Inspection on 25/07/08 for Mallard Court

This inspection was carried out on 25th July 2008.

CSCI found this care home to be providing an Good 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

Mallard Court 30/07/07

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Mallard Court Avocet Way Kingsmeade Bridlington East Yorkshire YO15 3NT Lead Inspector Anne Prankitt Key Unannounced Inspection 25th and 28th July 2008 10:30 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 Mallard Court DS0000069344.V369198.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. Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mallard Court Address Avocet Way Kingsmeade Bridlington East Yorkshire YO15 3NT 01262 401543 01262 403344 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) www.barchester.com Barchester Healthcare Homes Ltd Mrs Sylvia Mary Burnett Care Home 70 Category(ies) of Dementia (70), Old age, not falling within any registration, with number other category (70), Physical disability (70) of places Mallard Court DS0000069344.V369198.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 only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Dementia - Code DE and Physical disability - Code PD The maximum number of service users who can be accommodated is: 70 30th July 2007 2. Date of last inspection Brief Description of the Service: Mallard Court is a Care Home with nursing that provides a service for people who meet the following criteria of need: - Dementia, Old Age and Physical Disability. The home is situated in the town of Bridlington and enables easy access to the local shops and public transport routes. Accommodation consists of seventy places within single and double rooms on two floors with lift and stair access. People have a choice of lounges and dining rooms in which they can relax and enjoy the company of others. The grounds of the home are designed to be accessible to those in wheelchairs and with mobility problems. Information about the home and its service can be found in the Statement Of Purpose and service user guide. People get a copy of the guide once they have been admitted. However, they get a brochure to look at when they first make enquiries about the home. The latest inspection report for the home is available from the manager on request. The registered manager told us on 28 July 2008 that the weekly fees range from £350 to £665 per week. This does not consider the free nursing care contribution where applicable. People pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager. Mallard Court DS0000069344.V369198.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 2 star. This means the people who use this service experience good quality outcomes. The key inspection included a review of the following information to provide evidence for this report: • • Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Comment cards from five staff members, and from one visiting professional. Comment cards were also sent to the registered manager to distribute to some service users, but none were returned. A visit to the home by one inspector. The visit took place over two days, because a two hour observation called ‘SOFI’ (short observational framework for inspection) was undertaken on the dementia unit to observe care practice, and how comfortable people were in their surroundings. This tool is used where people may have difficulty saying what it is like to live at the home. • • During the visit to the home, several people who live there, some staff and the manager were spoken with. Four people’s care plans were looked at in detail, as well as three staff recruitment files, some policies and procedures, and some records about health and safety in the home. Care practices were observed, where appropriate. Some time was also spent watching the general activity to get an idea about what it is like to live at Mallard Court. The registered manager was not available on the first day. However, she was on duty on the second day. Feedback was given to the deputy manager on the first day, and to the registered manager on the second. What the service does well: The home is clean, comfortable and well maintained. This helps to make it pleasant and safe for people to live in. The registered manager does not admit people to the home until she is satisfied that she has enough information to tell her that the home will be able Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 6 to meet the person’s needs. Well trained staff look after people’s care needs safely and respectfully. People have good care plans which are individual to them. Staff follow the care plans to help to make sure that the care and health support people get is consistent and correct. People say that staff treat them well, and with respect. They said ‘I love it here. People are very kind and good. I was having problems at home. Now I feel totally safe’, ‘I am very happy with the care’, ‘It’s marvellous here. We couldn’t ask for better’, ‘I’m very happy – staff seem to understand – they are very caring’. Enthusiastic activities co-ordinators provide people with a range of activities. They ask people to make sure that the activities are meaningful and of interest to them. People have a choice about whether to join in. People can maintain links with families and friends outside the home who are important to them. People get a good choice of meals. The menu takes into account people’s likes and dislikes so people don’t have to eat food that they do not enjoy. One person said ‘I can have my meal in my room, in the dining room, or downstairs. Whatever I want’. Another said ‘We have a wonderful cook you know’. The company has systems in place to check that standards do not slip, and to promote continuous improvement. What has improved since the last inspection? What they could do better: Some improvements could be made to the way that staff look after people’s medication to reduce the risk from errors which could be easily avoided. When helping a person with their meal, staff could always sit with, rather than stand over, the person. This will make the mealtime more relaxed and sociable, and will stop the person from feeling they need to rush. The mealtime on the dementia unit could be better organised, with more staff available to prompt people who need help. This would help to avoid their meal getting cold because the support they need is not available to them. Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 7 The home could inform the local authority promptly if there is any allegation of abuse at the home so that the local authority can begin their enquiries without delay. The home could also do better by telling the Commission for Social Care Inspection about any allegation made to them, as required of them by law. The lines of accountability could also be made clearer to senior staff who manage the home in the absence of the registered manager. This would help to ensure that the home continues to run in the best interests of people in her absence. Staff could make sure that fire doors are not wedged open. By doing so, the doors will be able to close should the fire alarm sound. This would in turn reduce the chance of fire spreading, and so reduce the risk to people from the spread of fire. Cleaning staff could always make sure that they lock their trolley somewhere out of reach when they have to leave it unaccompanied. Staff could also make sure that the sluice rooms are kept locked. This would help to reduce the risk of people getting hold of hazardous chemicals which could harm them, or of being scalded from very hot water. The registered manager could make sure that she always checks any gaps in employment of prospective staff. This would give her more evidence to decide whether the person was suitable to work with vulnerable people. 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. Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use the service experience good outcomes in this area. People are assessed, and are consulted before their admission to the home. This helps to keep them involved in decisions made which will affect their life. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Before being admitted, the registered manager gets written assessments about people’s current needs from the person’s care manager, or from the hospital staff, depending upon where they are being admitted from. The registered manager or her deputy also visit the person to carry out their own assessment. This information helps the manager to check whether the home will be able to meet the person’s needs successfully. Although confirmation was provided that the assessments were completed before the person was admitted, the paperwork completed by the home was not always dated. Staff need to remember to date such documents so that they can use them effectively if they need to refer to them for information in the future. There are three units provided on two floors. The ground floor provides nursing care. The first floor is separated into two units, providing dementia care and Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 10 personal care only. The registered manager said it is important that the pre admission assessments are done properly and thoroughly, so that the person is admitted to the right unit, providing the right facilities and the right staff skills mix. People are invited to visit the service so that they can see for themselves what it is like, and whether it will be suitable for them. One person said ‘I have never regretted coming here once.’ The assessment is shared with staff who work on the unit, so that they have some understanding about what care will be needed when the person arrives. After admission, another more in depth assessment is carried out to check that the information already collected is right. People are given questionnaires periodically, which ask them whether they were happy with the information they got before they were admitted. The registered manager confirmed that the response from them was positive. A recommendation made at the last inspection said that the home should consider producing the Statement of Purpose and service user guide in more appropriate formats, to make the documents more meaningful and interesting for the people using the service. The registered manager explained that changes to the Statement of Purpose are made by the company, and not by the home itself. Therefore she has not been able to implement the recommendation. However, it would be good practice to do so. The home does not provide intermediate care. Therefore standard 6 is not applicable. Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience good outcomes in this area. Staff have an individual and respectful approach when providing people health and personal care support. Although some improvements could be made to the medication practice to reduce the risk to people from avoidable error. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: After people are admitted, the staff carry out further in depth assessments. This helps them to check that the information they have is correct and complete, and also that the care support the person is getting is right. Individuals are also assessed to measure whether they are at risk from, for instance, pressure sores, poor nutrition or falls. From these assessments, action plans are developed which tell staff what to do to keep risk to a minimum for the person concerned. This helps to maintain their good health and wellbeing. Where their care plan said that people needed special equipment, such as air mattresses to reduce the risk of developing pressure sores, this equipment had been provided. All of this information is then used to develop care plans, which are reviewed regularly, and amended to reflect changes in people’s needs. The plans gave a Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 12 good overview of people as individuals, and how they like to receive their care. This attitude towards care helps to avoid rigid routine. People who could comment agreed that their care was flexible, and that staff knew just how they liked it to be given. When a person’s care is reviewed with their care manager, this is usually done with the home and the family present, with any