and handling, dependency, continence, nutrition and pressure area care. These are being reviewed on a regular basis. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 13 Where required monitoring charts are being completed, to monitor people’s health and well being, such as turning charts. On the whole these were being completed well, with a few exceptions on the 8th to the 11th January, where an individuals night turning chart had not been completed. Additionally, some of the health monitoring charts did not have the date at the top of the sheet, making this difficult to track regular monitoring was taking place. Examination of incident and accident records showed that from the 6th December 2008 to 26th January 2009 there had been 77 falls recorded, 25 of these had occurred on the ground floor, 35 on the first floor and 17 on the second floor. Although this is a large home, these figures reflect a high number of falls occurring. Three residents in particular appeared to have recurrent falls. The homes documentation relating to ‘legal aspects of meeting the standards’ states ‘if a resident is prone to falls, a preventative care support plan and risk assessment must be implemented and where possible the home should contact the a falls co-ordinator. Although, the home have referred to the falls coordinator in the past more needs to be done to minimise the risks to residents of further falls. Daily records are well written and provide a good overview of how each individual has spent their day, they also document the care provided and give an indication of the individuals health and well being. Staff spoken with were able to give a verbal account of the needs and preferences of individual residents, they were also clear about their responsibilities to ensure people are treated with dignity and respect at all times. The interactions between residents, relatives and staff were observed to be friendly and appropriate. People in the home are able to access health care services. Peoples nutritional needs are closely monitored with regular weights undertaken and supplements provided as needed. The home has a positive relationship with the local General Practitioner’s (GP) and district nurses who make regular visits to the home. Dates and details and outcomes of appointments had been clearly recorded in peoples care plans. To ensure residents receive medication as prescribed, requirements were made at the random inspection in July 2008 for improvements to be made to medication storage, to ensure medication with a limited shelf life has a date of opening recorded on the container and /or carton and for changes in medication to be confirmed by the date and signature of the person making the change. Purpose built medication rooms with hand washing facilities have been created on each floor, providing sufficient space for medication trolleys, adeqaute space for checking in supplies and space to safely store medication, including metal controlled drugs cabinets, which have been fixed seculey to a solid wall. The room and the medication fridge temperatures are being checked and recorded daily and showed that temperatures were within recommended Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 14 levels. Medications, such as eye drops that need to be stored in the fridge, are being stored and used correctly in line with the manufactures instructions. The home has an efficient and comprehensive medication policy in place with detailed procedures for staff to follow when ordering, storing and administering medication. The practice of administering medication is generally well managed. Photographs of residents had been attached to the front of their Medication Administration Records (MAR) charts to avoid mistakes with the person’s identity. The MAR charts inspected were found to be completed correctly, with no gaps. Where changes in medication had been on the MAR charts, these were clearly marked when the changes were made and who had made them, including the signature of the GP and staff. This was clearly demonstrated when checking the MAR for an individual who has regular tests and changes with regards their warfrin. Staff had made good use of the codes and reverse of the MAR chart to reflect if medication had not been administered and the reason why. The home has developed a record of communication, with the GP which is held in the MAR folder and provides a record of what and when medication has been prescribed and stopped. The manager is in the process of discussing with the GP and district nurses to implement and use relevant documentation, such as the Liverpool Pathway to provide palliative care, which will ensure people living in the home are supported at the end stages of their life, to remain in the home, if this is what they choose. The home has also developed a bereavement pack, which provides useful information, contacts and processes following the death of a relative, such as dealing with probate. There is also information to support people to deal with the loss of their relative, including the grieving process and selected poems. Madelayne Court DS0000068095.V374033.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, People who use the service experience good quality outcomes in this area. People using this service are provided with activities that meet their expectations and which meets their social and recreational interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans viewed contained a social history and family tree, providing a good profile of the person. These provided information of the individuals past, focusing on significant and important events in their life, what matters to them and why. This information provides vital links to the persons past, which has formed their identity, and forms the basis of communication and provides staff with an understanding of the individual’s current behaviours. Evidence of an activities programme was seen and individual records were maintained of residents’ involvement. The activities schedule showed that in house activities consist of arts and crafts, karaoke, music sessions and exercises to music. Reminiscence sessions also take place including ‘sweet memories’. Sweetshop owners visit the home with a range of old fashioned sweets, which promotes memories and discussion. An album of photographs confirmed a range of activities that had taken place, including trips out to the Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 16 seaside, coffee mornings, Christmas fete, quiz