Inspection on 13/02/08 for Mallard House

This inspection was carried out on 13th February 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mallard House 08/05/06

Mallard House 24/11/05

Mallard House 22/07/05

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

CARE HOME ADULTS 18-65 Mallard House Dunthorne Way Grange Farm Milton Keynes Bucks MK8 0DZ Lead Inspector Mike Murphy Unannounced Inspection 13th February 2008 10:00 Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 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 House DS0000063734.V359876.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 Adults 18-65. 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 House DS0000063734.V359876.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mallard House Address Dunthorne Way Grange Farm Milton Keynes Bucks MK8 0DZ 01908 520022 01908 524532 rufaro@pjcare.co.uk 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) P J Care Limited Mr Joseph Olorode Care Home 53 Category(ies) of Dementia (53) registration, with number of places Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 24 Service Users with cognitive impairment 29 Service Users with early onset Dementia Date of last inspection 8th May 2006 Brief Description of the Service: Mallard House is a purpose built 53 bedded nursing home which provides care and accommodation for adults over 18 years of age with cognitive impairment and acquired brain injury. The home is registered and the owner is an established provider of care in Buckinghamshire. The home is situated in a residential area and is conveniently located for the centre of Milton Keynes. The home has its own transport, which facilitates access to the community for residents. The accommodation has all single rooms with en-suite facilities (shower, hand basin and WC). Support from a range of health professionals has been established within the local healthcare service. A landscaped garden is accessible to all residents. The fees at the time of this inspection ranged from £950.00 (for short term respite care) to £2,000.00 per week. Mallard House DS0000063734.V359876.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. This inspection was carried out by one inspector in February 2008. The inspection process included consideration of information supplied by the manager in advance of the inspection, examination of records (including care plans), discussion with some staff and residents, discussion with managers, a walk around the home and garden, and observation of practice. Questionnaires were sent to relatives, residents, health and social care professionals and staff but the results were not available at the time of writing this report. They will however, be considered as part of CSCI’s ongoing regulatory responsibilities for registered services. Mallard House is a two storey purpose built home situated in the residential area of Grange Farm in Milton Keynes. It is just under three miles from the centre of Milton Keynes. The home provides good quality accommodation for up to 53 people with acquired brain injury and early onset dementia. All bedrooms are single and have en-suite facilities. The home has good systems for assessing and deciding whether it can meet the needs of people referred to it by healthcare organisations and local authorities. Care is provided by a mix of healthcare professionals - registered nurses and healthcare assistants being the largest group. Support services are provided by housekeeping, catering, administrative and maintenance staff. Staffing levels and standards of service are good. Standards of record keeping are generally good. Care records are detailed and include the contribution of nurses, other healthcare professionals (such as occupational therapists, physiotherapists and psychologists), social activity or rehabilitation staff, and external professionals (such as GPs, NHS staff or social workers). A care plan and diary is agreed for each resident. This includes a mix of activities: individual and group, inside and outside of the home, recreational and therapeutic. The home is involved in a pilot scheme in the implementation of the Liverpool Care Pathway which aims to provide best quality care for people at the end of their lives. The home’s policies and practice address equality and diversity. Staffing levels are good, and the home, in liaison with a local training agency and a NVQ provider, maintains an ongoing programme of staff training and development. It is an ‘Investors in People’ organisation. The home has a positive approach to monitoring and improving the quality of its service. Overall, on the basis of the evidence of this inspection, this home is Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 6 considered to be providing a good and valued service to residents and their families. This report takes account of the response of PJ Care Ltd to this inspection. What the service does well: What has improved since the last inspection? What they could do better: Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 7 Ensure that it provide evidence of full conformance to the Regulations in the recruitment of staff. This is to protect residents from the appointment of staff who are unsuitable for such work. Develop a more person centred approach to care planning documents. 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 House DS0000063734.V359876.