CARE HOMES FOR OLDER PEOPLE
Magdalen House 98 London Road Gloucester Glos GL1 3PG Lead Inspector
Mrs Kate Silvey Unannounced Inspection 15th March 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 Magdalen House DS0000016497.V287082.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. Magdalen House DS0000016497.V287082.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Magdalen House Address 98 London Road Gloucester Glos GL1 3PG 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) 01452 386331 01452 384368 The Gloucester Charities Trust Mrs Hazel Newman Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Magdalen House DS0000016497.V287082.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th August 2005 Brief Description of the Service: Magdalen House is a purpose built care home, which provides nursing for twenty-nine service users. The home is within walking distance of the city of Gloucester and is on a main bus route. A qualified nurse is on duty at all times. Health care services are available to all service users. Service users can register with their own doctor in the area. The accommodation is on two floors accessed by a large passenger lift. There are twenty-seven single rooms and one double room all with an ensuite washbasin and toilet. There are four well equipped bathrooms to suit all needs and level of ability. All rooms have a call bell. The communal areas include comfortable lounges on each floor, a dining room attached to the lounge on the ground floor, a garden room and seating in the reception area. There is level access to the spacious gardens that surround the home. There is an unused daycentre adjoining the home. This area is sometimes used for functions and training by other organisations. Residents from the warden-controlled flats, within the complex, also have access to the homes catering facilities if they wish. A dining area is available on the first floor for this purpose. Magdalen House DS0000016497.V287082.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over one day with two inspectors for part of the day. Care records, medication records, recruitment records, staff training information and some health and safety records were seen. Service users and care staff were spoken to and several friends and relatives were seen and spoken to. The environment was inspected including the garden areas. The management and provision of food was looked at. The registered manager and deputy manager were both on duty and able to assist with the inspection. What the service does well:
The staff complete a detailed pre-admission assessment to ensure that service users needs can be met before they enter the home. Good care plans are recorded ensuring that service users needs are identified and care staff have a plan to work to, which is regularly reviewed. The service users spoken to said the staff were kind and they felt well cared for. Medication was generally administered safely and was well recorded. At the time of the inspection a number of friends and relatives were visiting. The inspector spoke to four visitors, three of whom were relatives and one was a friend. They were all very complimentary about the staff, stating that they responded to needs and requests in a prompt and caring manner, and that they were seen as good listeners. The food provided is excellent giving the service users the wholesome food they want in a pleasant and dignified manner. The home takes complaints seriously and investigates them well. The environment was clean and well maintained and the gardens were well cultivated providing a pleasant home. The home has a well trained care team who are supported to continue learning to ensure they are competent to care for the service users. The home has good procedures for looking after service users monies and they are safeguarded from financial abuse. Magdalen House DS0000016497.V287082.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Magdalen House DS0000016497.V287082.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 Magdalen House DS0000016497.V287082.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): 3 The outcome for service users is good as the staff complete a detailed preadmission assessment ensuring the service users needs can be met before entering the home. EVIDENCE: A pre-admission assessment for a service user was seen and it contained very detailed information. Magdalen House DS0000016497.V287082.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): 7,9 The care plans were good, and they were detailed and well set out to ensure the service users needs are met and they were reviewed regularly. The medication administration was generally good, a minor shortfall in storage and dating opened medication was easily rectified. The homes medication policies and procedures protect the service users. EVIDENCE: Samples of the care plans were seen and all were well recorded and had good regular reviews. Detailed daily records had been completed and there was evidence of healthcare professionals supporting service users. Nutritional risk assessments had been completed for service users identified with a problem and fluid charts were seen maintained when required. Two care plans case tracked with the service users were consistent with their needs and the service users were complimentary about the care staff. Magdalen House DS0000016497.V287082.R01.S.doc Version 5.1 Page 10 The inspector watched the medication administration upstairs and checked the trolley and the cupboard. A sample of the monitored dosage system revealed the correct dosage. Administered medication was stored safely and appropriately, however, one self-medicating service user was not safely storing a prescription only cream in use in her bedroom. There was a confusing notice in the medication cupboard, which stated that when medication is opened the finish date should be added. Staff questioned stated that they would put the start date when opening. Staff could confuse a finish date with a start date, the manager agreed to look into this on the day. Administration records were very good and the new plastic coated pictures of all the service users were clear and helpful to the staff. The GP reviews all service users medication every six months and the psycho-geriatrician had recently reviewed a service users medication. The supplying pharmacist checks the stocks and administration every three months. Medication policies and procedures were seen. The home had a correct procedure for disposal of medication. Magdalen House DS0000016497.V287082.