nights which is open to families and strawberry teas in the garden, museums and pubs for lunch. Entertainment is also brought into the home, this was confirmed in the afternoon of the second day of the inspection, a duo, ‘dessert dreams’ provided musical entertainment. People were observed joining in the singing, clapping and generally enjoying the occasion. One member of staff was observed in a smaller lounge engaged in conversation and dancing with an individual who had chosen not to joint the entertainment, but could hear the music. Other entertainment brought into the home has consisted of, instrumental bands, students from a local school to perform a carol service and singers from a local university. Time was spent talking with two activities co-ordinators employed at the home. They confirmed they had received training to undertake their role and how to get the best out people using the service, including those with a dementia. Training has included, using the snoozelen on site, providing stimulation and relaxation either on one to one basis or as a group. Staff confirmed they had attended dementia training ‘Yesterday, Today and Tomorrow’ and SONAS. SONAS is an activity based programme designed to enhance the lives of older people in residential care. Sessions include gentle exercise, stimulation of the senses, interactive singing, relaxing music, a shoulder back rub is offered to those who agree, followed by lively music using percussion instruments and dance, (if able) followed by poems and proverbs to stimulate the memory. People spoken with were mixed in their views of sufficient activities being provided, one person commented, “ I visit the home regularly and see activities occurring at least two times a week, which provides my relative with physical and mental entertainment and exercise” and “we do not often see activities taking place” and “it would be nice for people to use the garden more in the summer months”. Discussion with the activities co-ordinators confirmed there is a broad range of activities taking place, however for the size of the home more could be done to ensure all people are provided with regular activities. Discussion with the deputy manager confirmed they are plans to review the activities co-ordinators hours to provide more activities in each unit and encourage care staff to take part in more activity based care, providing one to one time with individuals. The home operates a four weekly menu, which includes a roast dinner twice a week and the opportunity to have a cooked breakfast on alternate days. Meal’s served looked and smelt appetising. People living in the home told us they liked the food provided in the home, however one person said they “did not liked the look of or the taste of the sweet and sour dish but had enjoyed the vegetables and the pudding” another person told us, “the food could do with being cooked a little longer”. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 17 Pureed food was served attractively to residents with separate meat and vegetable portions. Hot drinks were seen being served during the day, and water jugs were seen in residents’ rooms. Food stocks were plentiful with an appropriate range of fresh, frozen and dried food available. Special diets are catered for and monitored, evidence of this was seen for an individual who requires a gluten free diet. Special gluten free foods are delivered to the home via the pharmacist, which are incorporated into the person’s diet, in conjunction with guidance provided by the nutritional and dietetic service. Madelayne Court DS0000068095.V374033.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, People who use the service experience good quality outcomes in this area. People who use this service and their relatives have access to a robust and effective complaints procedure and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Runwood Homes have robust policies and procedures in place to deal with complaints, whistle blowing and to safeguard the people living in the home. A notice is also on display in the main reception inviting people to discuss any concerns with the management team they may have about the service. People using the service and their relatives confirmed they were aware of the complaints procedures and were clear they would talk to the manager if they had any concerns and were confident that there concerns would be dealt with. Residents and relatives told us “the manager has an open door policy, they are very approachable” and “I feel able to discuss any concerns openly with the manager, who responds promptly to any concerns I may have”. The homes’ record of complaints identified that there have been six complaints made about the service, since the last key inspection. Records showed that the management and staff take complaints seriously. These had been fully investigated in line with the homes procedures and feedback provided to the complainant of the outcome of the investigation and action taken as a result. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 19 The random inspection in July 2008 identfied that care plans and risk assessments needed to be further developed to provide guidance for staff to deal effectively with behaviours that can be challenging to others, such as pyhsical and verbal agression and to ensure staff recivied training for dealing with inappropriate behaviours. The training matrix confirmed staff have recivied dementia training, which included managing behaviours, however the seven care plans seen did not reflect these people had behaviours that were particularly challenging. Therefore, other than plans developed to support staff to manage the individuals dementia, no other plans or risk assessments for dealing with challenging behaviour were seen. This needs to be followed up at the next inspection. There has been a further allegation of alledged abuse made about the service since the random inspection. We (The Commsion) recivied an a telephone call on the 20th Janauary 2009 from a Police Constable Special Officer (PCSO), who had taken details of a safeguarding concern raised anonymously with them, regarding concerns about the welfare of an individual living in the home. The concerns were that this person ‘had bruising and swelling all the way up their arm, and was losing weight and appeared depressed’. The management team confirmed there had been an anonymous allegation reported to the police, that two unidentified persons had entered the home and the room of an