CARE HOMES FOR OLDER PEOPLE
Magnolia House 42 Hull Road Cottingham Hull East Yorkshire HU16 4PX Lead Inspector
Ann Day Unannounced Inspection 22nd August 2006 14:15p 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 Magnolia House DS0000066548.V305181.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. Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Magnolia House Address 42 Hull Road Cottingham Hull East Yorkshire HU16 4PX 01482 845038 01482 848271 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) Park Lane Healthcare (Magnolia House) Limited Mrs Susan Bottomley Care Home 74 Category(ies) of Dementia - over 65 years of age (74), Old age, registration, with number not falling within any other category (74) of places Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection August 2005 Brief Description of the Service: Magnolia House is a care home offering personal care for up to seventy- four older people who have dementia care needs. The home has been significantly extended and accommodation is on two wings, two floors and within single and double rooms, many with en-suite facilities. There are communal areas for the service users and extensive well-maintained gardens, with seated areas for the service users to enjoy. The home is situated in Cottingham, close to the local bus route, and is within walking distance of the shops and local amenities. Magnolia House is owned by Park Lane Healthcare Ltd. Fees £370.00-£460 Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection included preparation, collation of information received, a pre inspection questionnaire completed by the providers of this service and fieldwork. The fieldwork included a tour of the premises; case tracking individual residents, noting their experience of care provided; examination of documentation; meeting with residents, interviewing staff members and the registered manager Susan Bottomley. The site visit to the home took place on 22nd August 2006 and was unannounced. Fieldwork took a total of 5.85 hours to complete. What the service does well:
Service users said, “ Food is very good, I tell them what I dont like”. “Nephew and niece, and son think it is a lovely place.” This one is best, the cleanest. Better since change of ownership. The home provides a visitors’ folder in the entrance hall, which contains comprehensive information about the home, accommodation, fees charged and also includes photographs of staff members. Case tracking confirmed good practice. The registered manager had visited prospective service users at home and undertaken a thorough initial assessment of their care needs. Personal care is of a high standard, care practice is consistent and service users can be confident that they will get support from people who understand their care needs. The home is clean, comfortable and well decorated throughout; the home is free of any offensive odours, and all communal areas offer a comfortable, homely and convivial atmosphere to sit and chat or to have a meal. Individuals liked their bedrooms, and were happy with the facilities in the home. Service users had access to an extensive landscaped garden; the garden has an ornamental pond, which is fenced for service users’ and visitors’ safety. A number of seating areas are provided and these were well maintained. Staff training is seen as a priority and staff benefit from regular supervision and appraisal. 75 of the home’s care staff have achieved NVQ Level 2 or above. Members of staff said, One of the better homes I have worked in, clean tidy doesnt smell.
Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 6 “The way it’s run, the atmosphere, I can go to the manager if had a problem”. “Sue (the manager) is approachable and the head of shift, can resolve any issues”. Great, good training opportunities, very good. The quality assurance systems are effective and the manager is proactive in addressing quality issues within the home. The views of service users, staff members, relatives and professionals visiting the home are sought on how the service can be improved. The home has achieved a number of external quality awards. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home. EVIDENCE: Case tracking confirmed good practice. The registered manager had visited prospective service users at home and undertaken a thorough initial assessment of their care needs. Four members of care staff were spoken to and were able to describe the admissions procedure and the importance of making sure that new service users felt welcomed. Written admission documentation was adequate and included a copy of the care management assessment. Basic information was available to staff to
Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 9 ensure they could meet the social, emotional and care needs of new service users. The written contract and terms and conditions of residence were on each service user’s file. The current fees were included and clearly laid out. This means that service users have the information they need about the service they will receive and how much it will cost them. The home provides a visitors folder in the entrance hall, which contains comprehensive information about the home, accommodation, fees charged and also includes photographs of staff members. This home does not provide intermediate care. Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The consistent good practice regarding the planning and delivery of care means that all services users can be sure that their health and personal care needs will be fully met. EVIDENCE: Service users’ care plans were comprehensive and there was evidence that both service users and their representatives/relatives are involved in their individual packages of care; and were involved in discussions when changes needed to be made to their plan. Care plans include health care requirements and service users felt that if they needed to see a doctor or attend an appointment this was arranged quickly. Personal care is of a high standard, care practice is consistent and service users can be confident that they will get support from people who understand their care needs. Care records and medication administration records are accompanied by the individual service user’s photograph to further aid identification. The medication records were of a good quality. Records of the receipt and disposal of medication were clear and accurate and the recording of the
Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 11 administration of medication was good. Controlled drugs were safely stored and recorded correctly. The home does not currently have a list of specimen signatures (those that administer medication within the home) , this practice was recommended. Only members of staff who have attended training administer medication in the home. The home’s administration, handling and storage of medication, is of a good standard. The home uses a Monitored Dose System (MDS). The home undertakes an Internal audit of medication and its administration on a regular monthly basis. The dispensing pharmacist visits regularly and is available for advise on an ongoing basis. Signage within the home is clear and is in line with best practice. Service users spoken with felt their privacy was respected and that members of staff were sensitive when they needed help with personal care. Members of staff had an overall understanding of the needs of the residents and were seen to be patient and kind when interacting with them. Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have a range of opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and are an enjoyable, social occasion for all of the service users. EVIDENCE: The home’s activities programme is on display; activities are recorded in progress and key worker notes, social care notes as part of individual case files. A Catholic priest and a vicar visit service users in the home regularly. There are residents meetings held regularly. The activities plan is drawn from the meeting but is not rigid, there is a relaxed atmosphere; it is their home. The home adopts a flexible eclectic approach to choices, which may include music and movement, quizzes and bingo. Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 13 All members of staff are involved in the provision and support of activities, particularly individual service users’ key workers. Hairdressing now takes place in the newly equipped salon on two days of the week. The salon has an adjacent relaxed seating area where patrons may chat and pass the time of day. There were friends and relatives visiting throughout the day. Residents moving about the home; some watching TV, many chatting with friends and staff. There is a telephone (payphone) for the use of residents, and many of residents have their own telephone in their room. Members of staff ask the residents what they would like to eat for breakfast, lunch and supper. A menu is available which is rotated on a three-four weekly basis. Each wing of the home has a dining area. A teatime meal was observed. Likes and dislikes were well identified, the cooked option for tea was bacon and mushrooms, and there were a number of cold alternatives to choose from including a variety of sandwiches and a dessert. Tables were laid with individual place mats, in convivial surroundings. Service users said, how much they enjoyed the food provided. Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 14 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): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives and friends can be confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse and their legal rights are protected. EVIDENCE: A complaints procedure was available to all service users and this was included in the service user guide. Each service user had a copy in their room. They all felt safe, listened to, and able to speak to the staff and manager if they were not happy about anything to do with their care. The home has received three complaints in the last twelve months, all of which were thoroughly investigated in accordance with the home’s complaints policy and procedures. Members of staff spoken to were sure where to find the complaints procedure and were able to explain what and to whom they would go if they received a complaint. Efforts had been made by staff to make sure that service users could vote at the last election, by post, or in person. The management and staff of the home have a good understanding of service users’ rights as citizens. Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 15 The home has the Protection of Vulnerable Adults policy and procedures in place and staff have received training. Staff spoken to had a clear understanding of the action to be taken if an allegation was made. Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 16 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): 19,20,22,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The good condition of the décor and fixtures and fittings means that service users live in a safe, comfortable and convivial environment. EVIDENCE: The home is clean, comfortable and well decorated throughout; the home is free of any offensive odours, and all communal areas offer a comfortable, homely and convivial atmosphere to sit and chat or to have a meal. Individuals liked their bedrooms, and were happy with the facilities in the home. Service users had access to an extensive landscaped garden; the garden has an ornamental pond, which is fenced for service users’ and visitors’ safety. A number of seating areas are provided and these were well maintained. The rooms of those service users whose care was case tracked showed individuals had been able to personalise their rooms, and they were
Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 17 satisfactorily clean and well presented. Service users felt their rooms were comfortable. The home has had a new modern assisted bath and hoist, fitted since the last inspection. The bath much improves the bathing facilities for the less able service users in the home. Sufficient aids and equipment were provided and all of these were of a satisfactory quality. The hoists were serviced regularly, which minimises potential risks for people who use the service. All chemicals used within the home are appropriately and securely stored. The home has a programme of routine maintenance and refurbishment, which is documented, carpets have been replaced since the last full inspection. Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are fully met, by a competent and trained staff group. EVIDENCE: The home currently has one care staff vacancy, the post has been advertised and an appointment has been made. Sue Bottomley, the registered manager said, that she was establishing a bank and care staff agreed that this would aid in times of shortage, due to holiday and sickness. The home has robust staff recruitment procedures and practices in place; staff files examined, were comprehensive. The home has a formal recorded induction programme for new starters in place and all new starters are issued with a staff handbook. Staff training is seen as a priority and staff benefit from regular supervision and appraisal. 75 of the home’s care staff have NVQ Level 2 or above. Four members of staff spoken to, were clear about their role, knew what was expected from them and showed a good understanding of the actions they needed to take to meet and promote dignity, privacy, equality and diversity. Service users’ needs are met. The rapport between the manager, staff and residents was seen to be excellent. Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 19 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): 31,33,35,38 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The management arrangements are meeting the needs of the service, residents benefit from a safe and well managed place to live. EVIDENCE: Sue Bottomley, the registered manager is very experienced in provision of personal care and management in a care setting. She has achieved NVQ Level4 and the registered managers award. Care staff said supervision is taking place regularly and that it was well organized, records confirmed that they received regular supervision and appraisal. Service users’ personal monies are well accounted for, transactions and receipts are recorded, and on examination were found to be accurate. The manager was advised to, where possible, move to a direct invoicing system for
Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 20 items such as hairdressing and chiropody; and to ensure that money transactions are countersigned. The quality assurance systems are effective and the manager is proactive in addressing quality issues within the home. The views of service users, staff members, relatives and professionals visiting the home are sought on how the service can be improved. The home has achieved a number of external quality awards. Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 21 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 4 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP9 OP35 Good Practice Recommendations The home should have a list available, of specimen signatures, of those trained members of staff who administer medication. The home should where possible move to a direct invoicing system for items such as hairdressing and chiropody; and ensure that all money transactions are countersigned. Magnolia House DS0000066548.V305181.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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