Inspection on 18/12/07 for Maesknoll

This inspection was carried out on 18th December 2007.

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 30/07/07

Maesknoll 03/08/06

Maesknoll 14/01/06

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 Key Unannounced Inspection 09:30 18 & 19th December 2007 th 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.V354235.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. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 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 maesknoll@bristol-city.gov.uk Bristol City Council Lesley Irene Edmonds Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 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. 30th July 2007 Date of last inspection Brief Description of the Service: Maesknoll is registered with the Commission for Social Care Inspection (the Commission) to give accommodation and personal care to forty people aged 65 years and over. The home is owned and run by Bristol City Council Adult Community Care and situated in the residential area of Whitchurch. Maesknoll is laid out over two floors and has a lift. There is a small patio and large areas of lawn surrounding the outside of the home. The fee for living at the home, in common with all other City Council care homes (excluding those for people with dementia) is £460 per week. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk A copy of the latest inspection report dated 31 July 2007 was displayed for people to look at in the entrance hall. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was to follow up a key inspection that was done at the end of July ’07. At that visit a number of requirements and good practice recommendations were made about improving the service for people living at the home. One statutory requirement (that is the first stage of taking legal action against the home) had been followed up at a visit on 30 November ’07. The requirement had been made about lack of supervision for care staff. Before this visit, all information the Commission for Social Care Inspection (the Commission) had received about the home since the last inspection was looked at. The acting manager Mrs Barbara Cairns was welcoming and open to the inspection process. Fourteen people living at the home were spoken with and answered questions for our survey. Ten staff were also spoken with. At the visit a range of records was looked at. These included: care files, complaints, accident and staffing records. What the service does well: What has improved since the last inspection? Eight out of ten requirements made at the last visit had been met and six out of seven good practice recommendations had been adopted. Requirements met centred around: Improving records, Making sure care plans are put in place for each person, Treating people living at the home with dignity and respect, Giving people more one to one time with staff, Making sure staff have essential training that helps them understand peoples needs better and: Making sure numbers of staff are sufficient to meet peoples needs. All the above help to make sure people living at the home have good quality lives based on care that puts them at the centre of things. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 6 In addition the statutory requirement made about supervision was also met. Records were seen of each care staff member’s supervision and a plan of future sessions was in place. Records showed that staff have opportunities to discuss their work that helps make sure people living at the home are kept safe and protected. Good practice recommendations adopted included: Improving the information given to people before or when they come into the home, particularly about cultural and specialist needs and: Helping people to feel more able to speak about their concerns if they have any and keeping their concerns confidential. All the above helps people feel ownership of the home and that it’s run in their best interests. What they could do better: Three requirements hadn’t been met at the time of this visit: Staff training, particularly in person centred care (meaning care that looks at a person’s whole life, history and needs rather than just focussing on basic physical care tasks that appear at the time) had improved. However, training in coping with behaviours that challenge hadn’t been done for a number of staff. All care staff including those that work at night must have the training so that peoples needs can be met positively. Team building sessions for the whole staff team hadn’t yet started although were to begin soon after this visit. The team manager for the home explained why the sessions hadn’t begun. However relationships between the management team and staff need to be rebuilt so that people living at the home get the best possible care from a united team. The requirement is therefore moved on with a short timescale. Care records still weren’t being recorded often enough. This affects people being cared for particularly if their needs change and no records are made about the changes. Ways of making sure staff write care records regularly must be found so that people get consistent care. The requirement is therefore moved on with a short timescale. New requirements made included: A number of people living at the home have difficulties in seeing or have some degree of dementia. However the environment doesn’t meet their needs. Little has been done to make sure peoples specialist needs are met by making the layout and fabric of the home easier to use. A specialist assessment of the environment must therefore be done so that people can find their way around and use the home more easily. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 7 Some care plans looked at didn’t show how peoples needs were to be met. Further, daily records also failed to show that care needs written in the plans were picked up and met in good time. Care plans and records must be improved so that people will benefit from having good quality care. Moving and handling risk assessments that alert staff to peoples ability to move around the home safely, must be looked at and improved. Differences between the assessments seen showed that needs aren’t being properly assessed and people may not be kept safe. A good practice recommendation made at the last visit had only been partly adopted. People had been asked about activities they would like and said that they would like to go out more. However very few trips out of the home had happened since the last visit. Further, activities already provided don’t take into account the needs of people with dementia or those that have sight difficulties. The range of activities needs to be widened to make sure people don’t get bored. Therefore, a new requirement and a good practice recommendation are made. These are to make sure activities meet peoples different needs and wishes and that they get opportunities to go out more often if they wish. Whilst a commitment to improving menu choices and quality of meals continues, some people commented on the temperature of meals. This should be looked at to make sure meals can be kept at the right temperature for peoples safety and enjoyment. 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. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 8 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.V354235.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improved information given to people living at the home helps them be clear about the service offered to them and their rights and responsibilities. Pre admission assessments show that peoples needs are picked up. However the environment fails to meet the specialist needs of people with dementia or problems with seeing clearly. EVIDENCE: Following a requirement made at the July ’07 visit, a copy of the home’s Statement of Purpose that had been changed and updated was sent to us in November ’07. The new Statement now has clearer information about the range of needs to be met, including those of people with mild to moderate levels of dementia. It’s also clearer in showing how those needs may be met. It also has a statement about equality and diversity (meeting needs of people from different groups in society). However this was very general rather than Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 10 making clear the provider’s responsibilities. It further placed the responsibility for this on the people themselves to say what their needs are. A second requirement made at the last visit about the service users guide was also met. A file is kept in each person’s room that has all the information they need and makes up the service users guide. Everyone also has a copy of the Statement of Purpose and the most recent copies of this were put into each person’s file while we were visiting. A third requirement about peoples contracts was also met. An action plan dated October ’07 showed that peoples contracts had all been looked at by the management team and checked for signatures, room numbers and charges payable. Eight were looked at and found to be properly recorded with room numbers, the person responsible for paying fees and signed either by people living at the home or their relatives. A sheet was seen in the service users guide that gave details of the total fee payable for living at the home. Pre-admission assessments were seen for some of the people whose records we looked at. These gave details of the reasons why people had come into the home and their care needs at the time of their admission. Care plans seen matched this information and built on them over time, as peoples needs changed. Thirty-two people were living at the home during this visit. From the home’s Annual Quality Assurance Assessment (AQAA) that we received after the last inspection, twenty-eight people were recorded as having problems with seeing. The acting manager hadn’t filled in the assessment and told us she didn’t think that number of people had such difficulties. However it was clear that there are a number of people with some degree of sight difficulty living in the home, as well as people with medium levels of dementia. We saw that for both groups of people the environment isn’t laid out or furnished in ways that meet their needs. Please see standard 22 for more about this and a requirement that was made. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The way care plans are written doesn’t make sure peoples care needs that have been picked up are properly met. Irregular checking of plans means that not all changing needs will be picked up and met. The way moving and handling risk assessments are done fails to make sure people are kept safe. Some medication records fail to show whether medicines are given as prescribed. Failure to do risk assessments for people that look after their own medicines may not keep them safe. Improvements in the way people living at the home are treated make them feel happier and more content. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 12 EVIDENCE: We had been given information from a relative in October ’07 about the lack of a care plan for one person living at the home. A previous requirement had been made about care plans at the July ’07 visit. The acting manager was contacted and a warning letter sent to the responsible individual (a representative of the local authority that keeps in contact with the Commission and makes sure the home is run to the required standard). This required that each person has a care plan that covers all needs and is kept up to date. An improvement plan had been sent to the Commission in October that said: ‘the team manager will check that any person admitted to the home will be provided with a care plan no longer than 28 days after admission’. The requirement was followed up at this visit and we found that out of a random sample of eight peoples care files looked at, all had care plans drawn up at the home. Some of these were for people that had recently come to the home. The manager also said that as far as she was aware everyone now had a care plan. Care plans were detailed and included things such as: Mobility Dressing/undressing Washing and bathing Diet Continence Chiropody Managing medication