Inspection on 24/05/06 for Magdalen House

This inspection was carried out on 24th May 2006.

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

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

Other inspections for this house

Magdalen House 12/02/07

Magdalen House 25/10/05

Magdalen House 05/05/05

Magdalen House 26/10/04

Magdalen House 22/04/04

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

CARE HOMES FOR OLDER PEOPLE Magdalen House Magdalen House Magdalen Square Gorleston Great Yarmouth Norfolk NR31 7BZ Lead Inspector Ann Catterick Unannounced Inspection 24th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Magdalen House DS0000034568.V297932.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. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Magdalen House Address Magdalen House Magdalen Square Gorleston Great Yarmouth Norfolk NR31 7BZ 01493 661598 01493 444432 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) Norfolk County Council-Community Care Position Vacant Care Home 38 Category(ies) of Dementia - over 65 years of age (38) registration, with number of places Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That the home should be registered to accommodate older people who have dementia. That the home should be registered to accommodate up to 38 Service Users. That the manager of the home is only responsible for the management of personal care offered to Service Users accommodated at this establishment. That the management of the home ensures that there is always a member of staff on shift who has received training in the care of people with dementia. This to be implemented by end of March 2004. That the management of the home undertakes a review of staffing levels, in view of the category of Service Users applied for and implements the result of this review by the end of March 2004. That the Norfolk County Council undertakes a review of the Services and Facilities offered at this establishment and implements a programme of improvements, which ensures a satisfactory level of service for the proposed life of the home. This review to be carried out by the end of March 2004. 25th October 2005 5. 6. Date of last inspection Brief Description of the Service: Magdalen House is a care home providing personal care and accommodation for 38 older people who have dementia. The home is owned by Norfolk County Council and is located in a residential area of Gorleston on sea. The fees for the home are £368.72p per week. The home was purpose built some years ago and provides single occupancy accommodation on two floors. There are two passenger lifts serving different areas of the home. Magdalen House has large gardens including a secure area suitable for safe usage for people with dementia. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and took place over a period of two days the 24th and 25th of May 2006. The inspector was able to speak with service users, family members, staff and the manager as well as look at files and documents. A full tour of the building was also made. Prior to the inspection three comment cards were received from relatives and two comment cards were received from service users. Comment cards are a useful part of the inspection process and the home may need to make relatives more aware of the comment card so they have the opportunity to complete them. Since the last inspection Sue Pennington has made application to become registered manager. The process had not been fully completed at the time of the inspection. An action plan had been received with regard the requirements of the last inspection however 6 of those 9 requirements have been repeated within this report. The manager, Sue Pennington and all staff were helpful and facilitating throughout the inspection. What the service does well: Service users physical and health care needs are met and staff are committed to meeting these needs. Those service users who were able to make comment about staff spoke in a positive way. For example: “staff are excellent can’t say a bad word about them.” “Staff are kind.” Relatives spoke very positively about staff although it was felt there were not enough of them. A good induction is offered to staff and staff are supported and encouraged to complete NVQ training. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Fourteen requirements have been made in this report and six have been repeated from the last inspection. It is acknowledged that there have been some improvements in some areas but the management need to improve their response to the requirements. The manager has no process in place that enables the quality of all aspects of the care provided to be audited, monitored, improved and reviewed. If this were the case many of the concerns identified by the report would have been picked up in the home’s own quality assurance systems. Some good practice was seen with regard medication but some inconsistencies were noted and caused concern. The Pharmacist Inspector has been asked to inspect this area in more detail. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 7 The staff numbers were not sufficient to enable very much person centred care and staff had little opportunity to spend time with residents other than when they were ‘doing something to them.’ Staff were seen assisting service users with personal and practical care needs but very little time was given to spending time just being with service users, chatting, communicating, listening, reading the paper or any other social interaction. Service users were observed to spend long periods on their own with no contact with others. A relative supported this view by saying that on some occasions that she visits she did not see any staff. The three comment cards received by relatives indicated that there were not sufficient staff. Some service users were walking about purposefully but not being offered anything purposefully to do. Staff need to have more training in providing care to service users with dementia and staffing numbers need to reflect this need. The quality of the environment is poor and standards of cleanliness not good. Fixtures and fittings were often seen to be of poor quality, tired and in need of replacement or repair. 