Inspection on 14/01/06 for Maesknoll

This inspection was carried out on 14th January 2006.

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

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

Other inspections for this house

Maesknoll 01/12/08

Maesknoll 18/12/07

Maesknoll 30/07/07

Maesknoll 03/08/06

Maesknoll 21/07/05

Maesknoll 28/03/05

Maesknoll 05/10/04

Maesknoll 25/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Maesknoll 101 Bamfield Whitchurch Bristol BS14 0SA Lead Inspector Sandra Garrett Unannounced Inspection 14th January 2006 09:30 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 Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 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. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Maesknoll Address 101 Bamfield Whitchurch Bristol BS14 0SA 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) 0117 3772690 0117 3772691 Bristol City Council To be Appointed Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate one named service user aged 58 years of age. Home will revert when named person leaves. 21st July 2005 Date of last inspection Brief Description of the Service: Maesknoll is a care home registered with the Commission for Social Care Inspection to provide accommodation and personal care to forty residents aged 65 years and over. The home is owned by Bristol City Council Social Services & Health (SS&H) and situated in the residential area of Whitchurch. Maesknoll is arranged over two floors with lift access. There is a small patio and large areas of lawn surrounding the outside of the home. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on a Saturday, to follow up issues in respect of requirements made at the last visit. Ten residents were spoken with and a range of documents examined that included care plans, daily and key time records, complaints and health and safety records. What the service does well: What has improved since the last inspection? From requirements made at the last inspection five had been met or partly met. Improvements were noted in respect of the following: From a requirement in respect of healthcare needs it was pleasing to note healthcare needs and appointments with healthcare professionals recorded appropriately. Further confirmation of this was seen by the attendance of visiting healthcare professionals on the day of the visit. A requirement in respect of clear medication administration recording was met. All medication administration sheets were reviewed and no gaps seen. Further administration sheets for medications treated as controlled drugs were in place, signed and witnessed correctly. Clear improvement was noted in respect of residents’ meal preferences, menus and quantities that had been subject to requirement at the last two inspections. Residents spoke highly of the quality of meals provided. A requirement to ensure care staff are offered training in dementia awareness that ensures residents with dementia have their needs met appropriately, was partly met. A number of staff had attended a recent session delivered by a deputy manager from another local authority home locally. Several staff had yet to attend future sessions that were being planned. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 6 A requirement to inform Commission for Social Care Inspection in respect of incidents/issues that adversely affect residents was met. The inspector had received a number notices that reflected prompt actions in dealing with incidents and meeting residents healthcare needs appropriately. The Commission can be confident that the home takes immediate action to protect residents and prevent further occurrences. A good practice recommendation in respect of making the home more secure to protect residents was being implemented by ensuring various security checks are carried out on a regular basis. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the standards above were inspected at this visit. Standard 3 was met at the last visit in July ’05. EVIDENCE: Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Inconsistent care recording may place residents at risk and attention needs to be given to ensuring all care plans are person-centred, holistic and regularly reviewed. Residents are looked after well in respect of their healthcare needs although prompt action in treating new conditions is needed. Effective medication administration ensures residents are kept safe. EVIDENCE: Three residents’ care records were examined. From these it was noted that care plans for residents with physical health needs were holistic, person-centred and with clear actions and outcomes recorded. One resident who had been admitted over two months earlier had no care plan (that should have been completed at the end of the four week trial period). It was pleasing to note that the assistant manager sent the inspector a completed plan following this visit that was comprehensive, detailed and written from a clear person-centred perspective based on the resident’s own comments. This is good practice. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 10 However not all care plans were consistently kept or reviewed. In contrast to the above, care plans of residents with mental health needs were inadequately recorded with lack of clear actions and outcomes for the residents concerned. Further it was not clear how much residents with mental health needs were consulted about their care or their comments considered. Negative language in respect of actions was seen that could be interpreted as the resident not complying with the care provided. It is appreciated that staff may experience difficulties in managing to care for residents with mental health impairments. However care plans and care records for this group of residents should be factual, objective and written in positive, person-centred language, to avoid possible discrimination. (Please see Standard 30 below for a requirement in respect of training in person-centred care planning for management and key workers). In general care plans lacked basic information e.g. what the resident chooses to be called. Personal histories on the profile were brief or not completed at all. Neither residents nor staff had signed some care plans seen. Some care plan review sheets showed that care plans were still not being reviewed monthly. Further, changes indicated on review sheets weren’t entered on to the plan itself. The requirement made at the last visit in respect of these issues is therefore carried forward with a short timescale. It was noted that specific risk assessments in respect