and money Family/friends and leisure interests and: Emotional needs/memory. Some people also had other care needs recorded on their plans. All plans seen except one had been signed by the person or their relative and the key worker (a named staff member who works closely with the person). One person’s plan had names recorded but all were in the same handwriting so it wasn’t clear if the person had been involved in discussion about the plan or had agreed with it. Some care plans didn’t have enough information to show how people were being cared for positively or from their own choice. Examples of this were that a person had been stopped from wearing tights and now wore knee high ‘pop socks’. There wasn’t enough information to show that the reason for the change had been properly discussed with her or that she had agreed with it. Another person’s plan said: ’encourage mouth care’. There was no information to show how this was being done. Specialist needs such as hearing and chiropody weren’t recorded fully enough to show that needs were being met. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 13 In one person’s plan chiropody had been highlighted as a need. records showed that the person had been complaining of pains due to long toenails. Not enough information was recorded her/his need to see the chiropodist was met in good time so made more comfortable. However daily in her/his feet to show that that s/he was New monthly review sheets had been put in place and these showed that care plans were being looked at regularly. However the sheets didn’t always show that changes were recorded i.e. one person needed a hearing aid. Neither the plan nor the monthly review sheets recorded if this need had been met although we did see the person wearing a hearing aid. For another person the review sheet had information about an issue that wasn’t part of the care plan. This raises the question as to whether care plans are meaningful for the person they’re written for. Some of the recording for the monthly checks was less about the care plan itself and any changes, but more like general comments such as those seen in daily records. Apart from the monthly check of plans no information was seen to show whether staff sit down and discuss it with the person and/or their relatives. Out of the eight looked at only one had a six-monthly review. This doesn’t make sure peoples needs are properly picked up and met and that they have opportunities to discuss them with staff. We asked people at this visit if anyone had talked to them recently about the help they might need. Comments were mixed: ‘What help I need they give me’, ‘I don’t want for anything here and if I do I only have to ask and they’d sort it for me’, ‘I’m finding it quite good here for a stopgap as I’m waiting to go to sheltered housing. So this isn’t really what I want’, ‘I’ve never asked for anything really but recently I’ve been feeling unwell. Staff know all about it’, ‘I tell them what I need or ask and that works’ and: ‘When I was bad they asked if I needed a wheelchair. I get on all right with the manager. I’ve got a lot to thank her for’. Each person’s care file looked at had a moving and handling risk assessment. This is done to make sure peoples needs for help with moving about the home are properly picked up so that they’re kept safe from risk of harm. From those we looked at, assessments didn’t match peoples abilities. For example, a person that was recorded as being independent in all areas had been assessed as being at medium risk of harm. Others that had some issues or weren’t fully independent had been assessed as being at low risk. Other information written on the sheet didn’t show the reasons why these decisions had been made. Further, it was hard to see how often risk assessments had been looked at to see if they needed changing. Some people that were at risk of harm from Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 14 individual problems such as falling hadn’t been assessed to try and reduce the risk of it happening. Daily records showed that healthcare issues were picked up. All GP, district nurse and chiropodist visits were recorded as were actions taken to protect health e.g. flu jabs, urine tests and medication changes. The Commission’s pharmacy inspector visited on the second day of this inspection. She found that medicines are supplied to the home using a monthly blister pack system. Staff said that they have recently changed the pharmacy they use, so that they could improve the way that medicines are looked after in the home. Staff said that this has been a positive change and helped them to give medicines more safely. They have also asked the pharmacy to provide some extra medication training for the staff that should further improve safety. Several people living at the home are able look after some or all of their own medicines. Lockable drawers are available in the bedrooms so that medicines can be kept safely. One person said they liked to look after all their medicines. Another person said that they liked to look after special medicines to help their breathing because they knew when they needed them and liked to be independent. The medication policy used in the home includes procedures and risk assessments to make sure that people who look after their own medicines can do so safely. However risk assessments hadn’t been done for the people who look after their own medicines. These should be done to make sure that their health is protected. Medicines were seen to be stored safely. A medicines fridge is used and records showed that this is kept at a safe temperature for storage of medicines. We saw people being given their lunchtime medicines. Staff gave them properly, checking if people needed those that are prescribed as ‘when required’ and making sure the record was signed after giving. This means that medicines were given safely and accurate records kept. The pharmacy provides printed medicines administration record sheets for staff to record the medicines they give. Handwritten additions to this had been signed, dated and checked to reduce the risk of mistakes being made. However, some improvements are needed to make sure that the records are always clear and accurate. For example one morning medicine hadn’t been signed as being given for two weeks, although it was missing from the blister pack and staff said that it had been given. In some cases medicines hadn’t been given, but the reason for this wasn’t clear. This was because staff haven’t been using the correct codes provided on the medicines administration record sheet. Action is needed to make sure a reason is always given if regular medicines are not given. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 15 For some medicines prescribed with a variable dose the amount given hadn’t been recorded. Records aren’t kept of the application of some creams and ointments, which are used in peoples own rooms. Records must be kept of all medicines given by staff. Records are kept of the receipt of all medicines into the home. More care is needed in checking the medicines received to make sure that they are always correct. One medicine prescribed twice daily had only been given once a day because the lunchtime dose had not been supplied. One supply of Paracetamol had a dose of one tablet but two tablets had been put into each blister. Any mistakes found when medicines are received must be checked with the pharmacy to make sure that all medicines are given as prescribed by the doctor. Staff said that records are kept of the disposal of medicines but that the disposal book had been sent to the previous pharmacy. This must be returned to the home so that a check can be done to show that medicines have been given as recorded. We also asked people whether they feel staff treat them with proper respect. They gave us lots of positive comments about this: ‘The staff are very good and they always respect me’, ‘Yes they all do’, ‘I just get treated like a normal person. We have a laugh and a joke sometimes and they pretty much do for me what I ask even if I want a cup of tea at 1.30 in the morning’, ‘I have no complaints about the staff at all’, ‘There is a degree of respect’, ‘They go out of their way for me’, The staff treat me well when I see them but again I don’t have that much to do with them’, ‘I get on very well with all the staff’, ‘Absolutely, no complaints there at all’. However one person said: ‘I’m not able to tell. They speak to me if I speak to them first. It all depends who’s on duty’. The atmosphere was light and warm at this visit with lots of preparations for Christmas underway. Staff spoken with said they’re now ‘allowed’ to spend time chatting to people rather than focussing on tasks such as bed making. Staff said they felt they’d been given permission to spend more social time with people. There was music and laughter from lounges and staff spoken with were upbeat and positive about the changes made since the last inspection. Call bells were answered promptly and people were seen and heard being treated respectfully. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 16 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): 12,14 &15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The range and type of activities and lifestyle choices offered don’t fully meet the needs or wishes of everyone living at the home. Improvement in daily living routines helps people have more choice and control over their lives. However, continuing issues with meals stops people from being fully satisfied with the standard of them. EVIDENCE: At this visit we asked people if activities had changed and whether they had joined in with any lately. Comments were mixed about the range and desire to join in and showed a limited range: ‘We had a singalong last week, I don’t think that there is as much as there used to be but I’m happy with what I’ve got’, ‘There is nothing regularly. They had carol singers in yesterday’, ‘I don’t bother with any - you have to consider my age: I’m too old for all that’, ‘I know they do some but I like to do my own thing’, Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 17 ‘There is plenty of entertainment here but I wish there was more for me to do; I’d like to do a bit of ironing or something. I couldn’t stand for long but I’d like to do something helpful because that’s what I’ve always done’, ‘There are activities but a lot of the times it feels like it’s things that I can’t do like card making and things like that. I feel alone and isolated because of my lack of sight’, ‘They have plenty of amusements here. Nothing is any trouble’, ‘Activities aren’t really my cup of tea. I do enjoy the entertainment sometimes and there were children here yesterday carol singing. That was nice’, ‘Last night there was singing and yesterday there were children singing carols so there are activities to enjoy’, ‘I know there is some but I don’t go because of my sight’, ‘I do join in sometimes but I have someone coming in to see me everyday as I have a big family’ and: ‘I don’t go to them but will go to the party tomorrow’. From all the above it’s clear that people that have sight difficulties feel excluded from the activities on offer. Further, the limited range of activities doesn’t always meet individual needs e.g for much older people or people with dementia. Efforts must be made to make sure people with dementia and people that have sight difficulties have equal access to activities that meet their needs and choices. People told us that they would like to go out more even if it was only for a short trip. The acting manager agreed that trips hadn’t happened often enough but she plans to make one of the assistant managers responsible for them in the New Year. This will mean that people will get more regular opportunities to go out to places they choose. A meeting had been held on 25 October ’07 when people were asked about outings. From notes seen of this meeting it was clear that people like to go out regularly either locally with their key worker or further afield e.g. to Cadbury Garden Centre, Weston-Super-Mare or Clevedon or the Zoo. People had said that they wanted ‘somewhere where they can go and walk about and go in the