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 DS0000034568.V297932.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 Magdalen House DS0000034568.V297932.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users and/or their families are offered the information they need to be able to make an informed choice as to whether or not the service will meet the individual’s needs. The manager has not been proactive in receiving written assessments from placing professionals or completing her own assessments of prospective service users prior to admission. The home does not provide intermediate care. EVIDENCE: The home has a Statement of Purpose and Service User Guide and these explain and identify the services and care provided within the home. Some information in these documents needs to be updated. For example the Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 10 manager no longer line manages the manager of the day centre and this needs to be taken out of the Service User Guide. The manager identified, within her pre interview questionnaire to become the registered manager, the assessments completed by the home, prior to admission were poor and were an area for further development. She felt that she needed to improve her individual skills in this area. She is in the process of producing a document with a tick box system to enable all areas of assessment to be covered. This will be looked at in detail at the next inspection. The file of a service user who had initially moved into the home for respite care and at a later stage became a permanent resident confirmed the lack of assessment prior to admission. The only assessment of file was a brief assessment from the hospital. A requirement has been made in this area. The home does not offer intermediate care. Magdalen House DS0000034568.V297932.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the service users health, personal and social needs are identified in care plans but these could be more detailed, especially around the social and needs of service users. The health needs of service users were being met with the support of the community health services. The home has a policy and procedure for the safe care and administration of medicines. Evidence on the day of inspection showed that these were not followed in all areas and the Pharmacist Inspector has been asked to assess this area in detail. The interaction between staff and service users was observed and on most occasions the relationship between staff and service users promoted the service users dignity and promoted privacy. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 12 EVIDENCE: The local authority has introduced new care plans, of a good standard, that when fully completed will include all of the information needed to ensure that staff are able to provide person centred care to the service users. A requirement had been made at the last inspection to ensure that the care plans were completed in full. The local authority Care Standards Officer had advised the CSCI that a care co-ordinator would be released from their duties until this task was complete. Unfortunately due to staff sickness the care coordinator was only able to do this for a couple of weeks and care plans are still not complete. Care plans generally included all of the information relating to physical and medical need but some care plans still offered little information with regard life history and personal information. Not all care plans were being reviewed on a monthly basis. A requirement has been made in this area. Medication is stored safely and securely in locked cupboards within the office. Metal trolleys are used to transport medication safely around the home for administration. Only staff with the responsibility for the administration of medicines have access to the keys for medicine storage areas and these staff are appropriately trained. The home maintains records for the receipt, administration and disposal of medicines. The records for disposal of medicines showed that on several occasions tablets had been found on the floors in bedrooms and lounges. This may indicate a concern about the way in which medicines are administered. A small sample of records for administration of medicines were inspected. • There was a record for each individual resident, which displayed a photograph. • The records were clearly laid out with the times for administration highlighted. • There was evidence of an audit trail and charts showed a carry forward figure and medicines received. • Medicines appeared to be administered at the correct times and verified with the staff member’s initials. The records were crosschecked with medication remaining in the blister packs and it was found that in all four cases the number of tablets remaining did not match the number on the chart. In some cases the difference was significant and could not be explained by the care coordinator on duty that day. A requirement has been made in this area. The interaction between staff and service users was observed and some good practice was seen. A carer who was assisting a service user with lunch was Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 13 doing this in a sensitive, quiet way whilst talking and encouraging her. Staff were seen to provide care in supportive and respectful way interacting with the service users and explaining what was happening. At other times staff were very busy and at some of these times there were occasions where the service uses dignity was not promoted. This was especially observed when staff were assisting service users to the toilet facilities before lunch. Staff were seen to focus on the task and not the person. Staff used endearing terms towards service users and it was not clear whether the service uses liked to be called “dear” or “darling”. A member of staff spoke of the “wanderers” when talking about service users that like to walk around the home. Inappropriate language was not intentional but showed lack insight in this area. Staff would benefit from regular training with regard working with service users with dementia. A requirement has been made in this area. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15 The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was no real evidence to suggest that service users were offered useful activities or occupation that met there social, cultural or recreational needs. Contact with family and friends is encouraged and supported. Service users were seen to have choice in some areas but not in others. The food served in the home was wholesome and nutritious although the menu did not appear to address the special needs of service users with dementia. EVIDENCE: The local authority Care Standards Officer had informed the CSCI that a senior care assistant would be given an additional five hours a week to become involved in activities. Although this was only 8 minutes a week for each service user it would have been better than no additional staff hours. The manager informed the inspector that these hours had yet to be allocated. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 15 Some staff were seen to be relating to service users very well and had an understating of the needs of service users with dementia. Other practice observed showed little understanding of the special needs of service users with dementia. Research and good practice clearly identifies the importance of staff having an understanding and knowledge of the service users social history, for example working life, hobbies, preferences, family etc. One member of staff was asked what they knew about one of the service users they cared for. It had already been established that this service user delighted in talking about their past. The inspector knew much about them and had only chatted for 20 minutes or so. The member of staff said she had not had time to find this out and knew nothing of their social history or life before dementia. It is therefore unlikely that this member of staff could begin to meet this service user’s needs. Staff need to have further training in person centred care and caring for people with dementia. A requirement has been made in this area. The menu was varied and nutritious but there appeared to be no particular thought to the type of food provided to service users with dementia. Finger foods were not readily available and most meals were dinners with gravy etc that made eating difficult for some. This meant that the food could only be eaten whilst sitting down and one service user was seen to distressed by this process. Finger foods would empower service users to graze through the day. Liquidised food should be liquidized as individual portions i.e. carrots, potatoes and meat. At the time of inspection the liquidized food had been liquidised all together making it a brown mush. A requirement has been made in this area. A menu board was displayed near the dining area offering information about the menu of the day. The downstairs dining area has a stained carpet that was full of old food debris. No napkins or tablecloths were used and the dining area was ‘out of bounds once laid’. Radiators were dirty and although light and bright there was opportunity for further development in this area. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 16 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 and 18 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure and details of this are contained within the Service User Guide and Statement of Purpose for the home. The home has an Adult Protection policy and staff are trained in this area. EVIDENCE: The home has a complaints procedure that is part of the Service User Guide. It is also displayed in the home. There had been one complaint since the last inspection and this was from a service user about a service user and had been dealt with appropriately. The local authority has robust policies and procedures in place for the protection of vulnerable adults. The policies include a whistle blowing policy that all staff are made aware of through their induction programme and in their handbook. All adult protection concerns are reported and investigate in accordance with the requirements. There have been no adult protection investigations since the last inspection. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 17 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, 20, 21, 23, 24 and 26 The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Several areas of the home were not safe and well maintained and no plan of maintenance and renewal was on site. Communal areas were limited and service users did not have access to all communal areas at all times. At the time of the visit the home was having some toilets refurbished and this meant that facilities were limited. When completed these should offer a good facility. Bedrooms are of differing size many being rather small. Several bedrooms seen were shabby and uncared for offering a poor facility. Not all areas of the home were safe for service users. Several areas of the home were not clean, pleasant or hygienic. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 18 EVIDENCE: Generally the home is in a poor state of repair and does not offer a comfortable environment to live. There is not clear programme of routine maintenance and this has left many areas of the home shabby and in need of repair or refurbishment. The downstairs dining area had a badly stained carpet with food debris embossed upon it. The carpet outside the dining area was also stained and the lounge area here was adequate but not a particularly inviting area to sit. In the dining areas the radiators had been covered with wire covers for safety but nobody had cleaned the radiators before this was done and they were dirty and stained. Some signage had been provided and familiar pictures and photographs were on bedroom doors and this was seen as improvement a good practice. Some general signs needed to be clearer and there needs to be more signage. These were only temporary signs and when further decoration is done more signage will be used around the home. It appeared to be general practice to lay the table for lunch during the morning and then lock the door so access was deprived to service users. This limited the amount of communal space accessible to service users. Since the last inspection a fairly large oblong flower type trough had had the stones in it removed but was now an unpleasant empty trough full of some stones and debris in. This facility could be used in a meaningful way for plants or similar. The upstairs dining area was adequate. When speaking to a relative in the large downstairs lounge she stated that the room became so cold in the winter, due to the poorly fitted windows that service users were at times not able to sit in their. A service user confirmed this by saying “yes it is jolly cold.” The upstairs lounge on Rosewood unit is now being used as a staff room. The downstairs staff room has been made into an activity room for service users, although it still appeared to be being used by staff as a staff room. It had an agenda for the team meeting on the wall, boxes of latex gloves and hand wash. Staff were also using the room to completed daily records. The light switch was covered and not usable, awaiting repair. The manager needs to ensure that this is a communal facility and is appropriate for service users. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 19 The downstairs toilets were being refurbished at the time of the inspection visit. One lift was also being worked upon at the same time and this was causing significant disruption for service users. It had been advised at the last inspection that these two jobs should not be done concurrently. The manager advised that this had not been the plan but the work on the lift had taken longer than expected. Several bedrooms were in a poor state with furniture and fittings not adequate. Several bedrooms inspected had stained carpets with a very strong odour. The home has two carpet shampooers, although neither were working properly at the time of the inspection visit. Clearly this had not been sufficient and the carpets needed replacing. It was the inspector understanding that when a bedroom became vacant a new resident was admitted without these carpets being replaced. This is poor practice and a requirement has been made in this area. The local authority Care Standards Manager visited the home after the last inspection and believed the problem with regard odours in the home had been dealt with. The manager informed the inspector that he did not enter the bedrooms as these are locked during the day. Some bedrooms had the curtain-tracking coming away from the wall, another bedroom had a hole in the wall where the door handle had hit and broken the plasterboard. A bedroom had lots of nails sticking out of the wall that needed to be either taken out or used to hang items on the wall. Much of the bedroom furniture was basic miss matching being tired and shabby. Commodes were rusty and poor quality. One had not been emptied at 11.40am. Beds were not made properly and had soiled and worn out bed linen. Several of the beds had blankets and not Duvets. When this is the case it would be assumed that the bed would be covered with a counterpane. In most rooms an empty duvet cover had been placed on the bed and in one bedroom a double sheet had been used. This lack of care within the environment is not acceptable. A requirement has been made in this area. Not all areas of the home were safe for service users. The area opposite the smoking room, a small storehouse, was open. Within this area two large ladders were housed against the wall and neither were secured to the wall. Mattresses and other equipment were in a side cupboard area. This was a dangerous area for service users to have access to. No lock was on the door. A requirement has been made in this area. On the ground floor near the managers room is a cupboard/store room with wheelchairs and other equipment. This door was unlocked and the inspector assisted a service user who had wandered in, out of the area, as the service user would have been at risk if she had remained there. A requirement has been made in this area. Upstairs a cupboard that housed a fuse box was unlocked and this could be a hazard to service users. A requirement has been made in this area. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 20 Throughout the home there were areas that were not clean. The home had two domestic staff on duty between 07.00 and 12.00 on the day of inspection. The inspector was told on some days there were three but generally two were on duty. At weekends one domestic is on duty. This is clearly not sufficient to keep the home clean. A requirement has been made in this area. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is not always enough staff on duty to meet the needs of service users. Staff are offered NVQ level 2 training and at the time of inspection nine staff were trained to NVQ level 2 or above and five were completing NVQ level 2. The local authority has a clear recruitment and selection policy and procedures that protects service users. The quality and competence of staff was variable and further training in specific areas is needed to ensure that all staff have the skills and knowledge to fulfil their role. EVIDENCE: On the first day of inspection the manager and one member of the care staff were off sick. This left the home with less staff than were planned. On the second day all staff due to be at work were on duty. On both days the home would have benefited by having more staff to meet the needs of service users. The care provided was often seen to be task led and not person centred. Service users appeared to be contained and safe with little evidence of any social time or encouragement in hobbies or occupation. On the second day of the visit one member of staff was offering communal activity in the main Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 22 downstairs lounge. Generally staff were observed to offer physical and personal care but very little time was spent with service users engaging in meaningful activity. Staff were rarely seen sitting talking to service users. It had previously been agreed that additional staff could be on duty at the time of the refurbishment of the toilets and the work on the lift. This had not taken place. Additional hours were to be arranged for staff to offer social activity. This had not taken place. Whilst the lift was being repaired most service users who lived upstairs were unable to come down to the ground floor. It had previously been agreed that this area would always be staffed. On the first day of the visit there were