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are thoroughly assessed by experienced staff before an offer of a place in the home is made. This process aims to ensure that the home can meet the person’s needs and to minimise the chances of admitting a person whose needs it cannot meet. EVIDENCE: Referrals to the home are usually made by care managers through local authority or local primary care trust channels. The referring professional will have completed an assessment of the prospective resident’s needs. After initial enquiry, relevant information is faxed to the home manager. This information is considered by the manager and at least one other experienced member of staff (a unit manager (who is a registered nurse), physiotherapist or occupational therapist). If the information indicates that the home may be able to meet the person’s needs then arrangements are made for the manager and another experienced member of staff to visit the person at their current place of residence. An assessment is carried out. The process is structured by, and recorded on, an assessment form. Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 10 The assessing staff record basic information on the person e.g. name, next of kin, current health and social care professional contacts, Mental Health Act status (where applicable), and a brief summary of the person’s past and current medical history. They go on to complete the rest of the form which covers; behaviour, breathing, cognition, communication, consciousness, continence, medication, memory, mobility, nutrition, orientation, pain, personal care, ‘psychological and emotional needs’, risk, senses, skin and sleep. The results for each section are recorded on a six point rating scale indicating the extent of a problem. The scores are summarised at the end of the assessment. Space is provided for the comments of the person and their relative or representative. The outcome of the assessment is discussed and communicated to the care manager by letter. Where a decision is made to admit the person arrangements are made for the family to visit, view the facilities, and meet staff - and perhaps residents. The Welcome Pack includes a summary of the home’s statement of purpose. The importance of the decision which the family and prospective resident have to make is acknowledged in the pack. Where all parties agree that the home can meet the person’s needs, and funding arrangements are confirmed, a three month trial admission is offered. A review is held at four weeks. Reviews may take place more often where required. The home maintains contact with the person’s family, social worker and other professionals via phone and email. Because the home accepts residents from anywhere in the UK regular personal contact is not always possible. The process for prospective residents referred for respite care is similar in structure to that for a prospective long term admission but is less detailed. A unit manager said that the home has referred a resident back to the care manager where it has been unable to meet the person’s needs. This may occur, for example, where the person’s behaviour cannot be safely managed in the home. The records of one of the residents selected for case tracking in this inspection were checked. The records confirm that the process outlined above is followed in practice and that the home endeavours to carry out a thorough assessment of needs prior to admission. Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive care plans are in place for each resident. Care plans include detailed risk assessments and evidence of liaison with health and social care agencies in the community. Together, these activities aim to ensure that peoples’ needs are met, that risk is minimised, and their independence is supported. EVIDENCE: A care plan is in place for each resident. This is based on the initial and ongoing assessment of needs. The care plan is summarised in a section of each person’s ‘Standex’ care file (a commercial care planning system) – a document which is used almost exclusively by nursing and healthcare assistants. The assessments on which the care plan is based may be in a number of documents: in a section of the Standex file (such as pressure sore risk or moving & handling assessment); in a main care file (such as an assessment by an occupational therapist or psychologist); or in a medical file Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 12 (assessments by doctors). On Oakley unit there is a separate file maintained by the activity co-ordinators. Each resident has a key nurse who is responsible for the co-ordination of care. The key nurse is supported by a designated key worker. Care plans set out the support which the resident needs on a day to basis. The main care file, as well as including important information on assessments, progress reports and correspondence with other services, also includes information relevant to the person’s day to day activities. In particular this includes the notes of the activity co-ordinators and a diary outlining the activities planned for the resident for the week. With regard to conformance to standard 6.7, care plans are not in a format which is appropriate to the abilities of many residents in this specialist service. The extent to which the home could rationalise its current arrangements and develop a more person centred approach to care planning was briefly discussed