shops’. People had also been clear about the types of activities they would like and had said that they would like exercise sessions, doing crafts, film shows, card games and more upbeat music rather than the ‘same old war songs’. We looked at the activities record book and individual peoples daily records to see if any of the above was being done. Key time records did show that people were able to get out with their key worker and some good examples of enjoyable time out of the home were seen recorded. The activities book showed that one exercise session had happened in August ’07, ball games had been enjoyed in October and a craft workshop (making Christmas cards that were later seen on one of the notice boards) had happened just before this visit. Other activities such as various entertainers Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 18 and the carol singers were also recorded. From all the above it‘s clear that people know what they want therefore every effort should be made to help them get it. The acting manager said that an occupational therapist from the In-reach team (a team of mental health professionals that work with homes to give advice, guidance and training) would be coming to the home in the New Year to do sessions with staff on person centred activities. This must include activities for people with sight difficulties and should also be age-related. In light of all the above a good practice recommendation is also made to make sure that the range of activities is widened to stop people from getting bored and frustrated. Further, to make sure outings and trips happen regularly. At the last visit, we were told that people were being made to get up to suit staff routines. At this visit we asked each person we spoke with about this. Everyone told us that they could choose to get up whatever time they want although they’re offered an early morning cup of tea. Records also showed that people choose to lie in if they want to. We asked what people thought of the food and whether it had improved. Again comments were mixed: ‘The food is always lovely’ ‘The food is all right and I’d say it’s stayed the same’, ‘The food varies from day to day but we get regular meals. What more can I ask?’, ‘I’ve only been here a few months but the peas have improved greatly, they used to be like bullets but not any more. The food is not bad at all’, ‘No complaints about the food at all. I’ve enjoyed everything I’ve had’, ‘I don’t enjoy the food here. The sort of things I enjoy they don’t do here very often’, ‘Yes, it’s been really good’, ‘The food hasn’t changed or improved at all it’s still the same’, ‘It’s edible but not what I would choose at home’, ‘The food doesn’t worry me because I don’t have a big appetite at all so anything suits me. I’d be just as happy with a bit of bread and jam’ ‘There’s no improvement but the food is ok, it’s silly things like no salt in the food and custard not being sweet enough. I’d say the food is average’ and: ‘The food is no different. Teatime’s a lot better. I like the buffet and like the hot choice at teatime. The food is not hot enough at lunch times’. We joined people at the second sitting on the first day of our visit and agreed that the meal of roast chicken followed by semolina wasn’t hot. The notes of the meeting held in October echoed this particularly about the breakfasts. People had said that the tea wasn’t hot enough and there were other issues about the quality of breakfasts offered. Staff spoken with however said that they felt people were enjoying the meals more, particularly since the menus had been changed. The introduction of a Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 19 buffet style tea with a hot choice had been well received and there was less food left over. People had been asked what changes they wanted to the menus but it wasn’t clear from looking at them whether all the changes had been added. The menus are made up of traditionally English food. It wasn’t clear how any cultural choices are made available to people if they want them. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improved management gives people more confidence in raising concerns or complaints. Properly trained staff make sure people are kept safe and protected from risk of abuse. EVIDENCE: Information about complaints was seen in each person’s service users guide file. A new leaflet had just been issued from Adult Community Care and this was seen in the files. One person had contacted us before the visit with a concern regarding a relative living at the home. The acting manager took quick action to resolve the concern and this had been done by the time we visited. A good practice recommendation had been made at the last visit about raising peoples confidence in making complaints and keeping information confidential. The manager said she had met with every person living at the home when she took over so that they could feel more confident in talking to her. Confidentiality had also been discussed in staff supervision and records showed this. The team manager for the home had also changed and she had visited and spoken with people. A copy of her visit and comments were sent to us before this visit. One person had told her that s/he ‘is able and knows where to make a complaint if needed’. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 21 We asked people if they felt they could go to the management team or staff if they had a problem or complaint. They told us: ‘Yes you can put it forward but whether it gets seen to is another matter’, ‘If I want anything I’d go straight to the office’, ‘I don’t see the manager much but I would have no problems in going to her with a problem and I know she would be there for me’, ‘I would talk to my key worker if any thing were worrying me’, ‘If I’m ever worried about anything I know I’ve only got to go to the office’, ‘If I needed to I would have to’, ‘I wouldn’t have a problem doing that’, ‘I would but I have none. I like it here that much and always have done’, ‘Yes I would definitely talk to them’, ‘It’s nice in here. I’ve got no complaints about it’ and: ‘Barbara is always busy, they all are. I go to whoever is available. If I can’t cope I’ll go to the manager. Other assistant managers are good here, much better than the last lot. They’re happier and get things done’. People had also told us previously that because they felt their confidentiality wasn’t respected this stopped them from raising concerns. This time people said: I’ve never heard them talk about anyone’ and: ‘No they don’t. No one ever talks about what goes on’. Only one formal complaint had been made since the last inspection. The team manager for the home had written to the person that made the complaint and a copy was seen in the complaints file about this. However, no other details i.e. about the date it had been made or the outcome was seen. The complaint, about missing property, hadn’t been able to be resolved although the manager said the person making the complaint was satisfied with actions taken. However no information was seen that confirmed this. A requirement made at the last visit about training in safeguarding adults from abuse for two staff members had been met. Information was seen in their files with copies of certificates of attendance. All staff have now done this training and those spoken with confirmed that they would know what abuse was if it happened and report it immediately. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the home is well kept, clean and hygienic, failure to meet the environmental needs of people with dementia or with sight difficulties puts them at a disadvantage compared to other people living there. EVIDENCE: The home was very clean and smelled fresh and pleasant in all areas. The main parts of the home had been decorated for Christmas (including the lift!). Lots of people had decorations in their rooms including Christmas trees and lights. Some bedrooms had been redecorated and one room was about to have new flooring laid. However for people with dementia or sight difficulties the environment can put barriers in their way. Examples of this were seen during the visit. One person with dementia likes to smoke. Staff had tried to stop her/him smoking in the bedroom with little success. Following a clear risk assessment and proper Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 23 facilities in her/his room s/he was now able to smoke there more safely. With agreement s/he had been moved closer to the smoking lounge on the first floor. The deputy manager had told us about helping the person to find the lounge by putting up signs. However when we met the person we found that the signs were almost totally invisible. They weren’t large enough or in colours that the person could easily see, nor were they put in the easiest place where s/he could see them. The smoking lounge is in a corridor on the top floor of the home that looks exactly like a ground floor corridor. The person was seen on the ground floor trying to find her/his way there and getting lost. More needs to be done to help people with dementia find their way around the home. Another person needed help whilst in the toilet as s/he couldn’t find the light switch. When we looked we found the switch was inserted flush to the wall and the same colour as the wall itself, that stopped her/him from being able to find it. Corridors in the home all look similar and whilst they all have handrails there is no way for people with sight difficulties to find their way around. Use of colour coding or textures would be helpful. Bedroom doors are numbered and named but for people with dementia or sight difficulties they may not be able to recognise their own rooms. Reasonable adjustments must be made for people to be able to have equal access to the home. Therefore advice from organisations that work with people with dementia or people with sight difficulties, must be sought to improve the environment. Maesknoll DS0000035910.V354235.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 &30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Proper checks on staff numbers makes sure people’s needs can be met. Progress with NVQ training makes sure people get good care. Further training needs to happen soon to make sure staff can care properly for people with mental health needs. EVIDENCE: Positive comments have been made in this report about improvements in the way the home is run and the care that people get. We also asked them if they felt the atmosphere in the home had improved. Their responses were mixed but showed more positive feelings about staff and the way they’re treated: ‘They come in and do their very best for us’, ‘They are all lovely I have nothing against them at all’, ‘It’s jolly good and always has been’, ‘The atmosphere is all right and I’d say it was about the same as a few months ago’, ‘It’s all right, nothing to grumble about’, ‘The atmosphere is ok but it doesn’t seem to ‘gel’ sometimes and I also think that they have to take on residents that they shouldn’t. On the whole though I think it’s quite nice here’, Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 25 ‘It’s very good’, ‘I don’t really know how to answer that because I live in my 4 walls other than going down for my meals’, ‘I don’t think that they can do anything different and I really do feel that they make the best of it’, ‘It’s very good and always has been. I’ve got no problems here, the staff are lovely and I’ve always been very happy’, ‘The atmosphere is good and has stayed the same. All I can say is that more staff is needed’ and: ‘Every day’s the same. Staff still don’t seem to have the time for a chat. I don’t want anything. I like to be left alone. I don’t like to impose on staff’. A requirement about doing a review of staffing levels made at the last visit was followed up. The review had been done and a copy of its findings was sent to us on 19 October ’07. The review found that a number of people with serious and high levels of need were living at the home during the last visit. The review identified the need for some people to be re-assessed by social workers and moved to more suitable homes. This had helped with staffing levels. However extra