significant amounts of time when no staff were in the dining/lounge area. The hot trolley had been placed in the dining area, switched on and was very hot. This posed a significant risk to service users. The inspector switched this off and staff were told of the risk at this time. A requirement has been made in this area. The home had an institutional feel that appeared to be for the benefit of staff. For example on the second day of inspection the tables in the large downstairs dining area were laid, squash poured in uncovered glasses and the doors locked to service users. It could be assumed this was done at this time, as staff were busy later. It deprived service users of this communal area for the rest of the morning. Bedroom doors were locked to lock out service users who may access bedrooms that were not there own. This is fine if service users want their doors locked but this also meant some service users were unable to access their bedrooms if they chose to do so. More staff to work with service users may be the more appropriate way to deal with this issue. Staff were observed assisting service users to the toilets, prior to dinner. It appeared that all service users were assisted to the toilet whether they wanted to go or not. Again the care appeared service led. There were not sufficient staff on duty and the individual needs and preferences of service users appeared marginalised. A relative said that she and her family visited on a regular basis and often spent significant amounts of time in the home without seeing a member of staff. On the agenda for the staff meeting someone had written: “working short handed, how do staff stand if something serious happens.” “If short staffed do we get extra pay.” This would suggest that being short staffed was quite common and an issue for staff. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 23 The rota did not appear to take into account the special needs of service users with dementia. Service users were seen walking about with no purpose and when staff did see them the response was often to suggest they sit down and wait for a cup of tea. This was meant in a kindly way but if more staff had been on duty staff could have enabled service users to participate in activity that was meaningful for them. Within a care plan it stated that a service user’s incontinence difficulties had worsened since her mobility had deteriorated. The lack of mobility should not have a negative affect on continence but should highlight that staff need to ensure that the service user is enabled to access the toilet on a regular basis. Need should reflect staff numbers and be adjusted accordingly. There were not enough staff on duty to ensure that the needs of service users were met. A requirement has been made in this area. Domestic staff are not employed in sufficient number to ensure that the home is clean at all times. Between 13.00hrs of one day to 07.00 the following day there are no domestic staff and carers would need to fulfil this role. At weekends it is usual for only one member of the domestic staff to be on duty. A requirement was made in this area. The home has a clear recruitment and selection process and this protects service users. Those staff files seen offered evidence that all appropriate checks and references had been sort prior to newly appointed staff commencing work. This area was also discussed at the managers fit person interview as part of her application to become a Registered Manager and her competence and knowledge in this area was sound. Staff are offered induction and foundation training. The home employs 29 care staff, nine of whom have NVQ level 2 or above and 5 are working towards achieving their NVQ level 2. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35, 36 and 38 The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager has been in post since December 2005 and has made application to become the registered manager. The home has no clear quality assurance system that audits the service. The SSD does carry out its responsibility as described in section 26 of the Care Home Regulations 2001. Service user’s financial interests are safeguarded by the homes policy and procedures in this area. Supervision has now started to take place on a regular basis. The home has policies and procedures to protect the health and safety of service users but at the time of the inspection visit some areas of the home were a hazard to service users. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home has had no permanent manager for some time and this is evident in the quality of service provided. The new manager had felt that staff moral was low at the time she was appointed and there were many areas that needed improving. The manager has no been in post for 6 months and believes that she has started to improve the service and outcomes for service users. She has made application to become the registered manager. The manager has said that she has yet to develop a quality assurance system for the home. With a good quality assurance system identifying, monitoring, improving and reviewing all aspects of the service much improvement could be made. There is concern that since the last inspection little improvement to the service has been made. Many of the requirements from the last inspection are to be repeated within this inspection and this should not be the case. A significant improvement in this area will be expected by the next inspection. A requirement has been made in this area. Since the last inspection the manager has developed the practice of regular supervision. She has arranged for supervision to take place in an office away from the home to ensure this is not interrupted. This was seen as good practice. Supervision agreements were seen on staff file, as was evidence of formal supervision. The local authority takes responsibility for any monies and personal allowances with the home being directed as to how much personal allowance any one service user may get. For some service users small amounts of money are looked after by the home. Documentation and records were seen and all were in good order. The home has a part time administrator who deals with this matter. Manual handling training is provided to