Inspection on 05/05/05 for Magdalen House

This inspection was carried out on 5th May 2005.

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 24/05/06

Magdalen House 25/10/05

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 Square Gorleston Great Yarmouth NR31 7BZ Lead Inspector Kim Patience Unannounced 05 May 2005 9:30 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 I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Magdalen House Address Magdalen Square, Gorleston, Great Yarmouth, Norfolk, NR31 7BZ 01493 661598 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) Norfolk County Council-Community Care Position Vacant Care Home 38 Category(ies) of DE(E) Dementia - over 65 registration, with number of places MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 That the home should be registered to accommodate older people who have dementia. 2 That the home should be registered to accommodate up to 38 Service Users. 3 That the manager of the home is only responsible for the mangem26ent of personal care offered to Service Users accommodated at this establishment. 4 That the management of the home ensures that thre 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. 5 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. 6 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. Date of last inspection 26 October 2004 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 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 I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took approximately 6 hours to complete. During the inspection the acting manager, the care coordinator and several members of staff were consulted. Two service users were interviewed and observations of others going about their daily lives were made. Records relating to service users and staff were reviewed as part of the process and the regulation 26 report prepared by the provider was used as one of the pre-inspection tools. What the service does well: What has improved since the last inspection? What they could do better: The building should be assessed with the needs of people with dementia in mind and resources allocated to make improvements that enhance the individual’s quality of life. Overall, the home does not provide suitable accommodation for people with these complex needs. A plan of maintenance and renewal needs to be implemented to ensure that all the environmental improvements are identified and that timescales for completion are set. MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 Page 6 The good documentation introduced needs to be completed to make it valuable and purposeful. A person centred approach should be adopted to ensure individuals health, social and emotional care needs are met. The home needs to appoint a manager as soon as possible in order to provide some stability. 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 I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 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 I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 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 No service user is admitted to the home without having their needs assessed thus ensuring that all needs can be met. EVIDENCE: Four service user files were inspected and showed that a pre-admission assessment was carried out prior to the individual coming to live at the home. The assessments contained sufficient details about their care needs to enable a decision to be made about whether they can be met. MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 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) 7,8,10 The local authority has introduced new care plans and other documentation that if completed as intended, would provide detailed information about the individual, their care needs and how these are met. This home needs to use the documentation in order to adopt a person centred approach, which is essential in meeting the care needs of people who have dementia. EVIDENCE: Four service user files were inspected. The files contained a care action and review sheet that provides a brief summary of the persons care needs, which is reviewed and updated as necessary. The care plans showed preferences around routines, dietary needs, likes and dislikes, social needs and interests. Some of the documentation had not been completed and in two cases there were no risk assessments when clearly by observing the individual and reading their daily records, risks were associated with some of the persons behaviours. See requirements Looking at the files and daily records for the four individuals it was clear that health needs were recorded and any change in health that required medical intervention was responded to appropriately. The new medical records sheet in MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 Page 10 the service users plan had not been used but is clearly a better approach to recording how the persons health care needs are met and any intervention, and it is recommended they be used. Some of the care plans inspected had been reviewed while others had not for some months. It is important that the home demonstrates that they are monitoring and recording any changes to individuals needs, again this is particularly important when caring for people with complex changing care needs. See requirements Through examination of records, discussion with services users and staff and observations made within the home, there was nothing to indicate that people’s rights to privacy and dignity were not upheld. Staff were observed to approach people in a respectful manner and were seen to prompt those people who were more confused to maintain their dignity in areas such as, appropriate dress. Some aspects of the environment, such as cleanliness, furnishings and some of the facilities do not necessarily promote peoples dignity and must be dealt with. See standards 19-26 for more details. MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 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) 12,15 This home accommodates people with dementia care needs and assessing these standards was difficult due to the issues around poor communication, however as stated in standard 7 the home needs to take a person centred approach to the care of people at the home in order to best meet their individual needs in respect of daily life and social activity. EVIDENCE: As mentioned previously in standards 7-11 the files pertaining to some service users were inspected. In some cases the sections relating to social care needs had not been completed and some did not contain any information relating to the individuals past. It is vital when caring for people with dementia that the home gathers as much information about the history of the individual as possible, along with their previous interests. This will enable the staff to build a picture of that person and begin to meet their social care needs based on their experiences and interests in an attempt to provide meaningful activity for them. See requirements During the inspection, activities were not observed, although staff were seen talking to service users, albeit in passing to attend to other duties. The area of activities will be explored in more detail at the next inspection. MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 Page 12 In respect of meals and mealtimes again it was difficult to ascertain peoples views on the standard of food, however one resident was able to say that she found the food uninteresting and often did not eat the food provided, another described the food as good and had no complaints. The acting manager eats with the residents and uses this as a way of monitoring the meals and the likes and dislikes of each individual by observing their responses. Service users preferences were being recorded in their plans and some notes were seen about particular dislikes and special dietary needs. The menu is displayed daily on a white board outside the dining room and acts as a constant reminder to people throughout the day. The dining room itself is a large open space and some thought could be given to improving the area to make it more suitable for people with dementia. See requirements The carpet was