with managers during the course of the inspection visit. It may merit further exploration with staff. Residents are supported in making decisions. This depends upon the capacity of individual residents and the assessment of risk. Key workers aim to involve residents in planning their care and in the formulation of their own daily diary. The ‘Welcome Pack’ includes contact details for four advocacy services: ‘Age Concern’, ‘MK Carers’, ‘People’s Voices’, and, ‘MK Centre for Integrated Living’. The home holds a monthly meeting for residents and relatives. Meetings are planned for the year and dates and times until December 2008 are included in each unit’s ‘Welcome Pack’. Attendance was said to vary and managers said that they were looking at ways in which this might be improved. It was thought that it might, in part, be due to difficulties which some relatives experience with travel. The home has a thorough approach to risk assessment and management. An overview of its arrangements is maintained by the health and safety manager and the clinical governance group. A methodology for calculating risk is available to managers and is summarised on a coloured chart. It was noted that an external consultant had been engaged to advise on some aspects of risk to some residents. Generic risk assessments cover such activities as fire safety, Legionella, aggression, use of the home’s vehicle, and COSHH – among many others. Resident specific risk assessments cover such activities as falls, moving and handling, activities outside of the home (including such matters as road safety or disorientation), risks in the garden, and, risks associated with epilepsy – among others. The thoroughness of the approach aims to minimise risk to residents and to optimise opportunities for residents’ participation in activities. Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents lead a varied lifestyle according to their individual needs, abilities and interests. This ensures that people experience a range of therapeutic, social and leisure activities and are supported in maintaining involvement with the local community. EVIDENCE: The home endeavours to support residents to maintain and develop their interests and skills as far as possible. There is a stronger emphasis on rehabilitation on the Brunel Unit where residents have experienced the effects of acquired brain injury conditions (such as a stroke). Activity on the Oakley Unit may be orientated more towards maintaining or minimising the loss of skills due to progressive disorders (such as a dementia). Residents’ interests are recorded in care planning documents and a resident questionnaire. Social care and rehabilitation programmes are recorded in care plans and related Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 14 documents – in particular in the resident’s diary for the week. A typical week’s diary will include a mix of activities: individual and group, recreational and therapeutic, both in and out of the home. There is a ‘diary meeting’ meeting each morning where plans for the day and other matters are discussed. The home employs a number of activity co-ordinators and activity assistants to support residents in pursuing a range of social activities. Activities include trips out to shops and places of interest. These include Milton Keynes, Northampton and Woburn Safari Park. They also include arts and crafts, a photography group, gardening, cookery and riding. Some residents participate in an MS (Multiple Sclerosis) group or stroke club in the area and some regularly go to a gymnasium in nearby Shenley Brook End. Residents have exhibited at a local art fair. Residents are supported in maintaining contact with their families. The involvement of families is encouraged and there is a monthly residents and relatives meeting. The manager is planning to establish a resident and relatives support group over the next twelve months. Other than meal times and the administration of medicines, the daily routine is flexible and can accommodate the varying needs of residents. Resident’s privacy and dignity is respected and staff do not routinely enter rooms without first knocking on the door. Some residents have a key to their own rooms and can access their own unit where the risk assessment does not indicate otherwise. Passes permitting entry to the home are issued to relatives by the administrator or nurse in charge. Long term passes for relatives visiting frequently are issued by the manager or by the facilities manager. The interior of the building is non-smoking. Residents are permitted to smoke in the garden. Almost all meals are prepared in the main kitchen. The catering manager said that menus are rotated on a six-week basis and that a dietician has advised on the nutritional quality of the meals provided to residents. Catering staff aim to use fresh ingredients as much as possible. Residents make their choice of meal from a menu circulated the day before. Breakfast, served between 8:00 am and 10:00 am, consists of cereals, toast, hot drinks and a cooked breakfast if desired. Lunch, served around 12:30 pm, is a two-course meal. It is a choice between a hot dish or soup of the day with a choice of sandwiches, followed by dessert. Dinner, served around 5:30 pm, is a two-course meal with a choice of main course. Supper, served around 8:00 pm, consists of a hot drink and a sweet snack such as cake or biscuits. In