all staff but unsafe practice was seen to take place. A resident who appeared to be asleep and at the very least had her eyes closed throughout the task was assisted from a chair. Both staff involved in this were relatively inexperienced staff. They omitted to make the area safe for themselves by moving any furniture that was in the way, they did not ensure that the service user was sitting in the most appropriate position for a successful move and pulled the service user up putting both her and themselves at risk. Another service user was moved with the aid of a stand aid and did not appear to be able to weight bare. She could not hold on to the bars of the hoist and staff held her hands/wrist as she was raised. This did not appear to be safe practice as this made service users wrists vulnerable, Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 26 especially if service users were being uncooperative at the time of the move. A requirement has been made in this area. Three storage areas were unlocked when they should have been locked and this created a risk to service users. Staff have received training in food hygiene but practice such as pouring orange squash in glasses at the dining table, at least an hour before lunch is poor practice. It was also seen that a service user who is cared for in bed had her jug of squash covered with cling film but the drinking container was not covered. Radiators were covered but some pipe work was still exposed. The home has a procedure for the documentation of incidents and accidents and this is to record each incident individually. This had not been done since March 2005 and staff were recording the incidents in a falls book. This was a general record that was not individual to the service users and would not meet the requirements of the Freedom of Information Act. Forty-four records had not been recorded as individual recordings. It is poor practice to have information about service users in a general log and not individually. An immediate requirement was made in this area. Risk assessments were seen on service users files. Initially a concern had been felt when a staff member was observed opening a locked bedroom door when the service user was in the room. However the risk assessment clearly identified that the service user chose to be in her room and chose to lock herself in. The explanation within the risk assessment and how this was dealt with was evidence of good practice. Another example of good practice was in relation to a service user who smoked and how any risk was minimised. Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 2 2 x x 1 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 3 3 x 2 Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action 01/07/06 1 OP3 14(1)(2) 2 OP7 15(1) 3 OP7 15(2)(b) 4 OP9 13(2) 5 OP12 16(2)(m)( The registered person must ensure that the needs of service users are assessed and these assessments are in writing and kept under review. The registered person must ensure after consultation with the service user or representative that a written plan is prepared, as to how the service users needs are to be met. This includes information with regard life history and personal social information. REPEATED REQUIREMENT The registered person must ensure that the service users plan is reviewed monthly. REPEATED REQUIREMENT The registered person must ensure that there are arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. REPEATED REQUIREMENT The registered person must DS0000034568.V297932.R01.S.doc 01/07/06 01/07/06 01/07/06 01/07/06 Page 29 Magdalen House Version 5.2 n) 6 OP15 16(1)(i) 7 OP19 23(2)(b) 8 OP19 23(2)(a) 9 OP19 13)4)(a) 10 OP24 16(c)) ensure that information about the service users preferences with regard social activity are known and acted upon and that person centred care takes place with one to one interaction between staff and residents. REPEATED REQUIREMENT The registered person must ensure that the food provide is properly prepared and is suitable for the service users. This relates particularly to finger foods being provided and liquidized food being prepared properly. The registered person must ensure that a plan of maintenance and renewal is written with timescales for improvement set. This should include those areas identified in St 19-26.REPEATED REQUIREMENT The registered person must ensure that the physical design and layout of the home is suitable to meet the needs of its residents. This relates to the need for signage, cues, communal areas and specialist equipment. REPEATED REQUIREMENT The registered person must ensure that all areas of the home that service users have access are as reasonably practicable free from hazards to their safety. This relates particularly to those cupboards and storerooms identified as being unlocked when they should be locked. The registered person must ensure that bedrooms have adequate furniture, bedding and other furnishings, including curtains and floor coverings to meet need. This applies particularly to bedroom carpets DS0000034568.V297932.R01.S.doc 01/07/06 01/07/06 01/07/06 01/07/06 01/09/06 Magdalen House Version 5.2 Page 30 11 OP26 23(d) 12 OP27 18(1)(a) 13 OP27 18(1)(a) 14 OP33 24(1)(2) that are soiled and have a strong unpleasant odour, curtain rails that are coming of the wall, bedding that is tired and inappropriate, rusty commodes and damaged and shoddy bedroom furniture. The registered person must ensure that all parts of the care home are kept clean and are reasonably decorated. REPEATED REQUIREMENT The register person must ensure that at all times there are staff in such numbers as appropriate for the health and welfare of service users. This relates particularly to the amount of domestic staff working in the home, as they are unable to keep the home clean at all times. The home must ensure that at all times suitably qualified, competence and experiences persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person must introduce a recognisable system for monitoring the quality of service. 01/07/06 01/09/06 01/09/06 01/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Magdalen House DS0000034568.V297932.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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