CARE HOMES FOR OLDER PEOPLE
Magdalen House 98 London Road Gloucester GL1 3PG Lead Inspector
Kate Silvey Unannounced Wednesday, 24 August 2005, 09:30
th 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 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 D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Magdalen House Address 98 London Road Gloucester GL1 3PG Telephone number Fax number Email 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 The Gloucester Charities Trust Mrs Hazel Newman Care Home with Nursing 29 Category(ies) of OP - Old Age (29) registration, with number of places Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: N/A Date of last inspection 7th March 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 areaThere 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 D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over seven hours. Most of the service users were seen and four were spoken to for some time. The registered manager, deputy manager and some care staff were involved in the inspection process. Samples of four care records were looked at in detail, and general policies were read. The communal areas of the home were seen including the laundry, bathrooms and most of the service users bedrooms. A copy of the staff rota was taken and staffing levels were discussed with the manager. What the service does well: What has improved since the last inspection? Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 Page 6 Activities have improved and two trips out were planned to Weston-super-Mare and Slimbridge Wildfowl Trust. Some service users recently went to see The Gang Show. The deputy manager has completed a ‘seated activities’ course, which is allied to the prevention of falls for older people, and was enjoyed by the service users. The deputy manager hopes to continue weekly classes with the service users. The providers’ Gloucestershire Charities Trust have agreed that all service users will have free chiropody treatment. New beds have been purchased and carpets replaced as required. 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 D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 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 standard(s) 3 The staff completing pre-admission assessments need to be consistent when completing records to ensure sufficient information is known. EVIDENCE: An example of a pre-admission assessment was seen and was incomplete. The deputy manager said more information was available, as a visit had been made to the care home where the service user had been. The service user was from the Trusts sister home and the staff had spoken at length to the manager and the service user before the admission. A detailed assessment was seen for another service user, which contained all the relevant information. It is essential that sufficient pre-admission information is recorded to ensure preparation for the service user and to use as a baseline for future progress. Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 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 standard(s) 7 & 8 The care records were detailed, well written and reviewed monthly. Healthcare professional support the service users and appropriate records were made of their visits. EVIDENCE: Four care records were seen in detail and a random medication check was completed. The care plans were very well written with clear actions for day and night care and meaningful monthly reviews. The daily records supported the care plan actions and were detailed. Adaptations in use were recorded in the care plan. Manual handling assessments were complete and regularly reviewed. The healthcare professional records were comprehensive and advice had been sought from man, including the district nurse, when required. The wound care was recorded appropriately and Polaroid photos were taken regularly to monitor rate the of healing. Care plans were written for any identified risks.
Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 Page 10 The service users spoken to said they were well cared for and were treated with dignity and respect by the kind staff. The registered manager was well liked and respected by the service users. Some service users were unaware of their care plan, although a key worker system exists in the home to ensure a more personal approach by a named carer. Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 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 standard(s) 12 The staff have made an effort to provide more activities in the home, however, there is some room for improvement to ensure all the service users need are being met. EVIDENCE: The deputy manager and the NVQ level 3 care staff had recently completed a SAFE (Seated Active Fitness Education) training course, which was part of an initiative by Care Homes Support Project for falls prevention. The deputy is now qualified to train others in the home and use the skills in the community. The deputy stated that service users enjoyed themselves while everyone was learning and she plans to continue with the exercises at least once a week. Two trips out have been planned to Weston-super-Mare and Slimbridge wildfowl Trust. Some service users recently went to the Gang Show in Cheltenham. There is no programme of activities but posters are put up for special events. The home continues to have two regular music entertainers, and an arts and craft session on a Wednesday afternoon with the work displayed in the home. Everyone enjoyed a barbeque during the summer. Occasionally wheelchair bound service users are taken out locally.
Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 Page 12 The care staff on the evening shift often do quizzes and play film videos for the service users. The Gloucester Charities Trust residential care home(Guild House) nearby are sometimes able to invite service users from Magdalen on their trips out in the mini-bus. It was suggested that the staff at both homes may be able to share and organise activities more, and a fulltime coordinator to cover both homes with the help of care staff may be a way forward to meet the needs of all the service users. Several service users commented on activities and although they were generally content some would like to go out more and perhaps have some interesting ‘talks’ in the home. The service users spoken with liked living in the home and said they were able to choose when they wanted to get up and go to bed and felt free to spend their day how they wished. Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 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 standard(s) 18 The care staff spoken to were well informed about the protection of vulnerable adults, however, the written procedures required some updating to ensure there was a clear reference for all staff to access when required. EVIDENCE: The homes policy for The Protection of Vulnerable Adults was seen. It should include the local arrangements for referral to the Gloucestershire County Council Adults at Risk team. Registered manager was well aware of this procedure and has previously contacted the team, however, this should be recorded. The registered manager was reminded of the useful information regarding POVA on the CSCI website. The care staff were asked about ‘whistle blowing’, which had been discussed at informal staff the types of abuse and felt able to address any issues. A record would also be sent to the providers, Gloucester Charities Trust. Care staff were reminded that the Commission must be informed under Regulation 37 (e) any event in the home which adversely affects the well-being or safety of a service user. Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 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 standard(s) 26 The home was very clean and free from offensive odours, which the service users appreciated. The laundry room must be locked when the staff to provide an environment safe from hazardous substance. EVIDENCE: There were two domestic staff completing cleaning duties on the day of the inspection, the manager stated there would normally be three. However, the manager was advertising and was hoping to recruit another cleaner. One domestic staff was spoken to and stated that the home was short of a cleaner and she was completing extra duties to maintain the standard. The domestic spoken to had received training in the COSHH (Control of Substances Hazardous to Health) and Health and Safety requirements. The home was very clean and free from any offensive odours.
Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 Page 15 The laundry room was clean and organised, and the laundry person knew about infection control requirements including the correct washing temperatures The laundry room should be locked when laundry staff leave the area, particularly when delivering clothing to service users, as there were hazardous substances stored in the room. All service users spoken to were pleased with the cleanliness of the homes. Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The high dependency of the service users accommodated means that at times there may be enough staff to meet their needs. The registered manager must complete a recorded review of the staffing levels and the providers must support the findings. EVIDENCE: The recorded staff review required at the previous inspection has not yet been completed. The previous staffing levels minimum requirements do not take into consideration meeting all service users needs and regular reviews are required. The staffing levels were discussed with the registered manager, care staff and service users and the inspector took a copy of the staff rota. Service users stated that the care staff were always very busy, and two said that there were times when the staff are slow to respond to the call bell. Staff comments included that as there are only three night staff at present so they can complete little in the morning, and the morning carers’ stage their lunch breaks between 11.00-12.00 in readiness for helping to feed the service users their lunch. Whilst this is good practice the need for sufficient care staff at the peak periods of activity, early morning and evening, must be met. The registered manager is advertising to recruit another carer on night duty.
Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 Page 17 The manager stated that the dependency levels remain high and sometimes weekends are more difficult, as identified on the rota. The registered providers must ensure adequate funds are available to meet the service users needs every day of the week and to take into consideration the registered managers recorded review of staffing levels when complete. Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 The registered manager has made progress in ensuring facilities are provided for the service users and continues to work with the providers to meet all their needs and provide sufficient information. EVIDENCE: The registered manager has almost completed NVQ level 4 in management with only two units to complete. The previous requirement to provide suitable telephone facilities for the service users privacy and dignity had not been addressed. This was discussed with the manager who agreed to finalise appropriate facilities by the end of September 2005. The manager stated that there were plans to alter the relative’s room into a respite room, where a separate telephone line may be installed.
Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 Page 19 The Service User Guide needs to be updated and distributed with the revised terms and condition included. The term and condition are the responsibility of the providers, and they should ensure that the update considers the recent Office of Fair Trading investigation into contracts. Information is available on the OFT website. The service users spoken to were very pleased with the food provided in the home. All the service users spoken to knew whom to share their concerns with and felt they were listened too and action was taken. Future plans included replacing the television to include a DVD player, and providing new hoists to include a weighing device. New beds had been provided and carpets replaced. It had recently been agreed by the providers that the service uses have a free chiropody service. Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 2 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x 3 x x x x x Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 Page 21 yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 4.2 Requirement The registered person must complete the amended Statement of Purpose and send a copy to the Commission. (This was a requirement for 31/04/05) The registered person must complete the Service User Guide and supply all the service users accommodated with a copy, and send a copy to the Commission. (This was a requirement for 31/04/05) The registered person must provide telephone facilities to ensure service users can make calls in private. (This was a requirement for 31/05/05). The registered person must record the review of staffing levels. (this was a requirement for 31/04/05)l The registered person must ensure that pre-admission assessments are complete. The registered person must ensure all service users social activity needs are met. The registered person must ensure that adult protection policies are updated. The registered person must Timescale for action 31/10/05 2. 1 5.2 31/10/05 3. 10 16.2(b) 31/10/05 4. 27 18.1 31/10/05 5. 6. 7. 8. 3 12 18 26 14 16.2(m) 13.6 13.4(a) 31/10/05 31/10/05 31/10/05 31/10/05
Page 22 Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 ensure an environment safe from hazardous substances. 9. 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. Refer to Standard 7 Good Practice Recommendations All service users as far is practicable should be aware of their care plan and consulted during reviews. Magdalen House D51_D03_S16497_MagdalenHouse_V246309_240805_Stage4_U.doc Version 1.40 Page 23 Commission for Social Care Inspection 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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