staff are now in place for weekends. From notes of a staff meeting held on 10 October a care assistant has now been added to the rota from 7am to help with people getting up and breakfast. Staff spoken with said that because they now felt able to spend time with people rather than do more domestic type work, this also helped. Rotas had been organised to make sure three hours key time is offered every day, either individually or in groups. Only ‘permanent’ agency staff that know the home and the people living there are employed that gives people more confidence. The staff group spoken with said they were all much happier since changes had been made. The change in the management team, re-organising work routines and staff changes had all helped make the atmosphere better. Staff gave examples of how they enjoy being with people and the manager also said she had seen and heard lots of jollity and banter between them. Copies of team meeting minutes were seen that showed issues from the last inspection had been clearly addressed with staff. Staff showed a willingness to join in the process of turning the home around and making it a much happier place for people to live in. Progress with National Vocational Qualification in Care training is being made. Only four care staff don’t have the qualification at any level and all four have started doing it. Staff were positive about doing the training and the manager said that the course is easier than before which helps staff be more confident in doing it. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 26 A requirement about staff training made at the last visit was followed up. The majority of staff had done training in person-centred care. This is training that shows staff how people should be cared for, putting them and their needs, wishes and abilities before basic tasks. Staff said that they already knew the principles of person-centred care but felt it was a good reminder of how people should be cared for. The acting manager and team manager had attended sessions and the team manager had given us positive feedback on them. She said: staff were: ‘all very honest and gave real commitment to moving forward. The training addressed fully the need for treating residents with respect and dignity. It also referred to confidentiality issues which resulted in a healthy debate’. This is commended. However, training in dealing with difficult behaviours hadn’t taken place in the timescale set as part of the requirement. Of thirteen staff files looked at only six people had done the training. The team manager had previously told us that staff would all be attending two sessions on the subject in early November. The requirement is therefore moved on with a short timescale. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 27 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): 32,33,36 & 37 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear and decisive management has helped improve life at the home and makes sure it is run in the best interests of people living there. Better checks on the quality of care given makes sure people have enjoyable and happier lives. Improved staff supervision helps make sure people are cared for properly and with respect. However continuing failure to record peoples experiences of care may mean they are put at risk. EVIDENCE: Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 28 Since the last inspection the management team has changed completely, although on a temporary basis. Reasons for this were to make sure a more experienced team that had no history with the home, tackled all the problems found from that inspection. The acting manager currently heading the team, Mrs Barbara Cairns, has many years experience of running local authority care homes and is trained to National Vocational Qualification in Care Level 4. Since she took over running Maesknoll she has identified lots of areas for change. Together with an experienced acting team manager she has put in place new systems, ways of working and made many changes. These have been done with full consultation and agreement from people living at the home. All changes were sent to us in the action plan that we received in November ’07. Mrs Cairns was welcoming and open to the inspection process. It was clear that her quick actions had gone a long way to meeting the requirements from the last visit and she spoke to us of her wish to improve the service further. She and the new team manager have kept in touch with us regularly since the last visit to update us on progress. The team manager had also sent us records of her visits to the home during the period between this inspection and the last. The records clearly showed her work with the acting manager to check on and improve the quality of care given. She had further kept in touch with us by email and given us regular updates on requirements and recommendations. This is good practice. It was disappointing to note that teambuilding sessions that were a requirement from the last visit hadn’t yet happened. The team manager gave us clear reasons for this. The first of the sessions for twelve staff was due to take place on 28th December ’07 to be followed by a second session on 8th January ’08 for the remaining thirteen staff. However as the sessions hadn’t started by the required timescale and the importance of them is vital in rebuilding a fractured staff team, the requirement is continued with a short timescale. A statutory requirement notice (the first stage of taking legal action against a home for failing to meet requirements) had been issued after the inspection in July’07. The notice had been served because three previous requirements about staff not being supervised often enough hadn’t been met. We visited on 30 November to follow up the requirement and looked at sixteen staff files. From this we saw that all except two staff had had one supervision session each by the due date (28 November’07. When we came back at this visit we saw records of sessions that both had had). However staff records were all over the place and at least two staff members’ files couldn’t