Inspection on 08/05/06 for Mallard House

This inspection was carried out on 8th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mallard House 13/02/08

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 1ZZ Lead Inspector Gill Wooldridge Unannounced Inspection 8th May 2006 9:20 Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 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.V287563.R01.S.doc Version 5.1 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.V287563.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Mallard House Address Dunthorne Way Grange Farm Milton Keynes Bucks MK8 1ZZ 01908 520022 01908 524532 jan@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 Care Home 55 Category(ies) of Dementia (55) registration, with number of places Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 26 Service Users with cognitive impairment 29 Service Users with early onset Dementia Date of last inspection 24th November 2005 Brief Description of the Service: Mallard House is a 55 bedded nursing home on two floors which has been purpose built to provide 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 close to the centre of Milton Keynes and is close to public transport links. The home has its own transport, which facilitates access to the community for residents. The accommodation has all single rooms with en suite facilities Support from other health professionals has been established within the local community. The staff team is developing to support the residents and care and nursing staff have an ongoing programme of training to support resident care. A landscaped garden is accessible to residents. The addition of pictures and an increase in residents belongings has added to the ambience in the home. The weekly fees range from £950.00 to £2000.00. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place at 9.20 am until approximately 4.20pm on 8th May 2006 with a follow up visit on the 12th May. The inspection was carried out by two inspectors, Joan Browne and Gill Wooldridge. The inspection consisted of a tour of the home, six care plans were studied and the care of residents tracked. Residents and staff were spoken to and lunch was observed. Medication records and staff personnel files were also studied. The residents, relatives and visitors to the home along with the owner, managers, clinical managers, trained nurses and staff made contributions to the process of inspection and did not appear phased by the inspection process. The development of the service was discussed. It is noted that the home is developing its systems which are supported by an enthusiastic staff team. The managers are not yet registered with the Commission, they will be referred to throughout the report as manager(s). Managers had requested that residents complete comment cards and these had been sent to the Commission. The detail of these will be discussed throughout the report. Five relatives comments cards were received all praising the home in some areas. Three relatives were not aware of the home’s complaints procedure. The inspector will respond directly to one relative who raised concerns. The home has recently been on television and in the local press regarding the its official opening and the company has been nominated for the small business of the year award. What the service does well: It was noted that residents and staff are developing positive relationships and there is an ongoing programme of training and support to ensure that the care of each resident is tailored to meet their needs, this is supported by some detailed care records. Staff described a supportive work environment and support from the acting managers, owner and trained nurses. All staff undertake a clear induction and receive mandatory training to support their practice. The owner described open communication within the staff team which includes regular staff meetings and senior staff meetings. The owner described a developing team spirit. Staffing levels appear to reflect the numbers of residents and their individual levels of need. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 6 Good liaison and support from a range of health professionals employed by the home support the care of residents. The home also has good links with the local health centre and neuro-psychiatrist. The home is newly built and meets the needs of residents. What has improved since the last inspection? What they could do better: The manager should develop a system which correlates the hand written information which is gathered during assessment and formalises this. Regulation 26 reports must be sent to the Commission monthly. The manager must ensure that any perceived restriction of liberty or concern, for example the holding of cigarettes, must be detailed in the care plans and discussed in a multi disciplinarily forum with the resident and their representative to ensure that the risk is acceptable to all and to ensure that documentation supports the home in their duty of care. Review should be as detailed at assessment and the home must maintain records for inspection purposes. Previous timescale not fully met. Risk management plans should support any concerns identified in the daily log and formal reviews held with residents and their relatives or representative. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 7 Staff should write and explain the level of support and prompting required by individual residents more fully. Staff should write entries in care records with a positive slant. Staff encourages residents and relatives to sign care documents. It is strongly recommended that issues identified in care plans are addressed in more detail. The managers should ensures that residents have access to an advocate. Further quality audits be developed to support gaining residents and relatives views. The managers should record any verbal concerns raised by residents and relatives. 