keeping with tradition Fish and Chips are served at Friday lunchtimes and a roast meat (meat or poultry with appropriate accompaniments) based dish is served at Sunday lunchtimes. The home’s satisfaction questionnaire includes a section on catering. The report provided for this inspection (for Oakley unit) indicated a good level of satisfaction with the food. 80 (16 of 20) of respondents rated the unit ‘good’ or ‘very good’ for offering drinks and snacks throughout the day. 79 (15 of Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 15 19) rated it ‘good’ or ‘very good’ for overall enjoyment of meals. There is a kitchen on each unit for making hot drinks and light cooking. Two residents were receiving nutrition through ‘PEG’ (Percutaneous Endoscopic Gastrostomy) feeds. The dietary regime for residents on PEG feeds is carried out under the supervision of a dietician. Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are well supported by the home’s multidisciplinary staff team. Arrangements for liaising with health and social care services in the community are good. Arrangements for the control and administration of medicines are satisfactory. These aim to ensure that residents healthcare needs are met. EVIDENCE: Nursing and other care staff were observed to treat residents with consideration and with regard to individual dignity. Personal care is given in the person’s own room or in bathrooms. Technical equipment is provided as needed and the advice of physiotherapists, occupational therapists or a speech therapist is readily available. As stated elsewhere in this report care staff were observed to respond effectively to an episode of aggression by one resident, using their knowledge of the person to de-escalate the event. Residents healthcare needs are assessed prior to admission and during the course of a stay in the home. Healthcare needs are recorded in residents Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 17 Standex care plans, main care file, activity or rehabilitation records, and medical files. Examination of the records of four residents whose care was being case tracked on this inspection, showed that actions to meet residents healthcare needs are underpinned by comprehensive assessments carried out by a range of healthcare professionals. These include assessments by registered nurses, neuropsychologists, occupational therapists, doctors, and physiotherapists. Records provide evidence of liaison with NHS general and mental health services, dentists, and a local hospice. Care plans identify key areas of need such as the support required in personal care, mobility, nutrition, medication, psychological support, and care required in relation to particular conditions (such as Epilepsy). All residents are registered with a local GP practice. Many residents are also in contact with a psychiatrist. Dental care is generally provided by NHS dentists based at Milton Keynes hospital. Opticians, NHS or private, are accessed generally in Milton Keynes. The services of other healthcare professionals are readily available. Medication is prescribed by the resident’s GP or psychiatrist. Prescriptions are faxed to the pharmacy. Medicines are dispensed by Jardine’s pharmacy and are administered by registered nurses. Arrangements for the storage of medicines appear satisfactory. The temperature of the store room is monitored. A portable air conditioning unit regulates the temperature where it rises to 27 degrees Celsius or above. A medicines refrigerator is available for medicines requiring cool storage. The temperature is monitored. A portable trolley is locked to the wall when not in use. There is a drawer for each resident’s medicines. Liquid medicines are stored in a separate container at the bottom of the trolley. There were no errors on the medicine administration records (‘MAR’ charts) examined. All sections were appropriately completed. It was noted that a cream for external use had not been labelled when opened. All creams should be labelled on opening to ensure they are used within the time specified on the particular product. The home’s arrangements for medicines are periodically checked by a pharmacist. The report of the most recent audit was seen on this inspection visit. The home is involved in a pilot scheme in Buckinghamshire and Milton Keynes on the implementation of the Liverpool Care Pathway, aimed at ensuring best practice in the care of a person who is dying. The process includes a detailed assessment of care needs, ongoing re-assessment of the effectiveness of care, and protocols for the management of distressing conditions (such as pain, nausea and vomiting or agitation and anxiety) towards the end of the person’s life. The home is also intending to implement the ‘Gold Standards Framework’, Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 18 an NHS supported initiative aimed at improving the organisation and quality of care for people in the last year of life. The home has a chart summarising the ‘general principles’ of the care of a person who is dying and who is a member of a religious faith. The chart guides staff in caring for people who are dying and who are members of the following religious faiths: Buddhism, Christianity, Islam, Judaism, Hinduism, and Sikhism. The home has a form for use in situations where a decision has been made not to resuscitate a person. One form, which included the term ‘..next of kin/nearest relative..’, signed by two close members of the person’s family (a parent and spouse) was discussed with managers towards the end of the inspection. It is important to stress that the matter was not raised in the context of the care of an individual resident but on whether the wording of the form had been considered in the light of the implementation of the Mental Capacity Act 2005 in 2007, and whether legal and professional best practice advice (such as that published by the Royal College of Nursing and British Medical Association in 2007) guided staff practice. Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good procedures for investigating complaints. It has a framework of policy and staff training with regard to safeguarding vulnerable adults and for responding to challenging behaviour. These aim to protect residents from abuse, to ensure that complaints are properly investigated, and to present a constructive response to challenging behaviour. EVIDENCE: The home’s complaints procedure is set out in the Welcome Pack booklet. The process outlined is straightforward. The procedure states that most problems can be dealt with through discussion with the head of department. It goes on to say that should the ‘….concerns not be of a nursing home nature…..’ then discussion with ‘….the General Manager would be appropriate’. It states that ‘For very serious complaints…’ contact should be made with a named Director of PJ Care Ltd. It states that ‘…all concerns will be dealt with within 21 days’. The procedure is also on display on the wall in the reception area. The procedure gives contact details for the CSCI in Oxford. CSCI has now changed its contact arrangements and the home would be advised to update its literature with the telephone number of the South East Regional Contact Team in Maidstone, Kent (Tel: 01622 724950) and the national customer service helpline (Tel: 0845 015 0120). Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 20 The company has a positive attitude to complaints. Systems are in place for recording complaints and information relating to those received since the last inspection was examined. According to information supplied by the manager eight complaints were received in 2007. CSCI has received one complaint about this service since the last inspection. Complaints are monitored and are reported to senior managers through the organisation’s clinical governance arrangements. The organisation has a policy governing staff action in relation to safeguarding vulnerable adults (previously known as protection of vulnerable adults). The policy was reviewed in November 2007. The document includes a flow chart of the procedure to be followed. This includes provision for an internal investigation by managers before statutory authorities are notified. The Director of Clinical Services states that the procedure has been agreed with the Adult Protection Team at Milton Keynes Council. Managers maintain good liaison with statutory authorities when investigations under the policy are carried out. Copies of the current Milton Keynes Adult safeguarding policy and procedure are available in offices. Two senior managers have been designated ‘SOVA leads’ on behalf of the organisation. Staff are informed of safeguarding arrangements on induction and subsequently at basic and update levels. According to information supplied by the manager 25 safeguarding referrals were made since the last inspection. Statutory authorities, including CSCI, were involved as appropriate. Staff are trained in responding to aggression. The training programme includes ‘Conflict Resolution’ and ‘Anger Management’. One incident of aggression which occurred around supper time (approximately 17:30 hours) on one of the units during the inspection visit was very well managed by staff. This involved a combination of prompt intervention, distraction, diversion and removing the person concerned to a quieter area of the unit. It also involved a review of possible causes after the event and completion of an incident form. There is a policy in place governing the management of residents’ monies. There is provision for secure storage of money and valuables in the home. Cash, valuables and receipts are retained in individual pouches. Records of transactions are maintained and receipts are retained. Systems are in place for limiting access to the safe. The arrangements are audited monthly by finance and by the manager. Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers a well designed, accessible, pleasant, clean and wellmaintained environment. It provides residents with a comfortable and safe place to live designed to meet individual care needs. EVIDENCE: The home is situated in a spacious, purpose built building in the residential area of Grange Farm, Milton Keynes. Car parking is available in the grounds – including designated spaces for disabled badge holders. The home is under three miles from Milton Keynes rail station. Buses from Central Milton Keynes serve the Grange Farm area. Entry to the home is regulated by staff. All areas are accessible by wheelchair. The accommodation is on two floors: ‘Brunel Unit’ is on the first floor. ‘Oakley Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 22 Unit’ is on the ground floor. Each unit has its own garden. There is a lift and stairs between the ground and first floors. The ground floor includes the