unidentified female resident, who was repoorted to have sustained bruisng to their hands, arms and hips. The police had made an unannounced visit to the home on the 19th January 2009 and were not able to investigate this concen further for lack of evidence. The manager had taken action to investigate these concerns, instegating discretete body mapping of all female residents to identify any unexplained marks or bruising. They had also consulted with the GP who confirmed that some of the bruisng identified could be related to people taking medication, such as asprin which makes them more susceptiable to bruisuing. The manager had changed the key code on both main entrances to the building to increase security. They had also reported the incident to social services and to us (the Commsion), in line with regulations. During this inspection we examined the nuritional records, body maps and incident and accident reports for all of the residents in the home. The records did not provide evidence to reflect any person in the home had severe bruising and swelling, or significant weight loss. We also telephoned and spoke to the police officer involved in the case who confirmed they could not find evidence to support this allegation. However, the body maps did highlight that a number residents had small brusies on their wrists. The manager was asked to investigate this and to forward the outcomes of their findings to us. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 20 The training matrix shows that all staff have received recent Safeguarding Of Vulnerable Adults (SOVA) training and that the service has robust recruitment procedures in place. Staff files seen confirmed all staff are subject to Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks, prior to commencing employment. Staff spoken with were clear about their role in the reporting of incidents of poor practice and suspected situations of abuse. They were also familiar with the whistle blowing policy and procedures and their duty of care to raise any concerns they may have about other members of staff conduct. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25, 26, People who use the service experience good quality outcomes in this area. Madelayne Court continues to provide people who live there with a safe, well maintained and homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Madelayne Court is a large purpose built three-storey building providing one hundred and twelve single en-suite bedrooms. The three floors are accessible by stairs and three lifts. Forty-one rooms are on the ground floor, divided into three units, Chestnuts, Cyprus and Elms. Fifty rooms on the first floor are divided into three units, Limes, Maple and Hollies. Twenty-one rooms on the second floor make up the last unit, Pine. The units on the first and second floor provide accommodation for people who have a dementia, with the ground floor providing care and accommodation to elderly people who may also have a mild to moderate form of dementia. The home has six bedrooms with adjoining doors to accommodate shared accommodation for three couples, if required. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 22 The gardens surrounding the property are laid mainly to lawn with established trees and are fenced. Gardens to the rear of the property have paved areas and raised beds that are accessible to wheelchair users. The home is welcoming, nicely decorated and well maintained to a good standard, providing safe and comfortable accommodation. Communal rooms are spacious and well furnished with a mixture of functional and domestic style furniture, lighting, carpets and curtains. Bedrooms are suitable for the needs of their occupants, with appropriate furniture and fittings. These were nicely decorated with peoples’ personal effects to reflect their individual personalities, hobbies and interests. The home had placed pictures and photographs of film and pop stars from the ‘Golden Age of Hollywood’ to help people find their way around the home. Residents had been encouraged to choose a picture, for their bedroom door, which would most reflect their personality and make their room distinguishable to them. Signage had also been placed on bathrooms and toilet doors to make these distinguishable. There are ten communal bathrooms and three shower rooms with toilets providing both assisted and unassisted bathing, which are fully accessible to people who use a wheelchair. The home is generally equipped with aids and equipment to maximise people’s independence, including grab rails and other aids, which are available in corridors, bathrooms, and toilets and where required, in residents own rooms. Pressure relieving mattresses and cushions are available and the district nursing service also provided specialist equipment as needed. All equipment was serviced as per manufacturers recommendations and confirmed from the records inspected. Call systems were provided throughout all individual and communal rooms. To ensure the safety of people living in the home, all radiators are guarded with purpose built radiator covers, or have low temperature surfaces, which minimises the risk of people falling against them and sustaining burns. During a tour of the home on the second day of the inspection, it was noted that alternate radiators in the corridors, throughout the home were not working. Radiators in peoples rooms and communal rooms were found to be working, however the weather had turned very cold and the manager was asked to look into this immediately, to ensure there is sufficient heating in the home to keep residents warm. Maintenance records confirmed hot water temperatures are being maintained with the safe recorded temperatures of 41 degrees centigrade for showers and 44 degrees for baths, which minimises the risk of people living in the home being scolded when taking a bath or shower. Two requirements were made following the last key inspection to minimise the risk of infection. These related to the removal of malodorous smells from two rooms identified and for a clinical waste bin to be provided in the laundry. A tour of the premises confirmed a waste bin had been provided in the laundry, Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 23 however the two rooms identified were still odorous. The home was found to be clean and hygienic throughout apart from two residents’ rooms that had a strong odour, which the deputy manager confirmed, was as a result of residents’ behaviour specific to their dementia. Both