Inspection on 12/11/08 for Malvern House

This inspection was carried out on 12th November 2008.

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

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

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Malvern House 10 St Stephens Road Saltash Cornwall PL12 4BG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mandy Norton     Date: 1 2 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Malvern House 10 St Stephens Road Saltash Cornwall PL12 4BG 01752842463 01752842463 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Martin Joseph Jackson,Mrs Polly Angela Jackson Name of registered manager (if applicable) Mrs Polly Angela Jackson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is 22. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Malvern House is a converted Victorian porperty that has been run as a care home for many years. It is close to centre of Saltash where there are a range local ammenities and access to public transport. The home is on 2 levels accessible via a passenger lift. A small number of rooms on the first floor are on a mezzanine landing and accessed only by the stairs or the Care Homes for Older People Page 4 of 27 care home 22 Over 65 22 0 Brief description of the care home stairlift. Communal space consisting of a dining room and a lounge are both on the ground floor. The garden has level access to it and garden furniture is provided for people to use. The home is registered to provide nursing care to a maximum of 22 people who are male or female and over the age of 65. The fees range from 390 - 570 pounds a week. Each person is provided with a contract once a settling in period has been achieved. The providers (Mr & Mrs Jackson) have bought the home in the last 6 months and following an audit of the environment have started making positive changes within the home. Mrs Jackson is currently the registered manager and runs the home with support from the matron (Mr Mills). Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place from 9.50am to 3pm on 12th November 2008. The inspection was conducted with the Mr & Mrs Jackson (providers) and the matron. Mrs Jackson is currently the registered manager. A tour of the home was carried out and people who live at the home were spoken to and observed. Care staff were also observed during the inspection. This report also contains information taken from the completed Annual Quality Assurance Assessment (AQAA) document and Service User and staff surveys submitted to the Commission prior to the inspection. Care Homes for Older People Page 6 of 27 There were 16 people living at the home on the day of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move to the home. People who use this service have up to date information about the home in order to make an informed decision about whether the service is right for them. Evidence: The manager said that people are always assessed prior to moving into the home to ensure their needs can be met, the matron went to carry out an assessment at the local hospital on the afternoon of the inspection. The information collected forms the basis of a care plan if the person is then admitted to the home. Prospective Service Users and/ or their relatives are invited to look around the home and ask any questions they may have. Care Homes for Older People Page 11 of 27 Evidence: The Statement of Purpose (a document containing information about the service and what it can offer, given to people who are admitted to the home) seen was up to date and contained all of the required information. The manager has stated that a Service Users Handbook has been developed since they took over and a copy is provided to each Service user in the home. The home also has a website (www.malvernhousenursinghome.co.uk) that people can use to find out about the home. It is easy to use and has a lot of useful information about the home and what it can offer. There is also a facility for people to contact the home via email and ask any question they may have. The current fee level ranges from 390 to 450 pounds per week for people assessed as needing personal care only (residential) and 510 to 590 pounds per week for people assessed as needing nursing care (correct November 2008). Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will be met. Evidence: Of the 3 care plans examined 2 had not been reviewed as regularly as they should have been but they did contain a lot of relevant information about the person and their health and personal care needs. The nurse who is a key worker for the person is expected to keep the care plans reviewed and updated. The nursing staff complete daily records about a persons welfare and detail what care has been provided following discussion with the carers who have provided the care along side the nurses. The matron said that during team meetings care planning is discussed and the importance of keeping them reviewed is stressed to the nursing staff. He is currently undertaking an audit of the care plans in place and from that will be able to establish where improvements can be made. Information was included about visits made by health care professionals such as GPs, opticians and dentists. The care plans are stored in Care Homes for Older People Page 13 of 27 Evidence: the office but are accessible to all staff who provide care. A tour of the home showed that equipment necessary for the promotion of tissue viability and prevention of pressure sores is available to meet peoples current needs. The manager said that they have enough equipment and more adjustable beds are now in place since the new providers took over. The medicines are kept in a locked trolley in a locked room. The drugs fridge has its temperature measured and recorded daily. An up to date medicines information book (BNF) and the most up to