be found at all. Again by the time we came back each staff member’s file had been put in order and all necessary records found. The team manager later sent us information about supervisions that showed dates regularly booked in for the first three months of 2008. One staff member spoken with on the 30th said Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 29 that she felt the atmosphere in the home had improved and that staff were getting clear management from the acting manager. Staff spoken with at this visit were feeling better about the changes made and were more animated and lively when talking to us. They confirmed that they were getting supervision more often. From supervision records looked at it was clear that the issues from the last inspection had been discussed, including respect for people living at the home and confidentiality. This is good practice. The final requirement made at the July ’07 visit wasn’t fully met. Whilst the quality and content of daily records was much improved, with clear evidence of key time and enjoyment of activities, there were still a number of gaps. These were most noticeable when for example someone returned from hospital (no record for some time following), or a pressure sore was noticed (no continuing record of what was done about it). For the person above who needed to see the chiropodist the record ended on 12 December so it wasn’t known if s/he finally got the treatment s/he needed. One person had several long gaps between the periods of 6 September and 12 December ’07. The longest of these was twenty days. As staff need to familiarise themselves with events in peoples lives especially if they’ve been away from the home for a while, this recording is vital to make sure people get continuing care and that problems or risks aren’t missed. The requirement is therefore moved on with a short timescale. Failure to meet the requirement could lead to enforcement action being taken. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 30 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 2 3 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 2 3 Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 31 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 OP1 Regulation 12(4)(b) Requirement Timescale for action 01/03/08 2. OP7 15(2)(b) The paragraph on Equalities and diversity in the Statement of Purpose must be amended to clearly show how people from different groups in society e.g. black or minority ethnic, sexual diversity, gender, disability and different religions will be welcomed and their specialist needs met. 1) Care plans must be 01/03/08 written to show that peoples needs are clearly picked up, actions are taken to meet those needs and outcomes are recorded. 3 Maesknoll OP8 13(4)(c) 2) Each person’s care plan must be looked at and discussed with them regularly so that care given continues to meet needs and changes are picked up. All the above will make sure people get the proper level of care they need throughout the year. Moving and handling risk 01/03/08 assessments must be looked DS0000035910.V354235.R01.S.doc Version 5.2 Page 32 4. OP9 13(2) at to make sure the right actions are taken to keep people safe. 1) Accurate records must be kept of all medicines administered by staff. This is to make sure that medicines have been given as prescribed by the doctor. 2) Risk assessments must be done for people that look after their own medicines. This will make sure their health is protected. Activities that are meaningful to people with dementia and suitable for people with sight difficulties must be arranged. This will make sure that they have equal access to enjoyable and stimulating activities as others do. An assessment of the home’s premises must be done to make sure it meets the needs of both people with dementia and people that have sight difficulties. This will make sure that people with dementia and people with sight difficulties have equal access to the environment they live in. All remaining care staff including those that work at night must receive from a recognised training provider, training in caring for older people with behaviours that challenge, from a personcentred perspective. (Timescale not met from January and July ‘07 inspections) 31/01/08 5. OP12 16(2)(n) 31/01/08 6. OP22 23(2)(a),(n) 01/03/08 7. OP30 18(1)(c)(i) 01/03/08 8. OP33 24(2),(4) Regular team building sessions for the whole staff DS0000035910.V354235.R01.S.doc 01/03/08 Maesknoll Version 5.2 Page 33 team facilitated by an independent person must be put in place as soon as possible to improve the quality of care for people living at the home. A report on the progress of sessions must be sent to the Commission within one month of them taking place. This will make sure that the atmosphere at the home improves so that people living there have positive outcomes for their care and quality of life. (Timescale not met from the July’07 inspection) 9. OP37 17(3)(a) Care records must be written regularly (at least once a week) to make sure important events are recorded and to show that people living at the home are getting the care and social stimulation they need. (Timescale not met from the July’07 inspection) 01/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations A plan of outings and short trips based on peoples wishes should be drawn up with dates so that their need for going out is met regularly. Further, a wider range of activities should be considered to Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 34 2. OP15 include daily living tasks that people may wish to do. This will give people a sense of purpose and make sure they lead more interesting and enjoyable lives. Attention should be given to making sure hot meals and drinks are kept hot before they are given to people so that they get more enjoyment from them. Peoples wishes and cultural choices should be incorporated more often. This will make sure meals are inclusive and suit more people more of the time. Maesknoll DS0000035910.V354235.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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