lobby, reception, administration offices, disabled WC, laundry, kitchen, and the ‘Oakley Unit’. Oakley Unit has 29 places. Entry and exit is controlled by electronic locks for safety reasons. All bedrooms are single and have en-suite facilities (shower, handbasin and WC). For safety reasons the en-suite rooms do not have doors but a door can be fitted if the resident wishes. In addition to the en-suite facilities there are two assisted bathrooms with WC and a separate WC on each floor. There is also a small kitchen on each floor. The first floor includes a therapy room, psychology office, staff changing room, and ‘Brunel Unit’. Brunel Unit has 22 places plus two self-contained flats. Like Oakley Unit, for safety reasons, entry and exit is controlled by electronic locks. All bedrooms are single and have en-suite facilities. Each unit has two living and dining rooms, a staff office, a clinical room, and store rooms. The selfcontained flats on Brunel Unit were not in use at the time of this inspection but were well furnished and suitable for assessment or rehabilitation purposes. They may also be used as relatives accommodation on occasions. Bedrooms and the shared accommodation in both units are located off a wide central corridor. This, combined with wood flooring, can have an impersonal and clinical feel. This may be unavoidable in a Unit which is providing care for over 20 people with complex needs, many of whom are physically active at various times of the day. The home has tried to reduce this effect by pictures on the walls. Bedrooms are of a good size and can be personalised by the resident if desired. Those seen during the course of this inspection were appropriately furnished in line with the needs and wishes of the resident and appeared able to accommodate equipment such as hoists if required. At the time of this inspection most residents were mobile and did not require special equipment to meet their care needs. Special beds and other equipment is provided where required. All areas of the resident accommodation are linked to the nurse call system. The laundry is well equipped, well organised and well staffed. It appears to be providing a good service to the home and residents. The kitchen was briefly inspected after supper around 6:00 pm. It was well staffed. The kitchen is well equipped and well organised. All areas were impeccably clean. Food stored in refrigerators was well organised and stored in line with good practice in food hygiene. Foods were appropriately labelled where required. Records of the temperature of food delivered, food stored, and of food cooked are maintained. Standards of cleanliness throughout the home are high. The garden of Brunel Unit was visited. The Unit is on the first floor and the garden is accessed via the lift or stairs. The value of the garden to residents well-being is clearly acknowledged and it is well designed with the needs of Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 23 residents in mind. This inspection visit took place on a cool grey February day and there was therefore, no great incentive for residents or staff to spend time there. A pathway facilitates wheelchair access. The garden includes areas of lawn and flower beds and is suitable for individual or group events. It is safely enclosed by a wooden fence. The garden is the only area of the home in which smoking is allowed. The subject of smoking is covered in detail in the ‘Welcome Pack’ given to each resident and their relatives. Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents needs are met through the employment of sufficient numbers of professionally qualified, well trained and well supported staff. Residents may be placed at risk by the appointment of staff before the results of a POVA First check are carried out. EVIDENCE: The home experienced a higher than average turnover of care assistants during the course of 2007. This was unusual and was mainly due to a particular set of circumstances which occurred in the autumn of that year. Managers had acted appropriately and effectively in the circumstances and CSCI had been kept informed. By the time of this inspection staffing levels for this category of staff were improving. However, these events have had a temporary negative effect on the proportion of care staff qualified to NVQ level 2 and above (this figure excludes registered nurses and other professionally qualified staff). Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 25 Staffing levels are good. On Brunel unit current staffing provides for two registered nurses, one clinical manager and eight rehabilitation assistants between 8:00 am and 8:00 pm. A rehabilitation co-ordinator works Monday to Friday. On Oakley unit current staffing provides for two registered nurses, one clinical manager and seven care assistants between 8:00 am and 8:00 pm. One activities co-ordinator and three or four activities assistants are also on duty for much of this period. Between 8:00 pm and 8:00 am there is one registered nurse and three care assistants on each unit. These figures do not include the home manager. In addition to care staff, the home employs housekeeping, laundry and catering staff in sufficient numbers to provide a good service to residents. Residents also benefit from the services of occupational therapists, a part-time psychology assistant, an occupational therapy assistant, and a physiotherapy assistant. A