Inspection on 28/01/08 for Malden House

This inspection was carried out on 28th January 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Malden House 02/01/09

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Malden House 69 Sidford Road Sidmouth Devon EX10 9LR Lead Inspector Vivien Stephens Unannounced Inspection 28th January 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Malden House DS0000070693.V353185.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.V353185.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 Post vacant Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Date of last inspection 9th January 2007 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. At the time of this inspection the range of fees was between £425 and £675 per week. Malden House DS0000070693.V353185.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. The home was sold to the present owners, Hartford Care Ltd, during September 2007. A few weeks after the change of ownership the registered manager resigned on health grounds. The deputy manager was given the post of Acting Manager temporarily until a new manager was appointed. We were told during this inspection that a new manager has been appointed and will take up her new post at the beginning of March 2008. The providers were in the process of providing detailed information about the home on their website at the time of this inspection – see www.malden-house.co.uk Several weeks before this inspection took place (and just before she resigned) the registered manager completed an Annual Quality Assurance Assessments and submitted it to the Commission. When we received this form we sent survey forms to the people living in the home, their relatives and representatives, to health and social care professionals and to the staff team. We received 8 completed forms from people living in the home, 6 from relatives/representatives, 4 from health and social care professionals and 3 from the staff team. Their responses have helped us to form the judgements we have reached in this report. This visit to Malden House began at approximately 9.45am and finished at 5.30pm. During the day we talked to the Acting Manager, four members of staff, ten people who live at the home, and also Mrs Jo Gavin who is the Responsible Individual on behalf of Hartford Care (Southern) Ltd, and also the registered manager of another Hartford Care home who has been visiting Malden House on a regular basis to support the Acting Manager. We carried out a tour of the premises, checking most of the bedrooms, all of the communal areas, the laundry, kitchen and offices. We also looked at some of the records the home is required to maintain, including assessment documents, care plans and daily reports, medication administration, menus, health and safety records, staff recruitment, supervision and training records. What the service does well: Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 6 Good care is taken before new people move in to make sure the home understand exactly what help the person wants and needs. The home will not let anyone move in unless they are certain they can provide the right care to meet their needs. They also give the person every opportunity to visit, ask questions and get to know they home before they decide to move in. Good written information is provided giving a wide range of information about daily life at the home. Experienced chefs are employed and they provide a good variety of nutritious and tasty meals to suit all individual tastes. People can request an alternative if they don’t like the main meal on offer. Individual dietary needs are catered for, and the chefs take great effort to make meals appetising especially for those who have poor appetites. Good systems have been put in place to ensure that all complaints, concerns or grumbles will be listened to and acted on promptly and satisfactorily. Staff have received training on adult protection and policies and procedures are in place to ensure any suspicion of abuse is acted upon in accordance with current good practice guidelines. Malden House has been well maintained and provides comfortable and attractive accommodation for the people living there. People particularly enjoy the lovely gardens. Good procedures are in place to ensure that people are safeguarded from harm. What has improved since the last inspection? Since taking over the home in September 2007 the new owners have made many improvements to the home, and have plans to make many more in the near future. An Activities Organiser has recently been employed and people told us how she has transformed daily life at the home. There is now a full and varied weekly timetable of activities to suit all interests. On the day of this inspection we saw a group of people taking part in an exercise session. We heard how people enjoy regular trips out, walks in the garden, board games, music, videos, or just sitting and chatting. The owners have put in place robust recruitment procedures to ensure that they only recruit staff who are entirely suitable. No new staff begin work until satisfactory references and checks are received. Thorough induction training procedures have been implemented. A wide range of training has been provided in recent weeks on all required topics. Plans have been put in place for future training for all staff including nationally recognised qualifications known as NVQ’s. Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 7 Good quality assurance systems have been implemented. We could see how the home has sought people’s views and acted on they have said. We saw the changes and improvements they have made, and are about to make, as a result of their quality assurance system. What they could do better: We heard how the change of ownership of the home coincided with a difficult period for the home when a number of staff resigned for various personal reasons. Many people commented on this difficult time, but we also heard about the way the new owners are addressing issues they have found. The following comment from a relative sums up what we found – “The transition of owners has been unstable, especially due to staff shortages. I have been assured that this is being dealt with, and feel confident that the new owners will soon resolve these issues. We are particularly impressed by the Manager, Jo Gavin, who has been reassuring and very professional during the transition.” New care planning systems are being developed, and, when completed these will help to make sure that people receive the assistance they need from the care staff. We were told that the home expects to complete the care plans soon after the new manager begins work in March 2008. However, at the time of this inspection we found some blank sections in the care plans that left care staff without guidance on important areas of people’s care needs. Following a serious concern that was raised by a hospital in August 2007 (just before the home was sold) relating to a person who was admitted with pressure sores, the home was asked to ensure that assessments are carried out to identify those people who may be at risk of developing pressure sores. During this visit we found that the relevant assessments in the care plans had not been completed and staff had not received training on the prevention of pressure sores. We also found that, while made many improvements have been made to the security and safe administration of medicines, some problems were still noted. Some gaps in the medicines administration records had not been followed up correctly to establish whether an error had occurred. A mistake had been made in the administration of an antibiotic and there had been no checks in place to pick this up quickly and prevent further error. No system was in place for recording the administration of creams and lotions, and for monitoring the skin to ensure the treatment is working. We also found there was no clear guidance to care workers on how to administer medicines that had been prescribed on an ‘as required’ basis. An audit of the medicines procedures had been carried out a few days before our visit and these matters had been picked up. We were told that they were planning to implement changes in the very near future to address these issues. Some people told us that the standard of cleanliness had dropped recently. We heard that this had been due to the shortage of staff at the end of 2007 Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 8 and that this was being addressed by the recruitment of new staff, although not fully resolved at the time of this inspection. 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. The summary of this inspection report can be made available in other formats on request. Malden House DS0000070693.V353185.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.V353185.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): Quality in this outcome area is good. 1, 2, 3, 6 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: Hartford Care Ltd provide a comprehensive information pack to people who may be thinking about moving to Malden House. Further information is also available on their internet web site. The Annual Quality Assurance Assessment completed by the providers before this inspection gave the following information about their assessment procedure – “We use an assessment tool for prospective residents to ensure they would meet the criteria applicable to our registration. Even if we have vacancies we do not accept residents whose needs we would be unable to meet at the time Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 11 or in the foreseeable future. It is unacceptable to accommodate a resident who will clearly need an alternative form of care in the near future necessitating an unsettling move for them. We encourage all prospective residents, if they are able, to visit the home prior to admission so they are able to ask questions and be sure they know the type of home we run and whether it would suit them. We offer a months trial period to all new residents to ensure that we are able to meet their care needs and that the right decision has been made. “ We heard from some of the people living at the home about the help they were given when they were thinking about moving in. Some had help from friends or family. One person said the home was recommended by her doctor. They all said they felt they had sufficient information to help them make the right decision. We also heard that some people had stayed at the home for a short break before making a decision about moving in permanently. We looked at the files of four people who had moved into the home in the last year. We found the home had gathered good information about the person to help them decide whether they were able to meet their care needs. We were told that it will normally be the responsibility of the manager or deputy manager to carry out intitial assessments – this will ensure that all assessments are carried out by a person who is suitably experienced and trained. We saw that some people have received contracts of residence from the new owners. We were told that the company are in the process of providing new contracts to every person living in the home. The home does not provide intermediate care. Malden House DS0000070693.V353185.