CARE HOMES FOR OLDER PEOPLE
Malden House 69 Sidford Road Sidmouth Devon EX10 9LR Lead Inspector
Vivien Stephens Unannounced Inspection 2nd January 2009 09:15 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 Malden House DS0000070693.V373639.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. Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Malden House Address 69 Sidford Road Sidmouth Devon EX10 9LR 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) 01395 512264 01395 512264 malden@hartfordcare.co.uk Hartford Care (Southern) Ltd Miss Sharon Hunt Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 19. 28th January 2008 Date of last inspection Brief Description of the Service: Malden House provides accommodation and personal care for up to 19 older people. The property is a large detached and extended building, standing in large and well-maintained grounds. It is situated in the Sid Valley approximately one mile from Sidmouth sea front. Bedroom accommodation for residents is on the ground and first floors, with a passenger lift to the first floor. All bedrooms are single occupancy. On the ground floor there is a lounge/dining room and separate smaller lounge. There is also a large conservatory that is used as a lounge. Copies of inspection reports can be requested from the home. Fee levels range from £450 to £650. Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
Several weeks before this inspection took place we asked the home to complete an Annual Quality Assurance Assessment (AQAA). They completed and returned it by the date we requested it. The form gave us some useful information about the way the home has been managed. We also sent some survey forms to the home and asked them to distribute them. We received three survey forms from people who live in the home, one survey forms from staff and one from a person who said they were not employed by the home (although the form they completed was specifically for staff). On the day of this inspection there were 18 people living in the home and one person was just about to move in the following day. Our visit to the home began at approximately 9.15 am and finished at approximately 5.30pm. The manager was off sick on the day of this inspection, although she came in for a brief period during the morning to discuss care plans, complaints, and she gave us access to the staff recruitment, training and employment records. During the day we also looked at medicine administration, menus, maintenance records, and the fire log book. We carried out a tour of the home, and looked at a random selection of bedrooms, bathrooms, toilets and the communal areas. What the service does well:
The home has good admission procedures that ensure people have enough information about the home and opportunities to visit and get to know the home before any decision to move in permanently is made. The company who own Malden House have recently introduced a new assessment and care planning system. The assessments we saw contained a good range of important information about each person’s family and friends, professionals involved in their care, and their health and personal care needs. The assessments helped the home decide if they were able to meet their needs. This information is then used to draw up and agree a plan of the person’s care needs. The care plans we looked at generally provided the care staff with clear instructions on how the person wanted to be assisted throughout the day. Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 6 The home employs an Activities Organiser who plans and organises a range of activities to suit the interests of most of the people who live there. People told us the standard of the meals provided is very good. The menus are varied and balanced and we heard that the chef takes great care to ensure everyone is offered a good choice of nutritious and tasty home cooked meals to suit all individual tastes. Special dietary needs are fully catered for. While most of the recruitment records we checked provided evidence of satisfactory references and checks, in one instance there was no evidence of a POVA 1st (protection of vulnerable adults) check. A copy of the confirmation e mail was forwarded to the Commission after the inspection that showed the home had taken up adequate checks before new staff had begun work. We were unable to see copies of the Criminal Records Bureau (CRB) checks during this visit but we were later given assurance by the company that the documents were held in the home. The records we saw showed that the home has taken all complaints, concerns or grumbles very seriously and has taken action promptly to address any issues raised. In the last year all staff have received training on the protection of vulnerable adults and they are now fully aware of the actions they must take if abuse is suspected. The home has been well maintained throughout. There is a programme of redecoration and upgrading and a maintenance person is employed to ensure that all repairs and maintenance is carried out promptly. All areas we looked at were comfortable and attractive. The gardens have been particularly well maintained and in the summer of 2008 the home won a Gold Award in the local Sidmouth in Bloom competition. The home has a range of methods to seek the views of the people living there, and their relatives or representatives. This includes the use of questionnaires, resident’s meetings, relative’s meetings, and by talking to people every day. We saw evidence to show that the home has either taken action, or have plans to address any issues that have arisen through these processes. What has improved since the last inspection?