recommendations for improvements discussed and recorded where necessary. The care plans for people on the dementia unit were particularly good. Sometimes people on this unit are unable to express how they are feeling. But the plans gave staff good pointers to look out for so that they could respond appropriately to different situations. For instance, one person’s plan explained that staff must be careful to use the right facial expressions when communicating with a person who is hard of hearing. However, the action that staff had taken where two people had suffered significant weight loss was not so clear. Their care plan did not say whether the doctor or dietitian had been told. Although the head of unit gave her assurance that these matters had been referred to the doctor, they agreed that they would follow the referrals up again. This will help to make sure that the home is doing all it can to maintain the nutritional wellbeing of the people concerned. The registered manager and her staff were very knowledgeable about people living at the home. This helps to make sure that care is consistent. People spoken with were highly satisfied with their care. People’s comments included ‘I love it here. People are very kind and good. I was having problems at home. Now I feel totally safe’, ‘I am very happy with the care’, ‘It’s marvellous here. We couldn’t ask for better’, ‘I’m very happy – staff seem to understand – they are very caring’. A relative also said that the care was good, and that approachable staff keep the family informed. They said that any minor grumbles about care are dealt with quickly. A two hour study was carried out on the dementia unit. This was done because before the visit, the registered manager told us that there were few people living on the unit who would be able to tell us what it was like to live there. Throughout the observation, people were spoken to with respect and good humour. Staff included people in conversation. The care that people got was the same as what was written in their care plan. This values people, and gives them a sense of belonging. People living on the units which provide personal or nursing care said that staff were always respectful towards them, despite sometimes being, as they described, a bit rushed. Staff were seen to knock on doors before they entered rooms, and they went about their duties quietly and cheerfully. Staff usually look after people’s medication for them. If people want to look after it themselves, staff will assess the risk to them before deciding whether Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 13 this will be possible. One person currently looks after some of their own medication. They had locked facilities in their room to keep it safe, and staff had a record of what they are prescribed. This means that the information can be passed on in an emergency if the person is not able to tell anyone at the time what medication they take. Medication is stored and administered separately on each floor. The records kept by staff showed that the temperature of the first floor medication room sometimes exceeds that which is recommended for the storage of some medications. We were told that this is being monitored already, and that the company maintenance team are considering corrective measures. These need to be put into place. Those senior care staff on the first floor who are responsible for medication have completed medication training. Nurses give out medication on the ground floor, where people with nursing needs live. There have been two reported medication errors made by staff since the last key inspection. On each occasion the right people, such as the doctor, were alerted straight away. Subsequently the staff members were subject to further training and supervision to make sure that they were safe to continue carrying out this task. The following shortfalls were raised at this site visit: • The way a staff member had amended the medication record for one person was not clear. It could have increased the chance of staff making errors. The registered manager agreed to look at this straight away, so it was more clear to staff what was prescribed, and when. Creams are not signed for by the staff member who applies them. One cream was no longer in use, but the staff who complete the records were still ticking to say that it had been given. Eye drops which had been opened and were in use had not been marked with either the day that they had been opened, nor the date that they should be disposed of. Some controlled medication was not stored in the cupboard expressly provided for the storage of such medication. Although only certain staff have access to this cupboard, the manager must check that the way it is being stored complies with the law. She has told us since the site visit that she has spoken to the pharmacist who is satisfied with the way that this medication is being stored. A controlled liquid medication with a limited shelf life had not been marked with either the day it was opened or the day that it should be disposed of. • • • • People living on the dementia unit were not disturbed with their medication until they had finished their meal. This is good practice, because it means that they can concentrate on their meals without unnecessary disruption. Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 14 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 and 15 People who use the service experience good outcomes in this area. Steps are taken to understand people’s individual social needs, so that staff can be sure that they are being considered each day. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Two activity co-ordinators work Monday to Friday. They provide people with a range of different activities. They are building up the information in people’s care plans, which will help them to get a better picture of people’s previous interests, and whether they are still relevant to them. Some people said the range of activities was good. They include activities in and outside the home, and involve both group and individual activities. And to help meet people’s spiritual needs, periodic church services and visits from the priest take place. The home has the use of a bus with a tail lift, and special equipment to hold a wheelchair safely in position. This means that a lot more people who may have a disability are able to get out of the home for the day. The residential unit has only a small communal sitting area which staff say is rarely used. The staff member spoken with said that people can use this sitting area, remain in their rooms, or go downstairs to the main sitting area, where there is lots of space. This gives people the opportunity to meet with others. Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 15 One person living on this unit explained that they are in no way isolated. They said that the activities person comes to see them regularly, to see what they would like to do for the day, and to arrange where they would like to go. Visitors were seen coming and going throughout the visit. One spoken with said that they were made to feel welcome when they visited. They were allowed to be involved in their relative’s care. This helps to maintain important family links. People agreed that they were given choices each day about how they wanted to spend their time, and when they wanted things done. For instance, one person said ‘I can get up when I want, go to bed when I want, and eat where I want’. A staff member explained how they manage to achieve this flexible routine, which means that they need to work differently each day to meet people’s choices. Another staff member explained how they try to help people living on the dementia unit to continue to make choices. They realised that this may be difficult, but gave a simple example whereby they offer people two outfits to choose from each morning. This allows people to have some control, however minor, over their life. Fresh meat, vegetables and fruit are ordered into the home regularly. People are offered a choice of meal at each mealtime. Each of the dining tables has a menu so that people can be reminded about the meals on offer that day. They can also choose where they want to have their meal. One person on the residential unit said ‘I can have my meal in my room, in the dining room, or downstairs. Whatever I want.’ If people are particular about their food likes and dislikes, they and their family can design their own menu, which the cook will try to follow where possible. This is very good practice, and shows that people’s individual requirements are being catered for. Snacks and drinks are served between meals, and the cook confirmed that sufficient food is left out overnight so that people can have something to eat if they wake up feeling hungry. The cook said the staff tell him and his staff when people have special dietary needs, so that he can make sure that people get the right diet. He fortifies meals when people suffer from weight loss, so that they provide extra nourishment in an attempt to keep people’s weight stable. People said that the food was of a good standard. When the mid afternoon trolley arrived one person said ‘I do look forward to this cup of tea and cake – we have a wonderful cook you know’. In between meals, people were provided with a regular supply of fluids. Staff were particularly attentive to this before, during and after people’s meals. This will help to aid good digestion. The meal time on the dementia unit could have been better organised. Everyone in the dining area was asked what they would like to eat. But only Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 16 one staff member was left to assist whilst the remaining staff helped people in their rooms. This staff member stood over the person they were assisting with their meal, whilst prompting a second person. This was not very relaxing for the people concerned. The plate guard attached to someone’s meal was the wrong way round, and would not have protected their dignity or their clothing if they pushed the food accidentally towards them off the plate. All of the people seated in the dining area were left mainly unsupervised until the other staff returned. More thought should be given to the way that the mealtime is organised, so that people get the support that they need to eat their meal whilst it is still warm. Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 17 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 and 18 People who use the service experience good outcomes in this area. People are confident that the home will always try to put right their complaints and concerns. However, failure by the home to act quickly in passing on safeguarding information to the local authority could result in a delay in any subsequent investigation taking place. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed in the home. The registered manager has provided a book at reception for people and visitors to write in if they have anything they want to tell her about. For instance, someone had commented that the new lighting system in the visitor’s toilet, which is on a timer, was not satisfactory. The registered manager intended to speak to the maintenance man to get this put right straight away. People living at the home thought that their complaints or concerns would be taken seriously if they had any. They had great faith in the manager and staff. People said ‘Minor grumbles are always dealt with appropriately’, ‘I have no complaints’, We see plenty of Sylvia (the registered manager). I am happy that she would deal with complaints’. The home has a copy of the local authority’s multi agency procedures for the protection of vulnerable adults. The local authority has been given the lead responsibility to investigate allegations of abuse made within care homes. The policy tells the home what constitutes abuse, and what action staff must take so that any allegations are reported to the right person within the local authority without delay. The homes policy supports this procedure. Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 18 Two separate allegations have been brought to the attention of the Commission for Social Care Inspection since the key inspection last year. Both were referred to the local authority by the commission to make sure that they knew about, and could investigate, what people had said. These have been looked at separate to this report, and the commission is being kept informed by the local authority about the outcomes. One of the alleged incidents had been reported to the staff straight away. The staff took some action to reduce the chance of further incidents happening. But there was an unacceptable delay between the time of the alleged incident and it being reported to the local authority. Although it was subsequently found that there was insufficient evidence to uphold the allegation, this failure by staff to report straight away to the local authority potentially delayed the start of any investigation. In addition, the home did not at any point tell the commission that the allegation had been made. The registered manager must make sure that we are notified by them as the law requires. The registered manager recognises there were shortfalls in the way that staff handled the allegation in her absence. By taking action to make sure that this does not happen again, this will help to protect vulnerable people in the future. A number of staff were asked at this site visit about what they would do if they witnessed abuse towards a person living at the home, or if they were told by a someone that they had not been treated properly. All were entirely clear that they would not keep this information secret, even if the person asked them to. By taking this action, they are protecting other people from harm who may be unable to speak out for themselves. Mallard Court DS0000069344.V369198.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 and 26 People who use the service experience excellent outcomes in this area. People live in a warm, comfortable and well maintained environment. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home is purpose built. The accommodation is provided on two floors. The ground floor provides nursing care. It provides a very nice conservatory, and separate sitting areas that people can choose from, including a quiet area where people can take their relatives when they visit. There are pleasant gardens which people living on the ground floor are able to access independently. The premises are kept well maintained by the company. Staff throughout the home reported that they have plenty of equipment, including hoists, to help make care easier and safer for people. The first floor is separated into two units, which are run by one group of staff. The first unit is a dementia unit. The second accommodates people who have been assessed as needing personal care only. Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 20 The bedrooms are mainly single, and some on the ground floor have lovely views of the garden. People said they liked their rooms, which they had personalised with their own belongings. One person said ‘I love my room – you can’t get better’. Memory boxes will soon be displayed outside the rooms of those living on the dementia unit, and the activities person is currently designing individual name cards for each bedroom door. These depict the personal interests of those living there, for example a favourite sport. This makes the room more personal to them, and helps promote independence by helping them to recognise it on their own. People said that their rooms were always warm enough. One person said ‘Look –I turned on my radiator this morning when I got up. I’ll turn it down later when it gets too warm’. People living on the first floor dementia unit can only access the gardens when there are staff available to supervise them. However, work has been done to make the unit more interesting. One corridor called ‘Memory Lane’ has been decorated with items from the past, such as a vintage wedding dress. There is also an indoor garden area, which is brightly painted and has garden furniture. The fire officer hasn’t visited for some time, but the maintenance man keeps good records which show how the fire equipment is tested regularly to make sure that it would still work properly in the event of a fire. The laundry is well equipped, and staff are provided with protective clothing while they work. Soiled linen is delivered in separate sealed bags by care staff. And staff get training in infection control. All of these measures help staff to work in a safe way to reduce the risk from cross infection. Mallard Court DS0000069344.V369198.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 and 30 People who use the service experience good outcomes in this area. People are cared for by staff who have regular training which tells them how to give good care in a safe way. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People’s views varied about whether there were enough staff. One person thought that staff were rushed. They said that this didn’t make any difference to the good care that staff gave, but they felt sorry for them because they always looked busy. Another, who said how much they liked the home concluded ‘We just seem terribly short of staff sometimes’. However, others commented ‘If I want anything I ask and there’s always staff there – day or night’, ‘There are always enough staff’. Someone said it is sometimes difficult to find staff on the dementia unit after the lunch period when staff changed over shift. This was not apparent on the day, but is something that the registered manager needs to monitor. Generally, staff thought that there was usually enough of them to get tasks done, and to spend some time with people socially. Although one said that it would always be nice to have another person on shift, as they strive to provide care which is person centred. On the ground floor, staff seemed very well organised, and there was no evidence of people having to wait a long time for their care. Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 22 Staff get a range of training which not only teaches them how to work in a safe way, but also gives them information about the special needs of people that they may look after at the home. For instance, some of those providing care on the dementia unit have attended training called ‘Yesterday, Today and Tomorrow’. This gives them better insight in to the needs of people with dementia, and how their condition may affect their daily lives. Others have completed training in ‘Equality and Diversity’. This will help them to understand people better, and how their care can best be given taking into account their individual beliefs and background. Care staff underpin their experience by undertaking National Vocational Qualifications in care. There is a rolling programme of training in place to help achieve a well qualified workforce. When she recruits new staff, the registered manager makes sure that she gets two written references and a POVAFirst check before staff start to provide care. However, in order to make the recruitment checks tighter, she needs to make sure that she explores any gaps in employment identified on the application form. By doing so she can be certain that the person has no employment history which would make them unsuitable for the care position. In the two files seen, both staff had begun to work before the full police check had been returned. The registered manager understood that this should only happen in extreme circumstances. The police check could provide additional information which may change her view about whether the person was appropriate to work with vulnerable people. However the registered manager said that it had been necessary to employ both staff before the full check was returned. She said she had made sure that both staff were supervised at all times until the full check was returned. New staff complete an induction so that they know how to give good care straight away, and staff records showed that they get supervision. This provides the opportunity to discuss and promote good care and work practice. Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 23 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 and 38 People who use the service experience good outcomes in this area. Robust management systems are in place to encourage continuous improvement. Some shortfalls in management, health and safety need to be addressed with staff to make sure that the level of service people get is consistently maintained. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The registered manager has worked at the home for twelve years. Previous to this she worked in a hospital setting. She is a qualified nurse with management qualifications. Everyone asked, including staff and people who lived at the home, said that she was approachable, and that she sorted things out if they weren’t right. A staff member said that she goes round the home every day she is on duty to check that there are no issues. Another said that she is always there if she is needed. One person living at the home said they don’t see her all the time, but that if ever they have asked to see her, she has Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 24 come straight away. The registered manager attends training to enhance the skills she already has. For instance, she is currently undertaking training on person centred dementia care. She has also attended a seminar led by the Alzheimer’s society, so that the care provided to people with dementia considers current best practice. Despite this strong management leadership, in her absence, senior staff failed to take the right steps to ensure that the right people were informed promptly following the allegation reported to them, and commented on, in ‘Complaints and Protection’ section. This needs to be monitored, because to keep people protected, the home needs to run effectively even when the registered manager is not available. The company has a series of people employed to visit the home and monitor standards to make sure that they do not slip. For instance, a clinical development nurse comes to look at care plans and care practice. And the medication systems on each unit are audited regularly by a staff member from another. Appointed health and safety people come to check, for example, that the kitchen is being run properly and safely. And the regional manager visits the home regularly to support the manager, and to check that the home is operating smoothly on a day to day basis. In addition, people, their families, and visiting professionals involved in their care are also asked to contribute their views about how they think the home is running. This information is asked for in tri annual meetings, and also by way of annual satisfaction surveys, which are sent out by the company. The company puts all the feedback together and publishes the results, which tell people how everyone thinks the home is performing, where it excels, and where it needs to improve. The registered manager knew what the results of the survey had concluded, and said that she draws up an action plan with the regional manager to look at how improvements can be made to address any shortfalls. For instance, the last survey showed that people wanted more outings, and these are being provided in consultation with people living at the home. And the special audit this month is all about activities, and whether any changes need to be made to what is offered to people. The results from the most recent survey were very positive, with 97 of people believing that the management of the home was excellent. This was discussed with the registered manager, who is focusing to make sure that improvements are made so that the remaining 3 are more satisfied next time they have the opportunity to comment. The home used to look after people’s personal allowance on request. The money was being saved in a joint account which was non interest bearing. This system is slowly being phased out. Instead, relatives will now look after people’s finances. The home sends the relative an invoice for costs incurred, such as hairdressing. But they also request a small amount of cash to be kept on the premises. This means that people still have the opportunity to handle Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 25 their own money if they want to. If people wanted to manage their own finances, the registered