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 The ethos of the home is good ensuring service users have choice and control over their lives and that their visitors are made welcome. However, there is a shortfall in the range of activities provided. The food provided is excellent giving the service users the wholesome food they want in a pleasant and dignified manner. EVIDENCE: At the time of the inspection a number of friends and relatives were visiting. The inspector spoke to four visitors, three of whom were relatives and one was a friend. They were all very complimentary about the staff, stating that they responded to needs and requests in a prompt and caring manner, and that they were seen as good listeners. The visitors said that they could call at the home at any time and felt welcomed. They were also aware of what to do if they had a concern, and were comfortable about approaching the manager of the home. Magdalen House DS0000016497.V287082.R01.S.doc Version 5.1 Page 12 The service users who are able have considerable choice. This includes when they get up and go to bed, what they eat, where they eat; also the ability to use areas of the home as they wish and, subject to risk assessment, the ability to go out of the home. There is also a service users committee and this provides an avenue for them to raise issues of concern. On a positive note the meetings are used to look at how the services are seen and what improvements can be made. A number of service users said that they were unsure about what activities were provided and also felt that the range of activities was narrow, and did not meet their specific needs. On the other hand some of the service users were taking part in the activities provided and enjoyed them. At the time of the inspection the dining room was being used for a music afternoon and service users were clearly enjoying the activity. There has been a change in the organisation of activities and it is essential that service users are consulted over the provision of activities in the home. To determine Standard 15 the inspector spoke to staff, service users and the chef who is responsible for the services. The dining room was clean and organised and the tables had been laid with care. Service users are able to exercise choice for all meals and it was evident that great efforts are made to provide meals the service users enjoy. This attempt to meet individual needs includes shopping for individual requests from the local shops. Service users told the inspector that the food was presented in an appetizing manner and that there was always more than enough. They also felt that they could comment if the need should arise. The inspector saw the afternoon tea and cakes being served and felt this was done in a friendly but dignified and professional manner. Magdalen House DS0000016497.V287082.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 The complaints procedure and the records seen were good indicating a well managed service where complaints are taken seriously and acted upon. EVIDENCE: The complaints procedure seen was comprehensive and was included in the Statement of Purpose and Service Users Guide. A complaint record seen indicated it was well managed and the outcome was satisfactory for all concerned. Magdalen House DS0000016497.V287082.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): 19,26 The environment is a good standard providing a pleasant home for the service users. EVIDENCE: The home was found to be warm, clean and odour free. All of the communal areas and many of the bedrooms were seen. The decoration, furniture and fittings were in a good condition. The presence of flowers and pictures around the home and the personalisation of the bedrooms has resulted in a pleasant and stimulating environment. The outside areas which are mainly laid to lawn are not being used due to the weather but continue to be maintained, and will provide a pleasant area for service users to enjoy in the warmer weather. Magdalen House DS0000016497.V287082.R01.S.doc Version 5.1 Page 15 The call bell system is old and needs upgrading, as it takes too long to repair when it goes wrong, and an emergency tone is required. The call bell cannot be heard in all places within the home and staff have to rely on seeing the call light on instead. Magdalen House DS0000016497.V287082.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): 29,30 The recruitment records were good aiding the protection of vulnerable service users. The home has a well trained care team who are supported to continue learning to ensure they are competent to care for the service users. EVIDENCE: Three recruitment records were seen of new staff employed since the last inspection. The correct information was recorded and appropriate checks had been made. The home has nineteen care staff, eight have completed NVQ level 2 in care qualification, and two more have almost completed it. Two care staff have completed NVQ level 3 in care. The manager is looking at experienced care staff completing additional training to ensure all foundation training criteria is met. Staff who are aged under 25 years have to complete a Modern Apprenticeship then start NVQ level 2 training. The trained nursing staff had recently completed wound care training and all staff had received specific ‘convene’ training allied to continence care. Magdalen House DS0000016497.V287082.R01.S.doc Version 5.1 Page 17 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): 35,38 The home has good procedures for looking after service users monies and they are safeguarded from financial abuse. Generally there were adequate safe working practices, however, there were shortfalls in the health and safety records, which are essential to protect everyone in the home. EVIDENCE: The recording of service users personal monies was checked. Staff have an induction programme which includes safe working practices. The lift and all hoist service documents were seen. Risk assessments and fire procedures had been updated and the manager was planning a fire training session for all staff. Staff had completed first aid training in 2004.
Magdalen House DS0000016497.V287082.R01.S.doc Version 5.1 Page 18 There was an infection control procedure, however, the need to check all water outlets for Legionella must be completed. No record of the gas central heating service could be found this must be accessible to the manager to enable her to be confident that the home is safe. The manager is responsible for health and safety matters and it is advisable that training is provided to ensure that this important role is completed satisfactorily. There was no evidence of a recent health and safety risk assessment. It was agreed at the inspection that until lockable facilities are installed for substances in the laundry room the door must be locked when there is no one in the room. Magdalen House DS0000016497.V287082.R01.S.doc Version 5.1 Page 19 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 X X X 2 Magdalen House DS0000016497.V287082.R01.S.doc Version 5.1 Page 20 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 OP27 Regulation 18.1 Requirement The registered person must record the review of staffing levels. (this was a requirement for 31/04/05 & 31/10/05) The registered person must ensure all service users social activity needs are met. (this was a requirement for 31/10/05) The registered person must ensure that adult protection policies are updated. The registered person must ensure all health and safety matters are complete. Timescale for action 30/04/06 2 OP12 16.2(m) 31/05/06 3 4 OP18 OP38 13.6 13.4 31/05/06 31/05/06 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 OP19 Good Practice Recommendations The registered person should upgrade the call bell system. Magdalen House DS0000016497.V287082.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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