Over the last year the care plans have been regularly reviewed to ensure they have been kept up-to-date. In the last year all care staff have received training on the prevention of pressure sores, and on palliative care. This means that any person in the home who becomes seriously ill or who may be close to death can be assured that staff now have the knowledge and skills to give them the care they need. Many aspects of the storage and administration of medicines have improved in the last year. Medicines are now stored in a quiet locked room, and a secure
Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 7 medicines trolley has been provided. Administration records have been completed each time medicines have been administered. The level of staff training has risen over the last year through a well planned training programme. The home has still not managed to achieve a level of at least 50 of staff with a nationally recognised qualification (known as NVQ’s), but they assured us that many staff were in the process of obtaining this qualification and when this is achieved they expect to exceed the 50 target. What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 9 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 Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home takes good care to assess people fully and ensure they have all the information they need before any decision to move in is made. EVIDENCE: In the few weeks before this inspection three new people had moved in and one person was expected to move in the day after this inspection. We looked at the way the home had assessed their needs and the information they had gathered about them. We also talked to some of the people to find out what information they had been given and how they had chosen Malden House. Some people told us they knew other people who had lived there, and others said their families had helped them to choose the home. We heard that people had been given written information about the home and had been encouraged to visit and get to know the home before they moved in.
Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 11 The company that owns the home had recently introduced a new assessment and care planning system. The new system had been used to gather important information about each person, their family and any professionals involved in their care before they moved in. They had gathered some basic information about the person’s abilities and the things they needed some assistance with and this information was used to draw up an initial care plan. When appropriate the home had also received a nursing assessment if the person had been discharged from hospital, and/or a social services assessment. The home told us in their Annual Quality Assurance Assessment (AQAA) – “Assessments are carried out on all potential Residents whether they are long term or respite to ensure that they meet our registration criteria and we will be able to fulfil their needs. We have a Service User guide on display in the front hall which states our aims and objectives, philosophy of care, services and facilities which are on offer. We aim to promote independence and maintain an active lifestyle. We are able to adapt our service to meet the changing needs of our Residents.” The home does not provide intermediate care. Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 12 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. 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. A recently introduced care planning system provides clear instructions to care staff on how each person wants to be assisted with their personal and health care needs, although some plans would benefit from greater detail about specific problems. Medicine storage and administration has improved over the last year and although we saw some weaknesses in the storage, recording and administration procedures the home acted promptly to address most issues. EVIDENCE: We looked at four care plan files to check the way the home plans and organises the care each person needs. We talked to the people whose care plans we looked at to check that the plans were accurate and gave the care
Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 13 staff a clear set of instructions with sufficient detail to ensure they gave the person the assistance they wanted at times to suit the individual. As already explained in the previous section (Choice of Home) the home had recently introduced a new care planning system and the manager had spent time transferring the information from the previous care plan documents. Some of the previous forms were still being used. These included nutritional assessments, manual handling assessments, and some parts of the care plan details. These forms showed that these specific areas of care and potential risk had been reviewed regularly. The new care plans included a “preferred routine” page that was written in large clear print. It set out clearly the person’s normal daily routines and explained to the care staff how the person wanted to be assisted with specific tasks throughout the day. We found that the care plans had been regularly reviewed. Overall we found that the care plans provided enough detail to give care staff a good basic understanding of each person’s individual needs. However, in some areas the plans lacked specific detail. For example one person was prone to depression and anxiety. The medication administration records showed that the person had been prescribed anti depressant tablets to be administered as required. There was no information in the care plans or the medicines administration records to explain when the tablets should be administered. The care plans did not explain what might trigger a bout of depression or anxiety, or any specific action that staff should take to support the person during these periods. We talked to one member of staff who had worked at the home for several years and we found that she understood the person well and knew what triggered the person’s anxiety. Therefore we were reassured that at least some of the staff understood the person’s needs. However, this information should be transferred to the care plans to ensure that new staff or agency staff have access to this information. We found that the care staff were extremely busy on the day of this inspection. Call bells were ringing constantly throughout the day, and at one stage four call bells were ringing and one person was heard banging on her table and calling out in order to try to attract the staff. The day before this inspection took place a new person had been admitted from hospital. The person had fallen during the night and suffered an injury. An ambulance had been called and paramedics had attended. The injury was diagnosed but a decision was made not to take the person to hospital. The person therefore needed additional assistance from the care staff. This placed an extra burden on the care staff team. Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 14 We found it was very difficult for the care staff to stop and talk to us. Some staff talked to us before they left at the end of their shift (this was in their own time). We found that the staff team were cheerful and positive and clearly enjoyed their work, but they confirmed that they were always rushed and that this meant they struggled to meet people’s care needs. We heard that recent new people who had moved in had increased their workload while staffing levels had not been increased. In addition the home had been without a cleaner for several weeks and the care staff had struggled to carry out cleaning and laundry tasks in addition to their regular care tasks. On the day of this inspection the manager was off sick and this also caused additional pressure on the care staff as they also had to carry out some of the tasks such as answering the telephone and dealing with care managers, visiting health professionals and relatives that would normally be carried out by the manager. We looked at the way the home stores and handles medicines. They used a monitored dosage system supplied by a local pharmacy. At the last inspection the home had recently changed ownership and the new owners had found some areas where poor practice had occurred, including poor recording procedures. The new owners quickly took action to address these problems. Over the last year care staff have received specific training on the safe administration of medicines. The medicines are now stored more securely in a locked trolley in a quiet room that is kept locked when not in use. Recent guidance from the Commission on safe storage and administration of medicines had been displayed on the wall in this room, indicating that the home were keeping up-to-date with current requirements and good practice. During this inspection we also found that the records of medicines administered had been signed each time a medicine has been given, and no unexplained gaps were found. This indicated that many areas of medicine storage and administration were now safer. However we found some aspects of medicine administration and storage that were unsatisfactory. These included the recording of medicines received into the home. A new person was admitted the day before this inspection. The names of each medicine and the amounts to be administered had been recorded, but the amounts of each medicine received into the home had not been counted and recorded. This meant that there was no safe method of accounting for each medicine. We talked to the member of staff who had been responsible for the receipt of the drugs into the home and she said she had been fully aware of the requirement to count and record the amount of each medicine received into the home but she had run out of time. (See Staffing section). A controlled drug was being administered at the time of this inspection. This had been recorded on the medicines administration recording sheets but the drug not been recorded in a controlled drug book as required. A book was
Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 15 available to record controlled drugs but it did not meet the required standard. The storage provided for controlled drugs did not meet current security standards. We talked to the manager four days after the inspection and she told us they had ordered the correct controlled drugs record book and a new secure controlled drugs safe. We were satisfied that the home had quickly taken action to ensure the home met current required standards. We also noted that the administration of the controlled drug had not been witnessed by a second, experienced and trained member of staff. Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 16 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. 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. People are offered a range of activities to suit most interests. People receive nutritious and tasty meals to suit their dietary needs and individual tastes. EVIDENCE: The home employs an Activities Organiser who has organised a range of activities for people living at Malden House. We saw a list of activities provided during December on display in the entrance hallway. This showed that something different had been planned for most days throughout the month. The home has a small lounge that has a large screen television, video and DVD players so that people can watch films or programmes of their choice. Outings are planned regularly, especially during warmer weather. We heard that board games and quizzes, and one-to-one chats have also been offered. On the day of this inspection a professional musician visited the home in the afternoon and a number of people sat and enjoyed listening to the music.
Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 17 Most of the people who completed a survey form before this inspection took place told us there are sometimes or usually activities they want to take part in. However, one person commented that the “Activities were very few”, and another person said they missed a previous activities organiser who had left earlier in the year. We talked to the manager to find out why a few people might not feel the activities offered by the home met their needs. We were given assurance that they are continuing to improve the range of activities through regular discussion with people. Resident’s meetings are held four times a year in the home. People are consulted on many of the daily activities in the home in these meetings. Relatives are invited to attend meetings twice a year to encourage feedback from them about the home and the services provided. On the day of this inspection we saw families and friends of the people living in the home visiting throughout the day. Everyone was made to feel welcome. We talked to the chef about the way people’s individual dietary needs and preferences have been met. The chef followed a set of menu plans that provided a good variety of well-balanced meals. The staff went around to each person to tell them what meals were planned for the following day and to check what they wanted. A record has been kept of the meals that each person has requested. They have also kept a record of the meals each person actually ate. The chef told us he provides special meals every day to meet individual requests in addition to the normal menu. He gave examples of recent requests for omelettes, salads, sandwiches and flans. He took a pride in producing tasty home-made meals using fresh ingredients. He made home-made soups, desserts and cakes every day. He explained how he likes to get to know any new person when they move in and find out what foods they enjoy, and any special dietary needs. The people we talked to during this inspection praised the standard of the meals provided. Many people told us the food is “Excellent.” Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that all complaints, concerns or suspicions of abuse will be listened to and acted on promptly and satisfactorily. EVIDENCE: The three people who completed a survey before this inspection took place told us that they knew how to make a complaint. The people we talked to also confirmed that they knew how to make a complaint and said they would talk to the manager if they had any concerns. The home told us in their AQAA – “We take all complaints seriously. We provide each resident with the complaints procedure on admission to the home. We are happy to meet with those who wish to voice concerns on a face-to-face basis. We hold relatives meetings to encourage relatives to voice any concerns they may have.” We looked at the records the home has kept of the complaints they have received in the last year. The records showed that each complaint had been listened to and acted upon. The staff training records showed that in the last year most staff have received training on the protection of vulnerable adults.
Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Malden House has been well maintained and provides comfortable and attractive accommodation for the people living there. At the time of this inspection the cleaning and laundry routines were unsatisfactory due to the lack of cleaning staff, although we were assured this was being addressed. EVIDENCE: We looked in approximately half of the bedrooms on a random tour, and also the communal bathrooms, toilets, lounges and dining room. We found that the home has generally been well maintained and attractively decorated and furnished throughout. The main communal lounge and dining room has recently been redecorated.
Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 20 There is a large bright and warm conservatory at the front of the house that provides a comfortable lounge space. There is also a dining room/lounge and a small quiet lounge with large screen television. All areas have been attractively furnished and decorated, and there were fresh flowers in the communal areas that created a welcoming and homely atmosphere. People have been encouraged to bring furniture, pictures and personal effects in order to make their rooms feel more homely. The bedrooms were bright and warm and in good order. Some of the communal bathrooms were beginning to show signs of wear and tear. The home told us they plan to upgrade these areas in the next year. One person who completed a survey form told us the “Washroom could be cleaner.” During our visit we found that the lounges, dining room and corridors appeared clean, along with many of the bedrooms. However some bedrooms appeared to be in need of vacuuming. We talked to the manager about problems with the cleaning and we heard that the cleaner had left several weeks ago. The manager said she was in the process of recruiting a new cleaner. In the meantime no additional cover had been provided and the care staff had been expected to carry out cleaning duties along with their caring tasks. We talked to the care staff on duty on the day of our visit and heard that they had vacuumed the whole home three days before. However, some bedrooms (especially those where people stayed in their rooms all day) needed to be vacuumed every day. We heard that several new people had moved in recently and this had created additional work for the care staff, leaving little time for cleaning or laundry duties. There was laundry piling up in the laundry room on the day of this inspection. The home employs a gardener/maintenance man. We talked to him and checked the maintenance record in the front hallway. We found that repairs were carried out promptly as soon as they have been reported. There are attractive gardens to the front and rear of the house. There are lawns, flower beds, trees and shrubs and places to sit and enjoy the gardens. The home won the Gold Award for the Sidmouth in Bloom award 2008. Malden House DS0000070693.V373639.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Unsatisfactory arrangements for providing additional staff cover during periods of staff sickness, staff vacancies, and times of high dependency levels has resulted in staff being rushed at times and some important tasks not being carried out correctly. The home follows satisfactory recruitment procedures that will protect vulnerable people from abuse. The level of qualified and competent staff has risen over the last year due to a good training programme. EVIDENCE: On the day of this inspection there were 18 people living in the home and another person was due to move in the following day. The manager was off sick on the day. There were 3 care workers on duty during the morning (one of these was an agency staff), plus a cook, an activities person and the maintenance man. In the afternoon there were 2 care workers, an activities person and the maintenance man. The home employs a cook every morning until early afternoon. In addition the cook also works two afternoons to provide supper. On the other five days the
Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 22 care workers prepare and serve the evening meals in addition to their other duties. We heard that the home is planning to recruit a supper cook for the remaining five days per week. As already stated elsewhere in this report (see Health and Personal Care and also Environment) the care staff were very busy throughout the day. Call bells were ringing constantly and it was very difficult for us to talk to the staff during the day. However, when we did manage to talk to them we found they were cheerful and positive. Despite the pressures on them they were calm and organised and managed to ensure that most of the regular care tasks were carried out. However, we found some tasks had not been carried out due to lack of time and these included cleaning and laundry duties, and some medicines received into the home had not been counted and recorded. The care staff we talked to said that they are always very busy, but recent new people moving into the home had caused added pressures. The home had been without a cleaner for several weeks. The manager told us she was in the process of recruiting a new person to this post. We were confident that the recruitment of a new person to this post will relieve some of the pressures faced by the care staff at the time of this inspection. We talked to the manager and we also talked to a senior manager employed by the company about staffing levels. We were assured that the home was in the process of recruiting a new cleaner. We also recognised that on the day of this inspection the situation was more difficult due to the manager being off sick, as the care staff were left to answer telephone calls and deal with visitors (including us). We talked to the manager on the telephone two days after this inspection and she assured us that agency staff had been employed to cover the cleaning duties. We were also told that they were considering increasing the care staffing levels due to the increase in numbers of people living in the home. We checked four employment files of staff recruited in the last year. We were unable to see copies of the Criminal Records Bureau (CRB) checks on the day but senior managers assured us following this inspection that the CRB records had been retained. During our visit we saw confirmation e mails that showed 3 of the 4 staff had been checked against the Protection of Vulnerable People (POVA 1st) list before they began work. No evidence was available for the 4th member of staff on the day of this inspection – evidence was forwarded to the Commission a few days after this visit. Information provided before this inspection took place in the AQAA, and on the day of our visit, showed that staff training has increased over the last year. The AQAA showed that the home employed 14 permanent care workers but only 2 of these held a nationally recognised qualification known as an NVQ to at least level 2. However, AQAA also showed that 70 of staff either held, or Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 23 were in the process of obtaining this qualification. This suggested that many staff were working towards this professional qualification. A training matrix has been completed by the home to show the training topics covered by each member of staff over the last year. This showed that staff have received a good range of training on all required health and safety topics, plus relevant health related topics including pressure area care, palliative care, and the Mental Capacity Act. Malden House DS0000070693.V373639.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well managed but there are weaknesses in the management of people’s physical needs that potentially places people who live and work in the home at risk. Good systems have been followed to seek people’s views on the standard of the services and a plan of improvements has been drawn up as a result of this. EVIDENCE: Since the last inspection the manager, Sharon Hunt, has been registered with the Commission. She has been in post just over a year. The registration process has confirmed that she is suitably qualified and experienced.
Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 25 On a side table in the main lounge/dining room there was a large print copy of the results of the home’s latest survey results. This demonstrated very good practice as it showed that the home had not only asked people for their views, but had also let them know the outcomes and what they planned to do to address any issues that had arisen. In addition to the use of questionnaires the home holds Resident’s Meetings four times a year. The manager also told us she has an ‘open door’ policy and also walks around the home every day to talk to people and check that people are satisfied with the care and services. We saw records of staff supervision sessions that have been held where there have been issues with specific staff. However there were no records of regular one-to-one supervision sessions other members of staff. The manager told us this had been difficult recently due to staff sickness but regular supervision sessions are planned for the coming year. The home’s completed AQAA shows that staff meetings have been held regularly. Since the last inspection secure lockable storage has been installed in each bedroom so that people can store money or valuables safely. The home does not hold cash on behalf of people and instead they will pay for regular items such as hairdressing, chiropody and sundry items and will invoice the person once a month. This reduces the risk to the home of cash being lost or errors being made. It also encourages people to retain responsibility for their own money and valuables, with support from their family or representatives if necessary. We looked at some of the home’s records on health and safety, including the fire log book and staff training records. We found that the home has carried out regular safety checks and servicing on all equipment. Staff have also received regular training and updates on all health and safety related topics. The home does not provide hoisting equipment for people who are unable to get themselves up out of a bed or a chair. The home has a ‘no lifting’ policy and have stated that if any person needs to be lifted they cannot remain in the home. At the time of this inspection there were a few people who were frail or poorly and who needed two care staff to assist them to move safely. We heard that at times the staff have had no option but to manually lift people even though they knew this was against the home’s policy. We talked to the manager about the unacceptable risks to the staff’s health and safety if they lifted people, and we asked her to discuss with her line managers the options the home can take, including obtaining suitable moving and handling equipment. Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 26 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 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 X 18 3 3 3 3 X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x 2 x 2 Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 27 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. 1. Standard OP9 Regulation 13(2) Requirement Timescale for action 01/03/09 2. OP27 18 (1) (a) 4. OP38 13 (5) All medicines received into the home must be recorded accurately to provide a clear system of accounting for all medicines held by the home and administered. Controlled drugs must be stored, recorded and administered according to current guidelines. There must be sufficient staff on 01/02/09 duty to meet the personal and health care needs of the people living in the home, and to ensure the home is clean and safe at all times. A safe system of moving and 01/03/09 handling people should be followed at all times. Staff should not be placed at risk of harm due to the lack of suitable equipment during those times when people living in the home have mobility problems and need to be lifted. Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 28 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 OP7 OP8 Good Practice Recommendations Care plans should explain clearly any special support and assistance to be given to people who have special health needs such as anxiety. The home’s recording systems should clearly set out any special information about medicines, including medicines that are prescribed on an ‘as required’ basis such as sedatives and pain relief. The care plans should explain when these medicines should be given and there should be a review mechanism in place to ensure the medicines have been administered correctly. Cleaning routines should be improved and sufficient staff should be employed to ensure that all areas are cleaned and vacuumed regularly. Staff should continue to work towards obtaining a recognised and relevant professional qualification so that at least 50 of staff are suitably qualified. All staff should receive individual supervision at least six times a year. 3. 4 5 OP26 OP28 OP36 Malden House DS0000070693.V373639.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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