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 adequate. This judgement has been made using available evidence including a visit to this service. Good care planning systems are being developed. In the meantime some gaps in the care planning and risk assessment may leave people at risk of developing health problems. Personal care is delivered to people in a way that respects their privacy and dignity. While many improvements have recently been made to the security and safe administration of medicines, further improvements and training are necessary to ensure the risk of error is minimised. EVIDENCE: We looked at the care plans of four people living in the home. We saw that a new care planning system has been introduced since the Hartford Care took over ownership of the home. We found that the main assessment sections had been completed, but many other important sections were still incomplete. We talked to Jo Gavin and the Acting Manager about their proposed timescales for Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 13 completion of these documents. We were told that when the new manager starts work at the beginning of March 2008 this will allow the current Acting Manager to spend more time on getting the care plans finished, and they hope the documents will be completed soon after this date. The care plans have been moved to a room that has recently been converted into an office and secure storage for medicines. All care staff are now expected to complete the daily report section in the care plans and to know what is written in the care plans. The care staff told us they like the new care planning system but they said they have found it has taken them some time to get used to the new way of working. The introduction of daily reports by the care workers demonstrated a big improvement on the previous practices in the home. It is now much less likely that poor practice will be unrecorded, and therefore not acted upon. The daily care notes gave us evidence of lots of good practice. We also saw an example of where poor practice had been discovered by a care worker and recorded in the daily notes. We talked to the care worker, the Acting Manager, and to Jo Gavin about the action that had been taken when this poor practice had been discovered. We were given assurances that the staff had been given verbal instructions in the daily handover sessions and they were confident that all staff were aware of the practice they should follow in future. However, this incident had not prompted a care plan review, and no written instructions could be seen anywhere to remind care staff on a daily basis on the way they should deliver care to this person in future. We were told about plans to introduce a covering sheet giving the preferred daily routine for each person and instructions to staff on how the person wants to be cared for. These will be reviewed and amended regularly to ensure they are always up-to-date. The people who completed a survey form before this inspection told us that they were satisfied with the way the home meets their personal and health care needs. We received several positive comments, including – “The support and care my father receives is excellent.” During September 2007 a concern was raised by a hospital following the admission of a person living at Malden House who was suffering from pressure sores (see also Complaints and Protection). Investigations were carried out but no conclusions were reached about the cause of the pressure sores. (Please note – this concern was raised during the previous ownership and management of the home). The current owners were informed of the outcome of the investigations and at the time they gave assurances that a programme of staff training, new care planning systems and risk assessments would be put in place. They agreed to provide specific training on skin care and prevention of pressure sores. At this inspection we found that no risk assessments had been carried out to identify the risk of pressure sores, and staff have not received specific training on skin care or prevention of pressure sores, Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 14 although the manual handling training had covered some aspects of skin care. We were given assurances that this will be put in place as soon as possible. We received three responses from GP’s and health and social care professionals. One response was very positive, with the comment “a very caring home”. One response was satisfactory, while another respondent told us they were “Never escorted to the patient”. We talked to the Assistant manager about this. She agreed that for a couple of months they had been extremely busy due to staffing problems and they had been unable to escort health professionals when they visited. She assured us that they have recruited new staff and are no longer so busy. Their current practice is always to escort health and social care professionals to the person when they visit. If the person wishes, they will remain with the person during the visit to ensure that they receive any instructions on changes to the care needs. We looked at the way the home stores, administers and records medicines. We found that the new owners have already made many improvements to the administration systems. The storage of medicines is now much more secure. A lockable medicines trolley has been purchased. The staff now take medicines in the trolley to administer straight from the pharmacy packaging to the person. This represents a significant improvement to the previous system of taking medicines in pill pots on meal trays. One person living in the home told us they thought they didn’t always get their tablets on time. We talked to the Acting Manager and care workers about why this person may have this concern. We were told that the introduction of the new medicines trolley had brought a change in the way medicines are given and this may have resulted in some people having their tablets a few minutes earlier or later than they had previously received them. They are, however, given out at a time much closer to the times set out on the Medicines Administration Record than previously given. We were told that people have now become used to the new way of administering medicines, and everyone has recognised that the new system is much safer. We noticed there were some gaps in the administration records that could not be explained. The staff said they were aware of the procedure that should be followed if they noticed a gap in the records, but despite this, no action had been taken. We also saw that in one case a person had been prescribed antibiotics to be given three times a day, but the records showed that the person had been given the tablets four times a day. We were told that the company had recently carried out an audit of the medicine administration procedures where they had picked up these problems and had already drawn up a plan to address some of the issues. We also heard that a training session had been booked on the safe administration of medicines for the following day. We were give assurances that the issues raised during this inspection would be covered during the training session. Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 15 We looked at the way the home administers creams and lotions that people have been prescribed. We found that there was no explanation in the care plans about how, where or why the creams should be applied, although we were told that in some cases the pharmacist has printed instructions on the packaging. A member of staff told us that one person self-administered her own creams but we found that this was not explained in the care plans or in the medicines administration charts. There were no records of administration of creams, and no explanation of how to monitor the person’s skin or action to be taken if the condition worsens or improves. The medical section of the care plan had not been completed in any of the care plans. We saw examples in the Medicines Administration Record of medicines that had been prescribed to be given on an occasional basis, when needed, were being administered routinely. We could see no reference in the care plans as to why this was happening. The care staff assured us that the person asked for the medicines every day and relied upon them. We talked to the Acting Manager about the importance of explaining in the care plans and/or the medicines administration records how medicines should be administered and why- particularly where sedatives, pain relief and other medicines are prescribed on an ‘as required’ basis. Malden House DS0000070693.V353185.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 excellent This judgement has been made using available evidence including a visit to this service. All aspects of daily life at Malden House are stimulating, interesting, and personalised to suit individual choice and preferences. People receive nutritious and tasty meals to suit their dietary needs and individual tastes. EVIDENCE: Since Hartford Care took over the ownership of the home significant improvements have been made to the daily life in the home. Many people told us how much they enjoy the activities provided by the recently appointed Activities Organiser. The comments we received included “Since the activity organiser arrived things seem to be moving in the right direction” “New appointment of activities lady seems an excellent idea. “I am pleased to note there will be more residents’ meetings. The appointment of an activities organiser has been an excellent decision.” “Social needs have improved under new ownership.” Activities have “improved greatly since Jean’s arrival”. Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 17 We talked to the Activities Organiser about how she has developed the weekly programme of activities. She gave us a copy of the current week’s plan of activities and told us that people had asked her for a weekly sheet, and for the colour of the paper to be changed each week to help them know which is the current plan of activities. She told us how she has consulted with everyone to find out what they want to do. The plan includes time for individuals – just for a chat if that is what they want – and also time for small groups either in the home or out in the community. On the day of this inspection a group took part in an exercise session in the conservatory. The week’s plan also included a trip out to look at the sea, film matinee’s board games, musical entertainments and an in-house shop. One person told in their survey form that they would like the staff to help them take a walk in the garden every day. During our visit we heard that the home has talked to the person about how this could be achieved, and a first step was to offer the person a ground floor room with patio doors opening onto the garden so that, in warmer weather, the person can go out safely on their own if they want. We were also told about the future plans to improve the care for each individual once the new manager starts, and when the recently recruited staff have settled into their new working patterns. The sheet we were given with the current week’s plan of activities included a note at the bottom that said “If you would like a walk in the garden or special requests please let Jean know.” We heard how families and friends are encouraged to visit, and how this will be improved in the future. They plan to improve car parking at the home so that people can visit more easily. They also plan to encourage people to enter through the front door rather than the back door, and to be welcomed by staff, offered refreshments, and escorted to the person they are visiting. We heard that, at times in the past people have entered the home through the back door without being noticed. They also plan to hold regular residents’ meetings, and to invite families to attend if they wish. We were told that the local vicar visits on the first Friday of each month and holds a communion service for those wishing to attend. People can receive the sacrament in the privacy of their rooms if they wish. Care plans included details of each person’s religion. We talked to ten people who live in the home. In addition seven people completed a survey form. Almost everyone praised the food highly. Comments included “Food is excellent.” People told us that the chefs are highly skilled and produce a good range of nutritious and tasty home-cooked meals. People told us about their favourite foods including homemade chocolate éclairs. We sampled the freshly made carrot cake and found it was delicious! We looked at the meals served to people midday and saw they were attractively presented, and looked appetising. Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 18 We looked at the printed menu that was displayed in the dining room and found the meals are varied and balanced. People are offered suitable alternatives if they do not like the main meal offered. One person told us there was “Too much pepper in food sometimes”. We talked to the chef about this. The chef told us that he goes out and talks to people every day about the meals and he is always willing to adjust the meals to suit individuals. He talked about the herbs and seasonings he uses, and how most people enjoyed meals that are well seasoned and strong flavours, but said that if the person told him they do not like strongly seasoned foods he would find a way to meet their individual tastes. He gave examples of how he has cooked meals individually to suit particular tastes or nutritional needs. We heard how foods are puree’d individually for people who can only eat soft food. The kitchen is modern and well equipped. The fittings are stainless steel. The home has not received a visit from the Environmental Health Officer in the last year and therefore no recent report was available. The kitchen appeared clean and well organised. The dining room has been attractively decorated and furnished. People can eat their meals in the dining room or in their own rooms according to their individual wishes. Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 19 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): 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 people we talked to during this inspection told us they felt confident that they could talk to the Acting Manager or to a representative of Hartford care Ltd if they had a concern or complaint, and they felt confident their concerns would be listened to and acted upon. One person who completed a survey form said they were unsure how to make a complaint since the home had changed ownership. We talked to Jo Gavin and the Acting Manager and we were given assurances that in recent weeks everyone has been given information about the new owners and management of the home, and that everyone now knows how to make a complaint. One person we talked to during this visit to the home told us “I feel I am in safe hands. They look after me well.” We looked at the records that have been maintained of complaints and compliments received. We found that the home has recorded complaints clearly and could demonstrate that they had taken the matter seriously, listened and taken action to resolve the matter to the person’s satisfaction. Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 20 We could also see that people have written to praise the staff for the good standard of care given. Since the last inspection one serious concern was raised in September 2007 under the previous ownership. A person had been admitted to hospital suffering with pressure sores. The matter was investigated and we found the records maintained by the home had been poor. The records failed to show that safe procedures had been followed when a skin problem had been noticed by a care worker. However, the outcome of the investigations were inconclusive. By the time the investigations had been completed the home had been sold. We talked to the new owners and the registered manager about the actions they should take to prevent similar concerns in future. These include risk assessments, training for care workers, and liaison with health professionals to ensure correct treatment is received. (See also section 2 – Health and Personal Care). Since the new owners took over the home all staff have received training on the protection of vulnerable adults and prevention of abuse. The new owners have introduced their own policies and procedures, including policies on protection, preventions of abuse and ‘whistle blowing’. We were told that the home has been asked to personalise the policies to ensure they are relevant to the home, and to ensure each member of staff is aware of, and understands the policies. The records of staff recruited since the new owners took over demonstrated that they have taken good care to ensure that the staff are entirely suitable before they are confirmed in post. (See also section on Staffing). Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 21 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, 26 Quality in this outcome area is good 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. People now benefit from recently introduced cleaning routines following a change of ownership and newly recruited staff. EVIDENCE: During our visit we carried out a tour of the home. We looked at most of the bedrooms, all of the communal areas, the kitchen, laundry and offices. We found the overall standard of maintenance, decoration and furnishings in the home was either good or excellent. The communal areas are spacious and comfortable. There are three different lounge areas and a dining room. Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 22 When bedrooms become vacant the rooms are redecorated and furnishings are renewed as necessary. On the day of this inspection a maintenance man was working in an empty room. The room was being redecorated, the washbasin/vanity unit was being replaced, and the radiator was about to be covered. We were told the carpet will be replaced. Most of the carpets are of good quality and in good condition. In some of the corridors, hall and landing the carpets have become worn and we were shown samples of the new carpets that have been ordered. We were also told about plans to replace some of the chairs. The gardens are large and well maintained. Many of the people we talked to said how much they appreciate and enjoy the gardens. There are safe paths and various sitting areas, a greenhouse and attractive planted areas. Comments we received from people included – “Nice atmosphere with lovely garden.” All bedrooms are single occupancy. Most have en suite facilities. One person told us they felt the car parking was poor. We talked to Jo Gavin about this. She told us they have plans to create a larger entrance area with improved car parking. They want to encourage people to use the front door when entering the home, rather than the back door – this will in turn lead to improved security and a better welcome for people when they arrive. Two people told us they were unhappy with the cleaning routines in the home – “The staff need to take more care when cleaning rooms especially as ‘bugs’ can be spread rapidly among older people, ” and “Carpet in my room needs hovering more frequently”. In a tour of the home we found that most areas appeared clean, although a few carpets showed some dust and looked as though they had not been vacuumed that day. We talked to the Acting Manager about the cleaning routines. She admitted that, at the end of 2007, several permanent staff left, leaving the home short staffed. Some cleaning tasks were missed as personal care tasks were treated as a priority. She said that new housekeeping staff have been recruited and they are beginning to reestablish good cleaning routines. A few days before this inspection took place all staff received training on infection control. We looked at the laundry and the way the home deals with clothing and other routine laundry tasks. The laundry is well-equipped, clean, and in good working order. The room is small and, while there is room to hang items of clothing, there is no room to provide a separate laundry basket for each person. A care worker told us that the day staff do the washing and night staff do the ironing. We saw that all items of clothing have been clearly marked and we were reassured that the staff take good care to ensure that clothing is Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 23 washed, dried and ironed quickly and returned to the correct person. The laundry was tidy and all washing was up-to-date. Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence including a visit to this service. People’s needs are met by sufficient competent, trained and experienced staff. Despite recent staff changes the new team are positive and enthusiastic and the home is working towards a high standard of staff recruitment, training and supervision. EVIDENCE: We were told that a few weeks after the new owners took over the home the registered manager left on health grounds and several other staff resigned for various personal reasons. This left the home understaffed for several weeks, and they had to use agency staff to fill vacant shifts. This was a very difficult time and they talked about how hard they had to work just to make sure basic tasks were covered. We were also told that, since the beginning of January 2008 several new staff have been recruited and the staff team were beginning to feel much more positive. We were told that there is now a very happy atmosphere throughout the home and the staff team were working well together. They told us how much their spirits have been lifted with the many improvements that have been made in all areas of the home, and staff said they felt as if they were beginning to ‘see the light at the end of the tunnel’. They said they were Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 25 beginning to enjoy their jobs and feel proud of the achievements they are beginning to make. We looked at four files of staff who have recently been recruited. The new owners have implemented efficient new filing systems that provide clear information about the dates each stage of the recruitment have been completed. We found that all necessary checks and references have been taken up before the staff have been confirmed in post. Each new member of staff recruited under the new ownership has completed a comprehensive induction training following a nationally recognised induction training standard. The staff have been given workbooks to follow, and each section has been signed by the person and the supervisor to confirm the section has been covered and understood. We talked to the care staff about the training they had received. They told us they had received a very large amount of training since the new owners had taken over. They told us that, while they had found there had been a huge amount of knowledge to take in over a very short space of time, they had enjoyed the training and recognised it’s importance. The staff were especially pleased about the moving and handling training they had received and the new equipment that has been provided, and talked about how much this has improved the safety within the home. We were given a copy of the recent training plan for all members of staff. We could see the dates that each staff had received training on health and safety topics, and the future training planned, including dementia, food hygiene, palliative care and prevention of falls. During the day we talked to a trainer employed by a local college who was visiting the home to agree future training for the staff team including nationally recognised qualifications known as NVQ’s. The trainer told us how impressed she was with the way the home was now addressing the training needs of the staff team. Seven staff were about to begin NVQ level 2 and one staff was about to begin NVQ level 3. Several people commented that some of the staff recruited from overseas have poor English language skills, and this has caused some communication problems for the people living in the home. We talked to the Acting Manager who said that some overseas staff had recently left and the remaining staff had reasonably good communication skills. All of the people we talked to during this inspection praised the permanent and experienced staff. Comments included “All staff are caring and helpful.” However, some people had been concerned about the high staff turnover towards the end of 2007. One person said “Experienced staff give a wonderful service but newer staff don’t seem to stay very long and aren’t trained very Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 26 much. “ We were satisfied that, while high staff turnover and poor staff training had been a problem in 2007, this had been addressed since the start of this year and that everyone was feeling much happier and more positive about the future at the time of our visit to the home. Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 27 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 good. This judgement has been made using available evidence including a visit to this service. The home is well managed. Systems are being put in place to regularly check on the standard of the services and make improvements where necessary. Good procedures are followed to ensure that people are safeguarded from harm. EVIDENCE: As already stated elsewhere in this report, the registered manager resigned at the end of 2007 and the deputy manager was appointed as Acting Manager on a temporary basis. She has been supported on a weekly basis by the registered manager of another home owned by Hartford Care Ltd. A new manager has been appointed and will take up her new post at the beginning of Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 28 March 2008. The people we talked to during our visit were happy with the way the home has been managed by the Acting Manager. Regular visits to the home have been carried out by the Responsible Individual in accordance with the regulations to the Care Standards Act. A record of these visits was seen during this inspection. The new owners have conducted their own quality assurance survey since taking over ownership of Malden House. They showed us the results of their survey and we found that many of the comments were similar to those we received in our survey. They were able to show us that they had listened to the things people had told them and had already taken action to address any issues raised. We were told that they plan to have various ways of consulting with people, including residents and relatives meetings, in order to ensure they are continuously improving the quality of the service. The home does not handle any cash or finances on behalf of people living at the home. People are encouraged to handle their own financial affairs. If people do not want to hold cash for personal items in their rooms the home will pay for incidentals such as hairdressing on their behalf and will invoice them monthly for items purchased. This significantly reduces the risk of financial abuse on people living in the home by any member of the home’s staff. The new owners have implemented many improvements to the health and safety procedures within the home. All staff have received training on health and safety topics, and further training is planned for the near future, including the control of substances hazardous to health(COSHH), food hygiene and health and safety. Training received recently has included fire safety, manual handling, infection control and first aid. We looked at the fire log book and saw evidence that regular safety checks and maintenance of the fire safety equipment has been carried out. The new owners have recently carried out a fire risk assessment. They told us about action they have taken to minimise the risk of fire as a result of this risk assessment. All accidents and incidents have been recorded appropriately and the owners have carried out a regular audit of the accidents and taken action where necessary to minimise the risk of further accidents. Hartford Care have introduced their own policies and procedures to the home covering all areas of health, safety and protection. These have been reviewed to ensure they are relevant to Malden House, and they have gradually been presented to the staff team to ensure they understand the content of the policies. Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 29 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 3 3 x x 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 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 3 18 3 3 X X X X X x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X x 3 Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15(2) Timescale for action Care plans must be reviewed and 01/04/08 updated regularly and must demonstrate any changes in care needs. The home must take sufficient action to prevent people from developing skin problems, including pressure sores. Action should include risk assessments, staff training, efficient working routines, good recording and reviewing systems and any equipment necessary. Any gaps in medicine administration records to be investigated and action taken. Regular audits of medicine administration to ensure that errors are picked up quickly and acted upon. 01/04/08 Requirement 2 OP8 12 3 OP9 13(2) 01/03/08 Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 31 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 OP7 Good Practice Recommendations The home should continue to work towards completing each section of the new care planning system and to agree the contents of the plans with the person the plan relates to. 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. The home must continue to improve the cleaning routines to ensure that all areas are cleaned and vacuumed regularly. 2 OP8 3 OP26 Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 © 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 Malden House DS0000070693.V353185.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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