heavily soiled and needs to be cleaned as a matter of priority. Equally, the small dining room on the first floor needs some attention, particularly to the cleanliness and the soiled carpeting, food and a fork was seen on the floor at 11.40am, presumably from breakfast time. It was also observed that an open draw of the dining room dresser had a rubber glove in it and it was not clear whether it had been used or not. See requirements MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 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) 16 The home has a clear and accessible complaints procedure. EVIDENCE: The home has a complaints procedure that is included in the service users guide. There have been no complaints since the last inspection. MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 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) 19,21,22,,25,26 This home does not provide the most suitable environment for people with dementia and requires substantial work in order to achieve this. The standards within the home were found to be less than satisfactory and require some attention. EVIDENCE: A tour of the building was conducted. Many issues throughout the building were identified and for ease of reporting and clarity, the main issues are listed in bullet point form below. • A service user had managed to open doors on the first floor, one to the sluice room and one to an electrical circuit board that was unlocked, therefore exposing her and possibly others to risk of harm. Strong offensive odour detected on first floor Curtains missing from one lounge window, curtain track hanging off the wall. Apparently pulled down by a service user three weeks previous. I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 Page 15 • • MAGDALEN HOUSE • • One bathroom not in use due to a fault with the bathing equipment. Bathroom on the first floor full of various items. Apparently no longer used as a bathroom but as a store room, however, the room was not locked and to a confused individual it may still appear to be a bathroom until inside. Carpets in the dining rooms on the ground and first floor were badly soiled and food on the floor had not been removed from the last meal. Toilet block on the ground floor still to be refurbished. Lack of signage and cueing features throughout the building, now considered very important for those with dementia. Lack of specialist equipment i.e pressure mats, alarms, sensory aids etc The layout in the main lounge areas is institutional and thought should be given to creating smaller areas more suitable for those with dementia care needs. • • • • • The manager confirmed that a sum of money has been allocated to the home in order to address some of the maintenance and renewal issues, however there is no plan in place and therefore what the money has been allocated for is not clear. But this should not detract from the positive move to invest in the improvement of the service. Requirements are made in respect of the above matters. MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 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) 0 N/A EVIDENCE: N/A MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 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 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) 31,33,38 The home does not have a registered manager at present and has experienced some changes in management over the last 12 months and the lack of consistency has not been beneficial. There is no recognisable approach to quality assurance at the home and this needs to be developed, with a focus on ensuring that service users and their representatives are given the opportunity to express their opinion. The home maintains procedures to ensure that the health, safety and welfare of service users and staff is promoted. EVIDENCE: The home currently has an acting manager who is employed as a temporary manager until a new one is appointed. This home would clearly benefit from a consistent approach of management. Staff expressed how difficult it is without the support and guidance of one person and talked of morale being low, possibly resulting in the higher sickness levels of late. MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 Page 18 Staff said the acting manager is doing a good job and trying to achieve some change there is a limit to his success on a temporary basis. A new manager must be appointed and subsequently registered without delay. See requirements In respect of measuring quality in the home there does not appear to be a recognisable system. The manager was unable to confirm whether service user/relative questionnaires developed by the quality assurance officer had been used and if so there were no results to show for this. However, The manager did talk about ways in which quality was monitored less formally i.e through discussion with staff and observations of service users responses. See requirements. During the inspection there was a genuine fire alert and the inspector was able to observe the fire safety procedures and evacuation of part of the building. The fire services were called and the procedure was carried out calmly and smoothly. The home has written procedures in place and were available for inspection. The records relating to fire alarm testing were inspected and the last fire alarm test was noted as the 13/02/05. This should occur weekly and therefore a requirement is made in respect of this. See requirements Other records in respect of health and safety were not inspected on this occasion. The lack of risk assessments relating to service users has already been highlighted in standard 7 and a requirement made in this respect. MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score N/A N/A 3 N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 N/A 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 N/A 14 N/A 15 2 COMPLAINTS AND PROTECTION 2 N/A 2 2 N/A N/A 2 2 STAFFING Standard No Score 27 N/A 28 N/A 29 N/A 30 N/A MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 N/A N/A 2 N/A 2 N/A N/A N/A N/A 2 MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 Page 20 No 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 7 Regulation 15(1) Requirement 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 the need for risk assessments.. The registered person must ensure that the service users plan is reviewed monthly The registered person must ensure that a plan of maintainence and renewal is written with timescales for improvement set. This should include those areas identified in St 19-26.. The registered person must ensure that all parts of the home are kept clean. This relates to food on the floors and offensive odours. 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.. Timescale for action 1.07.05 2. 3. 7 19 15(2)(b) 23(2)(b) 1.07.05 1.07.05 4. 19 23(2)(d) 1.07.05 5. 19 23(2)(a) 4.10.05 MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 Page 21 6. 7. 31 33 8(1)(a) 24(1)(2) 8. 38 23(4)cv) 9. 19 13(4)(a)( b)(c) 10. 15 16(2)(m)( n) The home must have a manager who is registered as a fit person to manage a care home. The registered person must introduce a recognisable system for monitoring the quality of service. The registered person must ensure that fire safety checks are carried out in accordance with the regulations. This relates to the fire alarm checks. The registered person must ensure that risk assessments are carried out on the premises and risks posed to people with dementia care needs are identified and eliminated. The registered person must ensure that service users or their representatives are consulted about their social interests and prefered activity. This refers to the need for person centred planning and the provision of meaningful activity for people with dementia. 4.10.05 1.07.05 6.06.05 1.07.05 4.10.05 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 Good Practice Recommendations MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 3rd Floor Cavell House St Crispins Road NorwichNR3 1YF Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI MAGDALEN HOUSE I55 S34568 Magdalen House V224660 030505 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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