individuals have recently been reassessed as requiring nursing needs and have therefore been found alternative placements. Once these individuals have moved the rooms are to be totally cleansed and redecorated including new flooring. The laundry facilities are clean and tidy with appropriate equipment to launder soiled linen, clothing and bedding. Sluice facilities were located on each floor of the home. Systems were in place to minimise risk of infection via the use of red bags for any laundry soiled by body fluids, placed directly in the washing machines, which had the capacity to carry out sluice wash cycles. Appropriate protective equipment, such as aprons and gloves and hand washing facilities of liquid soap and paper towels are provided in all en-suite and toilet facilities, where staff may be required to provide assistance with personal care. During a tour of the home two staff were observed using a stand hoist to transfer a resident from an armchair into their wheelchair. The resident appeared unable to weight bear and the staff appeared to be struggling to assist the individual, who was becoming visibly distressed. The staff and deputy advised the individual was normally able to participate in the process. The deputy was advised they needed to reassess the individuals moving and handling needs to ensure they are provided with the appropriate equipment to safely transfer, whilst protecting their dignity. This assessment had been completed by the second day of the inspection and the individual has been assessed as requiring a full body sling for all transfers, as they had lost confidence in there ability to weight bear, which has gradually deteriorated. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30, People who use the service experience good quality outcomes in this area. People using this service are supported by a staff team that are trained, skilled and in sufficient numbers to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection the home have developed new posts of unit managers. Examination of the duty roster confirmed the there is a unit manager and a care team manager on each floor, supported by six care assistants, on the ground floor, between 7am – 2 pm and five carers between 2-9 pm, with an additional staff member between 7 am – 11 am and 7-9 pm as a floater for forty residents. On the first floor, there are six care assistants between the hours of 7 am – 9 pm, with an additional staff member between 7 am – 11 am and 6-10 pm as a floater for 50 residents. On the second floor there are two care assistants between the hours of 7 am – 9 pm for twentyone residents. Two care team managers and seven care staff cover nights. There was evidence from the staff rota, discussion with residents, relatives and staff that staffing levels are well maintained and from observation these appeared to meet residents needs. Discussion with staff confirmed they had been recruited fairly and that they received good training and support to ensure they have the skills and knowledge to do their jobs and to meet the different needs of the people living in the home. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 25 Most recent training has included safeguarding adults, first aid, moving and handling, health and safety, Control of Substances Hazardous to Health (COSHH), food hygiene, fire safety, care planning, customer care and medication. More specific training to meet the needs of the people using the service has included dementia, Parkinson’s disease, hydration, epilepsy, pressure area care and management. The home recruits a high number of staff from overseas, to ensure they are able to fully communicate with the people living in the home, Runwood require staff to complete an English oral and written test as part of the interview process. The deputy manager has recently completed ‘train the trainer’ training and has been verified to be able to cascade training to staff. Examination of six staff files confirmed, all relevant documents and recruitment checks, required by regulations, to determine the fitness of the worker had been obtained prior to them commencing employment. The home also has a support sheet used for interview and recruitment, with a list of topics used to promote discussion with the interviewee, to evaluate their understanding of safeguarding adults, what makes a good team, the Care Standards Act 2000 and dementia. Runwood Homes have developed their own induction training programme, which meets the requirements of the Skills for Care Standards, Common Induction Standards (CIS). Information seen in staff files confirmed employees had completed their induction training within the first six weeks of their employment. Staff spoken with confirmed they had received a very good induction when they first stared working in the home, which included an orientation tour of the home, discussion of policies and procedures and training to do their job. Staff are encouraged to complete a National Vocational Qualification (NVQ). In addition to the manager, deputy manager and three unit managers the home employs a total of eighty support staff. These consist of nine seniors, thirty six care assistants, thirteen night care assistants, three administrators, a cook and two kitchen assistants, two activities co-ordinators, thirteen domestics and one maintenance person. The manager has completed a level 4 NVQ and Registered Managers Award. The deputy has the equivalent of level 3 NVQ and is also a registered nurse. The three unit managers have obtained a level 3 or 4. Eight of the nine seniors have completed level 3 and twenty nine day and night care staff have completed NVQ level 2 or above. The activities coordinators, the cook and both kitchen assistants have both completed level 2. Seven of the housekeepers have completed a level 2. These figures reflect 50 of staff hold a recognised qualification, which meets the National Minimum Standard (NMS). Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 38, People who use the service experience good quality outcomes in this area. The management and administration of the home is based on openness and respect and is run in the best interests of the people living there by a competent and qualified manager. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a registered nurse and has twenty-five years experience of working in both the private and nursing sector. They have completed the Registered Manager’s Award (RMA) and holds a level 4 National Vocational Qualification (NVQ). They continue to undertake training to update their knowledge, skills and competence. They have recently attended training to familiarise them selves with new legislation, Depravation of Liberty (DOLS). They have also completed a ‘For Dementia’ course and a ‘Leadership Matters’ course in person-centred dementia care. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 27 Discussion with staff, residents and relatives provided positive feedback about the manager. People told us, the manager responds well to concerns, they have regular relatives meetings and have an open door policy, I feel kept informed and “we are happy working at the home, we are treated well, both managers are very approachable, it is happy place to work, we love the residents and have a good staff team, we have regular supervision and staff meetings, it is a good place to work”. The organisation and the manager ensure Madelayne Court is run in the best interests of the people living there, by ensuring systems and practice are regularly reviewed and monitored. A corporate quality assurance programme is in place, whereby an annual audit is undertaken of all Runwood Homes. The most recent quality audit of the home, available at the inspection, had been completed for December 2007; the results for the audit of 2008 had not been completed. Feedback provided in the 2007 audit confirmed people are satisfied with the service they receive. Comments included, “I am very happy here” and “every lunch is nice” and “I am very happy here, the staff are so kind and helpful”. Regular meetings are held to ensure people are kept informed about changes within the service and to seek the views of residents, relatives and staff. Examples of recent relatives, staff, housekeeping and unit managers meetings, were seen at the inspection. The service development manager undertakes regular monitoring visits to the home as required under regulation 26 of the National Minimum Standards (NMS). The home monitors all complaints and compliments and the manager continues to let us know about things that have happened since our last key inspection and they have shown that they have managed safeguarding incidents in the home well. Runwood Homes produced a business plan for 2008, this looked at the strengths, weaknesses, opportunities and threats to the service and linked into a development plan, which demonstrated the achievements of the service and identifies where further improvements are required. Runwood Homes have also produced a ‘People First’ newsletter, informing people who use the service, their relatives and other visitors of the strengths of the service and areas requiring further devolvement. This was displayed in the entrance of the home for visitors’ information. The home has policies and procedures in place, which safeguard peoples financial interests and ensure that secure facilities are provided for the storage of any money looked after on their behalf. Residents’ records were not inspected on this occasion but were found to meet the required standard at the previous key inspection. Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 28 Staff files confirmed that regular supervision takes place. The documentation reflects that these sessions include discussion of general work objectives, medication competency assessments, performance and development and identify training needs. Staff also confirmed they have regular staff meetings and handover sessions between shifts and were kept up to date with the care needs of the people living in the home. The home takes steps to safeguard the health, safety and welfare of people living and working in the home. Risk assessments are carried out for all safe working practices with significant findings recorded and the action taken to minimise risks occurring. The most recent Gas and Electrical Safety certificates, including Portable Appliance Testing (PAT) were seen and records showed that all equipment is regularly checked and serviced. The fire logbook showed that the fire alarm, emergency lighting and fire fighting equipment is regularly serviced. Emergency lighting and the fire alarm system are tested weekly and regular fire training and drills take place. To ensure staff and the public are protected from health and safety risks, two requirements were made following the last key inspection, for items assessed under the Control Of Substances Hazardous to Health (COSHH), such as washing up liquid and air freshener spray must be kept locked away when not in use and for external clinical waste bins to be locked at all times. Used disposable gloves had been left on the ground. A tour of the home confirmed there were no cleaning products left about the home unattended and the clinical waste bins, which are stored externally, were locked and none of the contents were seen lying on the ground. Madelayne Court DS0000068095.V374033.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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 X 3 Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12 (1) (a) (b) Requirement A falls co -ordinator or similar professional must be contacted to obtain advice and / or training for the further prevention of falls. This particularly relates to individuals that are identified as having repeated falls. This will protect people identified as at risk from further falls and injury. The manager must investigate where body maps highlighted that a number residents had small brusies on their wrists and forward the outcomes of their findings to us. This will establish if service users are being harmed or suffering abuse or being placed at risk of harm or absue. Timescale for action 17/03/09 2. OP18 13 (6) 01/03/09 Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 31 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 Improvements could be made to the recording on health charts, such as turning charts, to ensure peoples health and wellbeing is being monitored. These also need to be dated daily to provide an audit, that regular monitoring is taking place. A schedule of periodic checking of radiators needs to be implemented to ensure that radiators in corridors (and throughout the home) are working, this will ensure there is sufficient heating in the home to keep residents warm. 2. OP25 Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Madelayne Court DS0000068095.V374033.R01.S.doc Version 5.2 Page 33 - 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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