manager said that they would try to support the person to do so. Locked facilities are provided in bedrooms so that people can store their valuables safely. The home also has a special account set up so that, if people go out on a trip organised by the home, the company pays for their meals. The premises are very well maintained. The maintenance team keep good records, which were fully up to date to show that they keep equipment serviced. The information provided in the Annual Quality Assurance Assessment supplied by the registered manager before the visit took place showed that systems such as gas and electricity are checked to make sure that they are working safely. The following shortfalls in staff practice which were noted at the site visit compromise the safety of people. Although they were put right straight away, the registered manager must remind staff of their responsibilities to keep people safe from avoidable risk: • All of the sluice rooms were unlocked, despite being fitted with keypads for easy access by staff. These were locked straight away. The registered manager did not think people living at the home were in any danger, but she agreed that the rooms must be kept locked to minimise the risk to people who may enter these areas, so they are not exposed to unregulated hot water and chemicals which may be hazardous. The cleaner left their trolley unattended, and could not be found. This posed unnecessary risk to people who had access to the hazardous chemicals kept on the trolley. The trolley was locked away immediately. We were told that this was an unusual situation, and that the staff member had been called away unexpectedly. However, people were left at risk. Three fire doors were wedged open on the first site visit. This practice contradicts the policy of the home, and also the fire safety risk assessment, which the maintenance man said was seen by the fire officer at their last visit. Staff were reminded that this was not safe practice and the wedges were removed immediately. The registered manager said that the company is considering the installation of self closing devices for fire doors. This is much safer practice, as these would allow the doors to close should a fire break out and the fire alarm sound. At the second site visit, the fire doors remained shut. The registered manager intends to approach the company again to see when these devices will be installed. • • Mallard Court DS0000069344.V369198.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 4 X X 3 X 2 Mallard Court DS0000069344.V369198.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 Requirement Medication systems must be improved upon and subsequently monitored to take into account the following: • Timescale for action 28/07/08 2 OP9 13 Entries made by staff on a person’s Medication Administration Record (MAR) must be clear and concise, to reduce the risk of the wrong dose being given at the wrong time. • Staff must not tick to say that topical medication has been applied by another staff member, when they are not sure whether it has or not. • Staff must make clear when medication with a limited shelf life needs to be disposed of. This will make sure that people get medication which is fit for use. Consultation must take place 31/08/08 with the supplying chemist to check that the storage arrangements used for controlled medication meet with current DS0000069344.V369198.R01.S.doc Version 5.2 Page 28 Mallard Court 3 OP18 13 4 OP38 23 5 OP38 13 6 OP38 13 law. All senior staff must be fully conversant and clear about the role of the local authority in investigating allegations of abuse, and the action that the home must take if anyone reports an allegation to them. This will help to keep everyone at the home safe from avoidable risk, and will allow the local authority to carry out their responsibilities. To reduce the risk to people from the spread of fire, fire doors must not be wedged open by unauthorised means, unless this arrangement has been agreed and formalised with the fire officer. To reduce the risk to people from hazardous chemicals, staff must not leave their cleaning trolleys unattended. Sluice rooms must be kept locked to reduce the risk to people from scalds and from contact with hazardous chemicals. 28/07/08 28/07/08 28/07/08 28/07/08 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 OP9 Good Practice Recommendations Plans to improve the medication storage facilities should be put into practice so people can be sure that their medication will be stored correctly and safely within the recommended temperatures. The staff member administering medication should be the person who signs the Medication Administration Record. Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 29 2 OP15 This will limit the possibility of the record being signed by someone else when the medication has not actually been given. When helping a person with their meal, staff should always sit with, rather than stand over, the person. This will make the mealtime more relaxed and sociable, and will stop the person from feeling they need to rush. More staff should be available to prompt people who need help at mealtimes on the dementia unit. This would help to avoid people’s food from getting cold, and the possibility of them losing interest in their meal, because the support they need is not available to them. Staffing levels should remain under review, taking into account the views of the people who live at the home, and current dependency levels. The employment history of all prospective staff should be explored fully, to check that there are no hidden reasons why the person should not be employed to provide care. The lines of accountability need to be made clear to senior staff who manage the home in the absence of the registered manager. This will help to make sure that the home continues to run in the best interests of people in her absence. 3 4 5 OP27 OP29 OP31 Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Mallard Court DS0000069344.V369198.R01.S.doc Version 5.2 Page 31 - 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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