of residents with severe mental health impairments had not been put in place despite clear evidence from pre-admission assessments and care plans. Healthcare visits were recorded appropriately in each resident’s records. Separate sheets were kept of GP, District Nurse visits and other healthcare issues, in each resident’s file. Chiropody as an assessed need was recorded on one resident’s plan and the chiropodist was seen visiting this resident on the day of inspection. However it was apparent that some healthcare issues could be missed e.g. one resident’s difficulty with hearing that had come on suddenly had been noted by an assistant manager yet no actions taken i.e. to make a GP appointment for her/him. Assessed needs in respect of pressure area care were seen recorded on the health record sheet. However no reference to this as an assessed need was seen on the care plan. Following a requirement made at the last visit in respect of medication recording, residents’ medication administration sheets were examined. All sheets were appropriately recorded with no gaps. Reasons for not giving medication e.g. if resident didn’t want to take it or was in hospital, were seen appropriately recorded. Controlled medication sheets were in place for residents having night sedation that is treated as controlled with quantity, balances left and two staff signatures appropriately recorded. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 & 15 Residents benefit from being able to see visitors and socialise together regularly. Improvement in meals and meal choices gives residents a positive dietary experience that meets their needs. EVIDENCE: This inspection took place on a Saturday and visitors seen at the home throughout the day. No activity was going on but residents said they like being in the bar in the evenings and having a drink. Following requirements made at the two previous inspections in respect of meals and meal choices, some improvement was noted. The majority of residents spoken to were positive about meals and food provided and the home overall. One resident commented: ‘the food is very good – I don’t think you’d get a better place’. This was echoed by a group of residents sitting together who said that they felt the food was good and they got whatever they wanted to eat. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 12 A menu for the day was seen in the entrance hall and a menu for the week was seen on the notice board close to the dining room. Individual meal preferences were pinned up in the dining room servery. It was noted that meal choices were discussed at the residents meeting held on 14 November ’05 and residents gave suggestions about new menu choices, sandwich fillings and soup flavours. Two cooks on duty were spoken with about residents’ preferences. In the inspector’s opinion cooks were less positive than residents as they said they feel complaints about the food make them feel they are not doing a good enough job. However from residents comments at this visit it was clear that the majority do in fact appreciate the quality, variety and quantity of meals provided. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Satisfactory complaints management and recording ensures residents can feel confident in raising concerns about any aspect of their care. Staff training in recognising and responding to abuse of residents ensures they are protected from harm. EVIDENCE: No new complaints were recorded since the last inspection and the standard was met at that visit. Residents had no complaints but were confident of raising any concerns and knew who to speak to about them. Complaints information was seen around the home and in residents’ rooms. Recent training for all staff in safeguarding vulnerable adults from abuse was seen in training records. All staff had done this training within the last three years. This is good practice. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Whilst the overall environment is homely, clean and hygienic, attention needs to be given to ensuring residents who smoke are not disadvantaged within the home. Attention needs to be given to ensuring residents’ live in an environment that is not institutionalised. EVIDENCE: All areas of the home were clean and hygienic at this visit and smelled fresh and pleasant. It was noted from the residents’ meeting held in November ’05 that new arrangements had been put in place in respect of where residents could smoke. However it was observed that these arrangements were breaking down, as non-smoking residents object to residents who smoke doing so in the bar lounge that is for everyone. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 15 There was a strong smell of cigarette smoke in one corridor and the lounge that could be used for residents who smoke was full of furniture at this visit and was not homely or inviting. One resident said s/he was reluctant to use it, despite the fact that it has a large extractor fan, as it felt unwelcoming. A good practice recommendation is made to ensure residents who smoke are not discriminated against and have a pleasant and homely environment in which to enjoy a cigarette. Further, non-smoking residents should not be made to share the same space as those who wish to do so. Residents’ individual bedrooms were observed and showed evidence of personal choice of décor and personal possessions. However notices pinned up on the walls spoiled the ambience of some pleasantly decorated and homely bedrooms, giving an institutional look and feel. Of particular note was the fact that in one resident’s bedroom some notices (even out of date ones) were pinned up in an area that detracted from the homely nature of the room i.e. close to family photographs and ornaments. A good practice recommendation is therefore made to ensure residents are able to live in an environment that is not institutionalised. A good practice recommendation made at the last visit in respect of drawing up a plan to make the home more secure, was being implemented by means of more regular checks and staff vigilance. It was noted that the home experiences acts of vandalism to the external areas. However it was noted that external lighting is checked regularly and electricians are called to ensure all such lighting works efficiently. Staff carry out security checks daily and are extra vigilant particularly during evening periods. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 Attention should be given to ensuring staff spend time quality time with residents wherever possible. Regular training in dementia awareness benefits residents that are cared for by staff who can respond to their needs. EVIDENCE: The assistant manager said that there are four care staff on duty each day and three each afternoon. Four care staff were seen on duty and interacting with residents. Residents said, however, that they didn’t think there are enough staff, commenting that: ‘we see them in the morning but after 10am don’t see anybody- the staff are there but we don’t see them to hold conversations with’. Residents went on to say they would like more time available with staff to be able to have chats with them i.e. ‘would like five minutes just to talk’. Two other residents later commented that they feel staff are ‘rushed’ A requirement made at the last visit in respect of training in dementia awareness was partly met. It was noted that a deputy manager from another local authority dementia care home is currently giving short training sessions on dementia awareness and had visited the home just before this inspection. However not all staff had been able to take advantage of these sessions. Previously staff had done dementia care training provided by Dementia Voice in 2003. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 17 It was further noted that all care staff had done training in effective recording skills. Please see Standard 7 in respect of person-centred care planning. A requirement is made to ensure management and care staff are given training in person-centred approaches to care planning particularly in respect of developing effective care plans for people with mental health impairments. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,35, 36,37 & 38 Regular stable management of the home is needed to ensure residents get the quality of care they need, from staff that get full opportunity through regular supervision to reflect on their working practices. Attention is needed to ensure that residents’ lives within the home are regularly monitored from a person-centred perspective that reflects both their needs and their enjoyment of living there. Prompt reporting of accidents and events to the Commission for Social Care Inspection ensures that actions are taken to protect service users from harm. Residents are kept safe in respect of health and safety practices and procedures in place at the home. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 19 EVIDENCE: One of the assistant managers was on duty and open to the inspection process. The acting manager who has worked at the home for many years has applied to the Commission to become the registered manager and will be interviewed shortly. A check of residents’ cash sheets was carried out. All cash balances were correct and the assistant manager was seen entering payments for residents’ newspapers on individual sheets. Two staff signatures where possible were seen for each transaction/balance on sheets. From examination of staff supervision records it wasn’t possible to check that these are carried out at least six times yearly, as not all records were available. However the assistant manager on duty who came to the home in August ’05, gave details of her supervision with care staff. For her group of staff evidence of one supervision session since August was seen although a couple of staff had had two sessions. It was noted that the assistant manager carried out supervision with two staff during this visit. Residents’ daily records were examined and these were a mix of qualitative and holistic together with subjective and negative. Good records were seen about individual residents’ enjoyment of Christmas at the home e.g. in one record it was recorded that the resident thanked staff for ‘a wonderful Christmas day’. Another record stated: ‘(resident) has really enjoyed Christmas and all her presents’. However for a resident with clear healthcare needs identified on the care plan, progress was not being recorded regularly. The resident has lots of health problems but records showed gaps of up to a month between records and nothing written over the Christmas period. A requirement in respect of ensuring notices of events adversely affecting residents being sent to the Commission was met. Staff at the home had kept the inspector informed of accidents, ill health and events adversely affecting residents and had updated her where necessary. The Health and Safety file including fire safety procedures was examined. The file contained completed staff questionnaires following a fire safety video. A sheet was seen that contained staff signatures for receipt of fire procedures. It was noted from the team manager’s record of visits to the home sent to the Commission in December ‘05 that Control of Substances Hazardous to Health (COSHH) assessments had been done and staff training in the subject was to take place in January’06. Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 2 X X STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X 3 2 2 3 Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 21 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 OP7 Timescale for action 15(1)(2)(c) Changes to residents assessed 01/03/06 needs must be documented in care plans when such changes happen. Where needs in respect of mental health are identified clear information in respect of this must be recorded on care plans Care plans must be reviewed and recorded every month Progress records especially where residents have healthcare problems or are at high risk must be recorded at a minimum weekly. (Timescale not inspection) 2. OP8 13(1)(b) met from the July ’05 Regulation Requirement Where residents may be at risk 01/03/06 because of their mental health, risk assessments must be put in place. (timescale inspection) not met from July’05 Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 22 3. OP30 18(1)(c)(i) Management and care staff 31/03/06 must be given training in person-centred care planning particularly in respect of developing plans for residents with mental health impairments 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. 2 3. Refer to Standard OP19 OP19 OP24 Good Practice Recommendations Attention should be given to drawing up a plan for making the external areas of the home more secure The lounge used for residents who smoke should be made more accessible and comfortable to them. Attention should be given to keeping residents’ rooms free from notices that suggest an institutional environment Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Maesknoll DS0000035910.V276608.R01.S.doc Version 5.1 Page 24 - 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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