CARE HOMES FOR OLDER PEOPLE
Maidment Court 47 Parkstone Road Poole Dorset BH15 2NX Lead Inspector
Trevor Julian Unannounced 06 & 10 May 2005 10:00 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. Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Maidment Court Address 47 Parkstone Road Poole Dorset BH15 2NX 01202 674423 01202 676410 Home.POO@mha.org.uk Methodist Homes for the Aged 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) Mrs Jacqueline Nelson CRH PC - Care Home Only 46 Category(ies) of OP - Old Age (46) registration, with number of places Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The twin suite, bedrooms 45 (a) and (b), is only to be let to a couple who have clearly expressed a desire to occupy such a room. Date of last inspection 06 October 2004 Brief Description of the Service: Maidment Court is registered with the Commission for Social Care Inspection as a care home for a maximum of 46 older people. The premises are purpose built and include a passenger lift to all levels. All service users’ rooms are single occupancy and have en suite facilities. The main communal space is provided on the ground floor, additional lounges, utility rooms and kitchen facilities are provided on the other floors. There are 10 single rooms on the ground floor; 13 singles on the first floor; 13 singles on the second floor; 8 single rooms and one suite of rooms suitable for a couple. There are a total of 5 assisted bathrooms, one conventional bathroom and a shower room. The home offers one room for respite care. The premises are located overlooking Poole Park and are within a short walk from the town centre. Mrs Nelson manages the home on behalf of Methodist Homes for the Aged (MHA). The home caters for a wide range of care needs but the majority of the service users require minimal support with daily living, some people do have early signs of dementia but the staff are able to meet these needs. As people develop heavier physical care needs these are managed by the home with input from the community nursing team and GP’s. Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 6th May 2005 and was concluded on 10th May 2005. The inspector was on the premises for a total of 7.5 hours. The whole process including preparation, report writing, totalled 16.5 hours The inspection was the first of two statutory visits to be carried out annually. Information was gathered through discussion with the residents, staff and management, some documentation was examined and there was a tour of the premises. For the purposes of this report service user and resident are interchangeable. What the service does well:
Records showed that assessments were carried out for prospective residents to establish their care needs and to verify they can be met within the home. Residents and staff confirmed that the assessments were completed prior to admission. The care plans seen were comprehensive and aided staff to know how the needs were to be met. Staff work with community health teams to meet the healthcare needs of the individuals. Residents said that the staff called for GP support as required although some were able to make their own arrangements; this was also the case for optician and dental services. During the visit several people were involved in an artwork session. There were a variety of activities planned with advanced information posted in the main dining area. Social and cultural interests of individual residents were respected and encouraged to promote a good quality of life. Several people were able to go out independently and most enjoyed visiting the park opposite the home. People also commented that the staff always welcomed their visitors and offered refreshments. The premises are comfortable and generally well maintained for the safety of the residents, visitors and staff. Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 6 The environmental standards in the home were good with a general maintenance programme in place. Residents said the home was kept warm and comfortable throughout the year. Radiator guards were in place to protect residents from the risk of burns. The organisation had a thorough recruitment policy which was followed at Maidment Court. New members of staff said they had started following suitable references and clearances being obtained. The organisation assists residents by referral to independent financial advice as needed. The home also works with a local advocacy service for those who need independent assistance. The home did not manage residents’ finances but would help by looking after personal allowances. The home had health and safety systems in place to protect residents and staff. These included fire safety, staff training, risk assessment, accident and incident reporting. Staffing levels have been maintained and there was little or no agency staff needed to cover vacant shifts. The home continued to be well run with the work of the staff praised by the residents and visitors. What has improved since the last inspection? What they could do better:
Although the home did carry out comprehensive assessment prior to admission the records sampled did not have letters confirming that the identified needs could be met. Staff supervision sessions were scheduled but often the files did not show that the meeting had take place. Each file seen showed some reviews had been carried out but not the six required for care staff annually. Medication records did not confirm whether allergic reactions were considered. This could have serious consequences should a person have an adverse reaction to their medication. Records for a new resident did not show the quantities of medication brought in to the home. Manuscript amendments to the medication charts were not countersigned this could lead to incorrect medication being issued.
Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 7 The premises were well maintained, however, a cover was missing from a lamp in the ground floor bathroom. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Maidment Court CS0000004051.V220796.R01.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Maidment Court CS0000004051.V220796.R01.doc Version 1.20 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 standard(s) 3 and 4 Standard 6- Intermediate care is not offered at Maidment Court. Assessments were carried out for prospective service users so that the home could establish their care needs and to verify that they would be met within the home. Individuals moving into Maidment Court did not receive confirmation that identified needs can be met therefore prospective residents were not assured that their needs could be met. EVIDENCE: The files of four service users were checked and each contained pre-admission assessments. The manager confirmed that she visited people to assess them prior to offering a placement. One new service user recalled the manager visiting her at her previous address. She said that the manager had been thorough in her checks and had felt confident that the home was suitable. She had previously visited the home and knew other people living at Maidment Court. Her family were also involved in the placement process. Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 10 The staff said that initial care plans were developed from the manager’s assessment. The home does confirm in writing to the prospective resident and their representative that a place is being offered however the letter does not explicitly confirm that the identified needs can be met. Maidment Court CS0000004051.V220796.R01.doc Version 1.20 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 standard(s) 7, 8 and 9 Care plans were in place to ensure that staff know how the needs were to be met. The staff worked to ensure that the healthcare needs of the individuals were monitored and met with support from the specialist community health teams. Medication systems generally provided safe systems for the administration of medication. However, some areas needed attention. EVIDENCE: The care plans reviewed showed appropriate level of recording according to the needs of the individual. There was evidence of regular monthly reviews and in the case of one resident the reviews were carried out as soon as the care needs had changed. The plans had been developed from the pre-admission assessment. The files did not show service user involvement in the review process. Staff said that the shift leaders discussed changes in care needs at each changeover. They then advised the care staff of the changes and to refer to the updated care plan for further information. A communication diary was in use to ensure significant information is passed on.
Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 12 The home worked with several doctors’ surgeries; the daily care records showed any referrals and outcomes. GP’s, community nurses and other specialist community teams visited the home. Residents confirmed that the staff call for GP visits as needed. Medication was held securely and well kept. The medication record sheets were up to date. However, manuscript additions were not countersigned to verify accuracy, there was no check of the medication brought into the home for a new resident and there was no recording of allergies on the medication records. Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 13 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 & 13 Social and cultural interests of individual residents were respected and encouraged to promote a good quality of life. Links with friends, family and the community were maintained in order to enrich the social life of individuals and reduce the risk of isolation. EVIDENCE: The home had an activity organiser who is also supported by other volunteers. On the day of the visit several people were involved with an art class, one person had taken to watercolours since moving to Maidment Court and had produced an extensive portfolio. The activity programme for the week was posted on the board in the main lounge. Excursions were booked throughout the spring and summer; during the previous week there had been an excursion to Exbury Gardens to enjoy the springtime flora. The care plans included a section on social history and interests. The home held weekly church services and fellowship meetings; some people attended local churches with support from friends and family. Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 14 Residents said that the home organised a good range of activity and entertainment. The home has seating areas in the garden and a path around the grounds; many of the residents retain reasonable levels of mobility and some are able to walk to Poole Park, situated across the road, via a Pelican crossing from the home. During the visit several friends and visitors were seen in the home. Residents said they were able to choose who they saw and that visitors were welcomed and offered refreshments. Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 15 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) Not assessed during this visit. EVIDENCE: Maidment Court CS0000004051.V220796.R01.doc Version 1.20 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 standard(s) 19, 21, 25 & 26. The premises were comfortable and generally well maintained for the safety of the residents, visitors and staff. There were sufficient toilet and bathing facilities allowing hygiene standards to be maintained. Housekeeping standards were good providing a clean environment resulting in a reduced risk of spread of infection. EVIDENCE: Since the last inspection the carpet had been replaced in the communal areas. The organisation had a programme of redecoration resulting in the premises being well maintained. The home was arranged to allow good access for wheelchairs; there was a lift providing level access to all floors. During a tour of the premises they were found to be warm, clean and odour free.
Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 17 The lamp cover in a ground floor communal toilet was missing. The bedrooms visited had all been personalised by the occupant. Each had supplied their own bed, other personal items included pictures, photographs and furniture. The rooms all had the recommended fixtures and fittings. All rooms have en-suite toilets and wash-basins. The hot water temperature in all baths was regulated to reduce the risk of scalding. All radiators were covered to reduce the risk of burns. Residents said that the home was well kept and during the winter the building had been warm. The assisted baths gave them a feeling of safety when bathing. Maidment Court CS0000004051.V220796.R01.doc Version 1.20 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 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) 29 The recruitment practice at the home is robust providing protection for the residents. EVIDENCE: The records for three carers were examined. Each contained an application form, two validated references and evidence of completed Criminal Records Bureau and Protection of Vulnerable Adults checks. One new member of staff said the recruitment process was thorough; she confirmed that she had not started until all her clearances had been completed. She was working with other staff as part of her induction. Maidment Court CS0000004051.V220796.R01.doc Version 1.20 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 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) 35, 36 and 38. The financial systems were in place to reduce the risk of risk of financial abuse. Staff supervision procedures to ensure staff were working as required were not up to date. To protect the residents and staff the home does promote their health, safety and welfare. EVIDENCE: The organisation had links to an organisation providing impartial financial advice to service users and their representatives. They provide talks on funding issues and will also work with individuals and families. The home did not act as an appointee, for Department for Works and Pensions (formerly DSS) purposes, for any resident. The home will assist people by managing their personal allowances these were not checked during this visit.
Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 20 Staff confirmed that there was a process for supervision and appraisal. The records showed that the staff were supervised however, they were not up to date. Records showed that the electrical and gas installations were checked by approved contractors. Accident and incident reports were correctly managed and all reports were analysed to monitor trends and to seek support as identified. The home informs the Commission of all significant events affecting the residents. Representatives from the organisation carry out monthly monitoring visits. Maidment Court CS0000004051.V220796.R01.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 2 x 3 x x x 3 3 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x 3 2 x 3 Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 22 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 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. Refer to Standard OP4 Good Practice Recommendations The registered person should demonstrate the homes capacity to meet the assessed needs of the service user and confirm in writing the home’s suitability for the purpose of meeting their (the service users) needs in respect of health and welfare (including specialist needs). Care staff should receive formal supervision at least 6 times a year. Details of any medicine sensitivity or ‘none known’ should be included on the medicine record chart. The missing light cover in the ground floor toilet should be replaced. Manuscript amendments to medication charts should be countersigned to verify accuracy. All medication brought into the home should have quantities recorded to ensure an audit trail 2. 3. 4. 5. 6. OP36 OP9 OP19 OP9 OP9 Maidment Court CS0000004051.V220796.R01.doc Version 1.20 Page 23 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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