physiotherapist, a consultant neuropsychologist, a speech and language therapist, and a neuro psychiatrist are engaged through a service level agreement (a form of contract) with Milton Keynes Primary Care Trust. There is a manager on call at all times. The home is supported in the recruitment of new staff by staff based at the organisation’s head office elsewhere in Milton Keynes. At the time of this inspection the home had some vacancies for care assistants, rehabilitation assistants and activity assistants. Seven personnel files were examined for conformance to Schedule 2 (of the Regulations). All staff are required to complete an application form. The design of the form enables managers to identify any gaps in employment and to explore these with the applicant. All forms examined were satisfactory. Applicants are required to complete a health declaration which is screened by an independent occupational health service. Applicants are required to provide two references. All had done so. However, the organisation’s reference request form is basic. Registered nurses registration status is checked with the Nursing and Midwifery Council (NMC). All staff providing care to residents are required to have an Enhanced CRB check. All seven files included an Enhanced CRB certificate. Care staff may be appointed in advance of receipt of the CRB provided a POVA First check has been carried out. In three of the seven files examined, staff appeared to have started work in advance of the POVA First having being received (two by one week and one by one month). The manager and the general manager, who were present throughout the examination of documents, said this could be explained by the staff concerned having started their induction at the company’s head office before the POVA First was received. Both were certain that the staff would not have started work in the home in advance of a POVA First check. This may be the case but there was no evidence on file to confirm that explanation. New staff are supernumerary for the first two weeks. New staff undertake a thorough induction programme. The probationary period includes completion of the Skills for Care Common Induction Standards. The company’s approach to Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 26 staff training and development is positive and aims to ensure that staff have the skills required to meet the needs of residents and to support the development of the service. The company has been accredited by ‘Investors in People’ (IIP) and a recent review by IIP has concluded that it ‘…continues to meet the requirements of the Investors in People Standard’. A copy of the report was made available to this inspection. Some staff who had acquired NVQ 2 or above moved on from the home in 2007. At the time of this inspection the home was not meeting the 50 target of standard 32.6. However, it was addressing this matter and expected to fully meet the standard later in 2008. The home provides many opportunities for staff training and development and this was acknowledged by staff spoken to during the course of the visit. One person said that PJ Care is “really, really good”, that staffing levels were good and that it enabled her to give a good standard of care to residents. That person had attended numerous training events over the last twelve months. Staff training is mainly provided through ’12 Training’ which, while now independent, was formerly part of the organisation and therefore has a good understanding of the work carried out by staff. This is supplemented by the ‘Care in the Shires’ training organisation which provides NVQ training. Staff training covers a wide range of subjects. These include Safer Patient Handling, Safeguarding Vulnerable Adults, Infection Control, Health and Safety, First Aid, Food Hygiene, Challenging Behaviour, Huntingdon’s Disease, Dementia Awareness, Epilepsy Awareness, Key Working, and numerous others. All staff have their own training folder. The company has produced ‘Clinical Supervision Guidelines’ which outline its approach to staff supervision. The manager said that the home is looking to staff receiving personal supervision on a six to eight weekly basis. Staff may also have mentoring with regard to specific topics or during their probationary period. Staff have an annual appraisal. Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home where a positive approach to monitoring the quality of the service is providing good care outcomes for residents. Arrangements for health and safety are thorough and aim to maintain a safe environment for residents, staff and visitors. EVIDENCE: The present manager has been in post since April 2007 (this inspection took place in February 2008). The manager is a registered nurse who has had many years experience in nursing and in care home management. The manager’s Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 28 application for registration with CSCI was being processed at the time of this inspection. The manager is a registered nurse, has a certificate in management, has acquired the NVQ 4 in care, and is an NVQ assessor. The manager is also qualified as a trainer in dementia care and in ‘Facilitated Learning In Practice’. The home’s quality strategy is closely aligned with the organisation’s arrangements for clinical governance and risk management. A senior manager holds the post of Director of Clinical Services and Quality. A