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. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 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.V287563.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. The procedures and practice indicate an assessment involving prospective residents and their relatives. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The home has a detailed assessment process. The home carries out an assessment in the prospective residents environment and involves residents and relatives in the process. Some assessment records seen were signed by relatives. One assessment document was hand written and difficult to read. Some documents seen were not always dated and signed although they were supported by a completed nursing tool assessment which was dated and signed. It is recommended that the owner/managers develop a system which correlates the hand written information which is gathered during assessment and formalises this. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Care plans are in place for all residents and are supported by a planned process of assessment. However, some inconsistencies noted may effect the service delivery. Generally residents are encouraged to make decisions however, the decision making process needs to be supported by residents or their representatives signatures. Risk assessments are generally in place. However, some further detail will further support residents in maintaining their independence and ensure risk management plans support the residents care. EVIDENCE: Seven care plans were studied and the residents’ care was tracked. Care plans covered areas such as personal care, nutrition, incontinence, diabetes, behaviour and social activity. The care plans identified race, disability, gender, age and religion. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 11 The care plans studied showed some good recording practice and well thought through care. Since the last inspection staff confirmed that they had undergone training in care planning facilitated by the owner of the home. One care plan did not have a positive slant for example Ms X ‘is not denied access to the beautician, hairdresser.’ It is strongly recommended that staff write with a positive slant. The level of assistance and or prompting was not always described fully in care records. It is strongly recommended that staff write and explain the level of assisitance and prompting more fully in care records. One carer described fully the care of a resident they had been working closely with. The detail they described was not recorded in the care plan however, it is acknowledged that the carer and the occupational therapist were working with the resident to review his care. One area identified in a care plan as a ‘crack in sacral area’ there was no recent evaluation or information to ascertain that the area had healed. It is strongly recommended that there is a formal audit to ensure these issues are addressed. All care plans confirmed resident’s likes and dislikes. Nurses and the chef confirmed that the kitchen staff are aware of residents preferences. Examples of good practice included clearly described approaches to residents and step by step instructions which would facilitate good care if the reader was a newly appointed staff member for example, ‘approach calmly but with confidence’ & ‘speak slowly and clearly’ It was evident that residents had been involved in the care planning process and their requests were seen in some documentation. Residents’ preferences for male or female staff to provide personal care was discussed fully with staff and the manager. It is identified in the homes policy that staff work in pairs and are identified for specific residents. It is advised that residents choice is recorded on all care plans on gender care. Upstairs an activity was observed where residents and staff discussed current affairs, this group was facilitated by an activity organiser. The residents were invited to choose their next outing which was planned for Thursday. Options were discussed and it was agreed that they would visit Bletchley Park. One resident was insistent that he was not going anywhere ‘that he was not able to Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 12 use the toilet’. Residents confirmed that they are consulted and felt very much involved. Staff confirmed ‘that residents are given real choices and they are not forced to do anything’. Any perceived restriction of liberty should be documented fully in consultation with residents and their representative and reviewed in a multi disciplinarily process on a regular basis as identified at assessment. For example, where relatives have asked staff to hold residents cigarettes. Not all residents who smoke had an appropriate care plan nor was it apparent that they or their relative had been involved in the decision for the home to support them in these areas of their lives. It is acknowledged that there is a system in place for the home holding residents money which involves the resident or relative or their representative. The owner confirmed that she was trying to find an appropriate advocate agency to support the residents. Two incidents indicated that there had been an altercation between two residents. There was no apparent risk management plan in place. The owner confirmed that the reporting of this incident in the daily log should have been clearer. Staff described relatives being involved in risk assessments, one document seen supported this statement. A relative has reported that their relative had several falls and is now in hospital. The falls had been reported and discussed with the manager and relative. It is a requirement of this report that risk assessments are reviewed when issues such as falls are identified. On the 4/5/06 it was noted in a