copy of the current ‘Quality Strategy’, approved in October 2007, was made available for this inspection. The strategy provides a very good foundation for continuing improvements in the quality of the service. The document includes a definition of quality, what it means for residents, what it means for staff, key principles of the strategy, and, in an appendix, key performance indicators. The document includes reference to (among others) ‘integrated working’ (involving all staff), partnerships (working with stakeholders), commissioning, risk management, health and safety, complaints, resident involvement, equality and diversity, education training and professional development, communication, and information. Evidence of action on each of these was seen on this inspection. The general manager said that the home was auditing the Standex care plans and medication records. A monthly audit of the environment is carried out by a senior manager. Reports of audits were seen during the inspection visit. It is noted that these incorporate the organisation’s Regulation 26 reports. The structure of the form has recently been changed so that the work carried out under Regulation 26 is more clearly identified. The results of a recent satisfaction questionnaire were seen. Subjects covered included ‘preadmission’ actions, admission, staff, catering, communication, ‘general’, and housekeeping. The summary report, presented in table form with additional comments or notes at the foot of each page, included information on the number of questionnaires sent out and returned, and the results summarised on a four point rating scale. At present, the survey does not extend to other stakeholders (in particular care managers and healthcare professionals in contact with the home) but the general manager said that the organisation would look into the feasibility of conducting such a survey in the future. A newsletter is circulated across the organisation quarterly. Copies of the Winter 2007 edition were freely available to residents, staff and visitors by the enquiries and administration office in the lobby. Arrangements for Health and Safety are satisfactory and the home seems particularly safety conscious. A health and safety manager is in post and is a member of the risk management group. A procedure is in place for calculating the risk in various aspects of the homes activities. In broad terms the procedure involves a calculation of the probability and severity of risk and the Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 29 potential impact on a person and the organisation should an adverse occurrence take place. This is summarised on a coloured chart. Systems are in place for recording and reporting incidents and accidents. These are considered by the risk management group and trends are monitored. Very good generic assessments are available to staff in the manager’s office. These include (among others) fire, Legionella, aggression, use of the home’s vehicle, manual handling, cleaning, and working at height. Individual resident specific and care related risk assessments are included in care plans and other care documents. Staff training in health and safety subjects is provided by ’12 Training’ – this covers all ‘mandatory’ subjects at induction, basic and update level. The monthly environmental audit and Regulation 26 visit includes attention to health and safety matters. Regular fire drills are held. A copy of a report by the health and safety manager of a fire drill in January 2008 was made available to this inspection. The report is thorough and includes clear recommendations for action by managers. Contracts are in place for the maintenance of fire safety equipment. The home was last inspected by Buckinghamshire and Milton Keynes Fire Authority in April 2007. An Environmental Health Officer inspected the home’s arrangements for food safety in May 2007. Three requirements were made and all were promptly and effectively acted on. Security in the home is good and access to all interior areas is well controlled. Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 4 3 4 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 2 33 4 34 1 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 X 3 X X 3 X Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 31 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 19 Requirement Records must contain evidence of full compliance with the Regulations in respect of the recruitment of staff. Timescale for action 29/02/08 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 YA6 Good Practice Recommendations Managers should consider whether there is scope for rationalisation in its care planning documentation with a view towards developing a person centred approach, part of which is in a form understandable to service users. Medication creams should be labelled when opened to ensure that they are used within the period prescribed for a particular product. Managers should ensure that the wording of the home’s ‘Do Not Resuscitate’ form meets current legal requirements and that its use in practice meets best professional practice. Managers should consider whether the home’s current reference request forms fully meets it current needs. 2 3 YA20 YA21 4 YA34 Mallard House DS0000063734.V359876.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 House DS0000063734.V359876.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!