daily record that a resident’s walking was causing concern, this was discussed with the occupational therapist who would ensure there was an update to the risk assessment. The trained nurse was unaware of any detailed risk assessment. One nurse described the diet of a particular resident, the detail of the support needed was not recorded in the care plan. The care of another resident was discussed with staff and they confirmed that the resident has use of an interpreter. One staff member has put some words together to support the team staff in communicating more effectively with this resident. Risk assessments are supported by ongoing support from the occupational therapist, physiotherapist and dietician. Records seen supported the staff statement of detailed assessments being carried out. The occupational Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 13 therapist stated that the communication with residents and relatives is open and ongoing to support any risk assessment. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 &17 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents are presented with opportunities to access leisure activities both inhouse and in the wider community. Further choice and opportunities should be developed which should ensure all residents social needs are met. Mallards House promotes flexible visiting which enables residents to maintain contact with family and friends. Residents are encouraged to discuss their meal preferences with the chef which should promote independence and choice. EVIDENCE: Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 15 Activities described by residents included small group activities such as arts and crafts, playing dominoes, darts, walks into town and trips out. Residents described a planned visit to the shops that afternoon. A group of six residents were participating in an arts and crafts session advertised on the white notice board in the lounge. It is acknowledged that a number of residents were obviously enjoying this activity taking pride in their achievement. Some residents may have chosen not to participate and it was unclear how their social and recreational needs are met. Three residents confirmed on the comment cards completed before the inspection and sent to the Commission, that there were no suitable activities provided by the home, a further five residents wished to be more involved in the decision making processes in the home. Four residents described not liking living in the home, however these comments need to be understood in the context of the residents presenting condition. This information was fed back to the owner for any appropriate action and also discussed with residents spoken with. The Television was on in the lounge with children’s television on. This may not have been appropriate. One resident described that staff respected his faith and read his regular magazine to him. Another resident stated that they didn’t think the African staff were that good. A further resident confirmed that the staff were friendly although he didn’t like the ‘regime’ for example set meal times. This was passed to the manager who discussed the issue with the resident. His relatives were spoken with and confirmed their involvement in choosing the home. The home has its own transport, which facilitates activities. Residents were seen to have a number of videos in their rooms and magazines to encourage their interests. Many bedrooms indicated the residents’ interests and many bedrooms viewed from the corridor looked more homely with residents having their personal possessions including photographs of family members. One manager described residents using the local gym. Care plans relating to social activity were seen and for some residents indicated their preferences for activities. There was a care plan in place for a resident to ensure that he is given privacy to fulfil his sexual needs. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 16 Three residents were sat chatting and talked about their families and regular visitors. Visitors spoken to described the home as welcoming with good staffing levels with lots of smiling faces. The visitors book indicates that the home has frequent visitors at varying times of the day. The lunchtime meal was observed. With a choice of main course, all portions were large. The tables were laid attractively which added to the ambience. The residents have chosen to have a light lunch which was a choice of soup and sandwiches or omelette vegetables and chips. The staff practice observed at this lunchtime was sensitive and discrete; staff were seen to be sat next to residents, taking time and encouraging residents to respond. The responses from some residents included smiles and positive eye contact. Staff were heard to offer residents choices. It was strongly recommended that the management review the process of disposal of food after meals at the last inspection. This has been actioned and has added to the ambience of the mealtime. Three residents comment cards indicated that they did not like the food sometimes. It is noted that the chefs have a key role in ensuring that residents likes and dislikes are reflected in the menu planning. Residents spoken with before and after the meal commented favourably about the food. Relatives are encouraged to visit and commented favourably regarding the service especially commenting on the good staffing levels. Two residents had stair gates across their bedroom doors, this was discussed fully with one resident, there was no apparent documentation to support this practice however, it was clear from the discussion that this was the resident’s choice. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made been made using available evidence including a visit to the service. Staff’s observed practice should demonstrate that residents’ physical and emotional needs are met. Medication procedures are in place which should ensure residents are protected. EVIDENCE: Staff were observed to interact with residents positively and described the care of residents with an unhurried feel to the day, staffs observed practice confirmed this. Staff were observed to support residents using the toilet sensitively. The home is supported by a neuro-psychiatrist. A psychologist, physiotherapist and occupational therapists are employed by the organisation. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 18 All temperatures, pulses and respiration (TPR’s) were noted to be recorded regularly dependent on the resident’s assessed needs. Residents weights were recorded. It was noted that all personal care was carried out in bathrooms and bedrooms which helped to maintain residents privacy and dignity. Residents confirmed that staff respect their privacy. One written response from a resident stated that his privacy was not respected. One resident was very noisy which was apparently having an impact on the group. Staff were seen to manage their behaviour appropriately and they were was taken outside to enjoy the garden. Behavioural charts were seen to support some residents care. One resident confirmed that her family washed her hair and that this was her wish. This was not documented in the care plan. Care plans regarding epilepsy need to show that staffs described actions, such as calling an ambulance, is recorded if a resident suffers from a period of continuous seizures. Staff practice regarding the administration of medication was observed at this inspection and noted to be satisfactory. The nurse was attentive and ensured the resident swallowed their tablets and or liquid before moving on to the next resident. The Medication Administration Records sheets were studied on both floors there was a minor inconsistency on the first floor however, the clinical nurse in charge was waiting for the nurse to return from her day off to address the issue with her. There is an audit system in place to monitor the Medication Administration Records sheets. The controlled medication book was checked on the first floor and the records tallied with the medication in the packet. The Medication Administration Records sheets indicated that the GP generally signs all hand written entries. However, the practice in the home is that when a new resident is admitted one nurse transcribes the residents’ medication to the Medication Administration Records sheet, maintaining the previous prescription and or the record from the residents’ previous home awaiting the GP signature. It is recommended that two nurses check and sign any transcribing. There is a list of staff signatures and names in the front of the Medication Administration Records sheets, this is noted as good practice. It is strongly recommended that the manager develop individual PRN management plans for the medication of any resident which may be perceived as controlling behaviour or having a sedative effect. This will formalise staffs good practice and to support the minimal use of PRN medication. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 19 Medication storage was a requirement of the previous inspection. The owner described moving the medication trolley. The storage of medication was discussed again and was reviewed and supported by a risk assessment at the follow up visit. The risk assessment was supported by the home’s pharmacist and one of the managers and owner confirmed that a self locking device was being fitted to the medicine cupboard door upstairs. It was described that the storage of medicine has been reviewed downstairs. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. There is a complaints procedure which should ensure that relatives and residents are listened to. Policies and procedures are in place which should ensure that residents are protected from abuse. EVIDENCE: The owner confirmed that she had not received any complaints since the last inspection. However, at the follow up visit an email was discussed. The owner had written to the relative in response to their concerns. One manager confirmed that one relative had raised some verbal concerns. It is strongly recommended that the managers record any verbal concerns and issues that relatives and residents raise and that these are recorded and actioned as appropriate. Relatives concerns raised with the Commission through the feedback system have either been addressed in the report or directly fed back to them individually. The main issue for relatives was that they were not aware of how to complain. The Commission has received one concern from a PCT this was discussed with the manager who had not received a copy of the letter. A verbal concern was raised with the Commission and discussed at the follow up visit. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 21 From discussions with residents it was evident that they are listened to and their views are that the care is good. One resident raised a concern which was passed back to the owner for her to action. Staff were able to identify that they would report any potential or actual abuse. Staff stated that shouting at a resident was unacceptable. Policies and procedures are in place to support staff practice. This should ensure residents are protected from abuse. Staff described that they would report outside the home if they suspected managers of not actioning any concerns or abusing residents. It is acknowledged that staff were confident in the management of the home to act on any potential or actual abuse. The owner confirmed that adult protection training takes place annually. Residents spoken with generally confirmed that they were able to raise concerns and stated ‘ I feel well cared for’. At the follow up visit the owner was requested to report a matter under PoVA which she agreed to do. One relative had complained in the interim between the inspection and follow up visit. The owner shared her response. It is noted that some of the individual points raised were not addressed and it is strongly recommended that the owner reviews her response. Since the inspection, this matter has been reviewed under POVA and the responsible individual confirmed that there have been no adult protection issues at Mallard House. Two residents monies were checked and the amounts tallied with the records kept in the home. Systems are in place which involve residents and relatives where the home has agreed to hold residents monies. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The environment has been designed to ensure that residents reside in an environment that meets their care and comfort needs. The addition of pictures should facilitate a more homely feel as has the completion of the garden. Standards of cleanliness in the home are good which should ensure that residents live in a clean home. EVIDENCE: The home was clean and tidy with no odour of incontinence, it was also warm and welcoming. Pictures and residents personal belongings in their rooms have added to the ambience. The home has adequate storage space which ensures that equipment is stored appropriately. The kitchenettes and bathrooms were clean and tidy. Staff were observed to generally maintain good hygiene practice. Staff described hand washing as a key to infection control. Staff were seen to wear gloves, aprons and hats to aid infection control, pedal bins also aid this process. The laundry was clean and tidy. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 23 Some residents’ bedrooms indicated their personality, interests and hobbies and some residents had been encouraged to bring items of furniture into the home. Some residents have a key to their own bedroom. The gardens have been designed to support residents’ needs and there has been considerable progress in this area. At the moment the spring bulbs are adding to the overall appearance of the garden.Some further planting of trees is planned to ensure that residents enjoy the view of the garden whilst maintaining their privacy. An air conditioning unit has been installed which has added to the comfortable feel of the nurses station. The owner discussed that one resident’s relative was concerned that the bedroom was not secure, they were offered an alternative bedroom which was refused. This relative was involved in the risk assessment to ensure the well being of the resident concerned. The owner described wishing to convert three bedrooms into rehabilitation flats, the owner is reminded to apply for a variation to facilitate this development. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Recruitment procedures are satisfactory which should ensure residents are appropriately protected. The appropriate staffing levels, a continuing emphasis on appropriate staff induction, training and on the job supervision should benefit residents’ care. EVIDENCE: Staff rotas indicate that staffing levels are satisfactory to meet residents’ needs. The rotas indicated that there are generally two registered nurse and seven carers supported by a manager on each unit. Activity organisers, housekeeping staff along with health professionals also support the care. The reception is also manned during office hours. The owner described ongoing recruitment to meet residents needs. Night staffing levels are three carers and one RGN on each floor. Staffing numbers during the inspection appeared to meet residents’ needs. Relatives stated that in their opinion staffing levels were good and staff were always smiling. Two relatives raised concerns regarding staffing levels, this was discussed with the managers and owner. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 25 The owner acknowledges that the team is still evolving and that ongoing training and support is the key to building an effective staff team. Staff confirmed there is an induction system and planned mandatory training. Staff spoken to described clearly their roles and senior staff were aware of their accountability. Newer staff described being part of the team and mandatory training and NVQ were part of the expectation from the management, this was supported by the training matrix. Support was described as was formal supervision, one staff member described lots of on the job support via a mentoring system but no formal supervision. It is evident that staff are clearer regarding their roles than at previous inspections and there appears to be a more cohesive approach to residents care. As stated earlier staff described practice and the actual care they provide for residents was not always fully detailed in care plans. Fourteen staff files were studied, these staff were those employed since the last inspection. Prospective employees fill in an application form and the home requests two references, two references were seen on all files. However, the authentication of references and ensuring that a reference is obtained from the applicant’s most recent or previous employer was not always evident. This was discussed fully with the owner. At the follow up visit the owner had added a statement which says ‘Please provide a company stamp company card or a company compliment slip.’ The owner also confirmed that the company rings to check out references. It is strongly recommended that this information is recorded and records maintained for inspection purposes. CRB’s and POVA First checks were seen on all staff files viewed. Work permits were in place where appropriate as was a health declaration and job offer with terms and conditions. The care and nursing staff are supported by a team of health professionals who discuss residents’ care and involve the training department to ensure residents’ needs are met. Staff described lots of recent updates regarding mandatory training and it was confirmed by staff that there is a lot of informal training taking place. Residents described that their care needs were met and praised the staff team especially the physiotherapist and occupational therapist and who encouraged their independence. The inspector explored the reported difficulty of residents and relatives understanding some staff. This was discussed with residents, relatives, staff and the owner. Residents generally described no problem with understanding staff, this was supported by the external NVQ assessor visiting the home and working alongside staff. All staff spoken to on the day of the inspection could Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 26 be understood. One resident stated that ‘there is a good lot of staff on today’ One staff member stated there was a problem a few weeks ago regarding staff speaking their own language however, this had ceased in the last few weeks. A notice in the nurses’ station referred to a situation described by the owner which reminded staff to speak English at all times. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Health and safety information was studied during this inspection which indicates that generally residents health, safety and welfare is promoted and protected. Further clear audit systems to support service delivery will ensure residents and relatives’ views are encouraged. Residents benefit from a well run home. EVIDENCE: The two unit managers are awaiting to be registered with the Commission. The home is being supported at this time by the owner. Quality assurance systems are in the process of being developed. The owner described focussing on the clinical issues such as care plans and medication. It Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 28 is acknowledged that staff training has had a positive effect on the content of the care plans. it is recommended that residents and relatives are engaged in the quality audit system. Health and safety records seen included a recent lift and hoist service along with fire records. Water temperatures were in place other than the most recent which is being sent to the Commission. Emergency lighting records are being sent to the Commission. A chlorination certificate was dated for 21st April 2006. Recent fire officer and environmental health officer reports were described by the owner as actioned. One residents recent accident and care was tracked. Staff need to write clearly and describe more fully the actions taken following an accident/ incident. However, the described practice was clear. This resident’s risk assessment was not updated following a number of falls described by the owner. It is required that all risk assessments must be updated following a series of or an important event effecting one or more residents. It was not evident that the family had been involved in the risk assessment. However, it is acknowledged that there were discussions with a psychiatrist and staff from the home which included the relative. Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 29 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 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 3 x x 3 x Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13 (4) Requirement Timescale for action 30/09/06 2. 3. YA7 YA9 13 (4) 13 (4) The manager must ensure that any perceived restriction of liberty or concern, as detailed in the care plans for example holding residents cigarettes must be discussed in a multi disciplinarily forum with the resident and their representative to ensure that the risk is acceptable to all and to ensure that documentation supports the home in their duty of care. Review should be as identified at assessment and the home must maintain records for inspection purposes. As above (Requirement 1) 30/09/06 Where there is a pattern of behaviour which may place residents at risk or a number or pattern of falls the managers must put in place risk management plans and review risk assessments. 30/06/06 Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA2 YA6 Good Practice Recommendations It is recommended that the managers develop a system which correlates the hand written information which is gathered during assessment and formalises this. It is strongly recommended that staff write and explain the level of support and prompting in care records more fully. It is strongly recommended that staff write entries in care records with a positive slant. It is strongly recommended that staff encourage residents and relatives to sign care documents. It is strongly recommended that issues identified in the body of the report are included in any evaluation system. It is strongly recommended that the manager ensures that residents have access to an advocate. The manager should develop individual PRN management plans for residents for medications that may be perceived as controlling behaviour or having a sedative effect. It is strongly recommended that the managers record any verbal concerns raised by residents and relatives. It is strongly recommended that the owner reviews her response to a recent complaint by addressing all the points raised. It is strongly recommended that the managers ensures that references are obtained from the prospective employees previous employer. It is strongly recommended that the managers ensure that if they do not receive supporting documentation regarding a reference they ensure the referees authenticity. It is strongly recommended that further quality audits be developed to support gaining clients and relatives views. 3 4 5 6 7 8 9 YA7 YA20 YA22 YA22 YA34 YA34 YA39 Mallard House DS0000063734.V287563.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 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.V287563.R01.S.doc Version 5.1 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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