date Standards for Medicines Management (newly published by the Nursing and Midwifery Council) were noted as available to all staff, this was noted as good practice. Nursing staff administer medicines. The medication administration records (MAR) sheets seen were mostly completed as required. The matron was reminded that staff giving medicines should always complete the MAR sheeet appropriately. The procedure for receipt, storage and disposal of unwanted medicines was explained and is in accordance with laid down legislation. Staff were heard and observed interacting with people appropriately and providing care and support in a discreet manner. Staff were knocking on doors before entering and doors remained closed whilst personal care was taking place. The manager commented that Malvern House pride themselves on their End of Life care and all the nursing staff are trained on the Liverpool Care Pathway (a framework for the care of the dying that can be used by all of the healthcare professional involved with a person at the end of their life irrespective of diagnosis or place of death. It details a persons wishes, social and healthcare needs, mediciation required and ongoing evaluation without different people having to ask the same questions of an individual all the time: www.mcpcil.org.uk) which we implement as soon as appropriate for the Service User. She also states that they have had feedback from visiting professionals that our Service Users are very well cared for in this regard. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities within the home and the local community mean that people have some opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and staff are available to help make them an enjoyable and social occasion for people. Evidence: The matron said that the activities co-ordinator (who has been employed since the new providers took over) is currently off sick but while she is away the staff group are trying to ensure that elements of the activity programme continue. He said that people are encouraged to exercise choice in how they spend their time and activities are offered individually and in groups. The care plans are designed so that information about peoples interests and hobbies can be recorded and can be used when trying to develop person centred care. None of the 3 care plans examined had information in them about peoples past or current hobbies and interests. Visitors are welcomed at anytime and residents can see them in their own room or the communal areas if they wish, some people regularly go out with friends or relatives. There is a mature garden Care Homes for Older People Page 15 of 27 Evidence: at the front of the house that the provider is trying to improve by cutting down overgrown areas and providing level access so more people can use the area. New garden furniture has been provided. During a tour of the home people were seen watching TV, listening to the radio and reading the newspaper. Many people have their meals in the dining room, which is spacious and bright. There are staff available to assist or support anybody that needs it whether they are in their room or the dining room. Special diets are catered and drinks and snacks are available 24 hours a day. Records are kept of what people eat to ensure they are receiving a balanced diet. The manager said the menus have been completely revamped since they took over and the quality of the food they buy has improved. Three Service user Surveys were returned prior to the inspection, 2 indicated the meals are usually good and 1 that they are always good. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. All staff undertake safeguarding training. This means that people who live at the home are adequately safeguarded. Evidence: The complaints procedure was seen displayed in the home and is included in the up to date Statement of Purpose. It is comprehensive and gives options about who to contact and timescales for responses to be made. The manager and the matron have consistently contacted the Commission promptly where any concerns or issues have arisen regarding staff or Service Users. There have been no complaints made to the Commission or the home since the new providers took over. The provider has made a referral to the local authority safeguarding team recently which remains ongoing at the time of the inspection. The manager has stated that she has had feedback from the Department of Adult Social Care that the home implemented the safeguarding process accurately and it has been well managed The matron said that people are seen by senior staff daily and hopes that any issues or concerns would be bought up at then. The 3 completed Service Users survey indicated that they knew how to make a complaint if necessary. Three of the 4 Care Homes for Older People Page 17 of 27 Evidence: completed staff surveys returned prior to the inspection indicated they knew what to do if somebody has concerns about the home and 1 indicated that they did not know what to do. A number of staff attended the County Council safeguarding training they also have information about safeguarding when doing National Vocational Qualification (NVQ) training and during induction training. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite ongoing refurbishment and redecoration people have a comfortable, homely and safe environment in which to live. Evidence: Malvern House is currently registered to take up to 22 people (20 being the maximum they currently take). There were 16 people living at the home on the day of the inspection. The home has recently been taken over by new providers who are gradually improving the environment and therefore the service they offer to people. Refurbishment and redecoration work is currently ongoing to achieve this. The current residents are not directly affected by the ongoing work. A tour of the home showed that peoples rooms are personalised with furniture and momentos they bought in with them. Two people spoken to said they were happy with their current accommodation. Lockable space can be provided in individual rooms if it is required. Many of the corridors have grab rails fitted to help people move around the home. There is some general wear and tear to the doorways which the provider will be addressing in the refurbishment programme Communal space consists of one lounge and a separate dining room, both on the ground floor. The lounge had a range of seating and a TV for people to watch if they wish. Care Homes for Older People Page 19 of 27 Evidence: There are enough assisted bathrooms and toilet facilities for the people who currently live at the home. Future plans include improving the shower room on the first floor which is outdated and rarely used. A mechanical sluice facility is available, which has recently been serviced to ensure it is working correctly. On the day of the inspection the home was clean, tidy and hygienic. Policies and procedures around infection control are up to date and available to staff at all times. In house training on the importance of infection control is routinely offered to staff. Comments made on completed staff surveys said that the new owners have made lots of improvements and that the home feels homely. The AQAA states that storage is a difficulty in the home and some areas would benefit from reorganising so that clinical equipment is not on view. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels and skill mix are satisfactory meaning peoples needs are being met at all times. The robust recruitment procedure means that people who live at the home are being looked after by appropriate staff and their welfare is not at risk. Evidence: The manager, matron, nursing and care staff are supported by an activity coordinator, catering, domestic, laundry staff and a maintenance man (who is one of the providers). This current staffing levels and skill mix are seen as sufficient for the number of people who currently live at the home (16) and is based on their dependency levels. The staffing levels have increased since the new providers have taken over. Following successful recruitment the induction process implemented covers health and safety, fire safety, safeguarding and individualised care. The staff member continues working under supervision until they confident and competent to be working alone. The AQAA states that over 50 of care staff (15 people) have at least an NVQ level 2, in care or health and social care, or above. Care Homes for Older People Page 21 of 27 Evidence: Training opportunities were seen displayed in the office during the inspection and staff files seen included a number of certificates for study days and statutory training that have been attended. The AQAA states that regular qualified and care staff meetings have commenced and are well attended. These meetings have proven productive and of benefit to service-users and staff. The home has a robust recruitment procedure that includes 2 written references and a CRB check. Staff files examined (3) had all the required information in them and were stored securely with only the provider and manager having access to them. The manager said she and the matron interview prospective staff using a formal interview format (completed form seen in one staff file examined) and only take the person on once satisfactory references and a CRB check are received. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and procedures now in place are designed to meet the needs of the service as they strive to develop the service the home offers to the people that live there. The attitude to health and safety shown by the providers, nursing, care and ancillary staff means that people live in a safe and well maintained environment. Evidence: The providers (Mr & Mrs Jackson) have had experience of running a care home prior to taking over Malvern House. Mrs Jackson is currently the registered manager. She is a level 1 registered nurse. The current matron (a level 1 registered nurse) has been at the home for 18 months. It is his first matrons post, the current manager is very supportive and is aiming to put him forward to be the registered manager when he has achieved Registered Managers Award (RMA) for which he is currently studying. A formal quality assurance assessment has not been carried out since the new providers Care Homes for Older People Page 23 of 27 Evidence: took over as they have been concentrating on making some initial improvements, carrying out an equipment audit and establishing a stable staff group whilst getting to know the current residents and their relatives and representatives. The manager said that a system will be developed and put into practice in the near future. In the meantime the manager and the matron have an open door policy and are happy to hear any concerns or issues as they arise and are then able to act on them immediately. The manager has stated that since she has been at Malvern House she has continually sought feedback from staff, relatives and Service Users in a nonformalised way as it has been such a short time since the change of ownership. It is her intention to provide a formal questionnaire in the second half of the first year of ownership. The AQAA states that a suggestion box is situated in the entrance of the home for relatives and visitors to use. This was seen when visiting the home. The manager demonstrated that money held on behalf of the current residents is kept securely and records are kept of income and outgoings and receipts are kept as evidence of the transactions. Residents have access to their money at all times. When the home was taken over the providers began an audit of fixtures, fittings and equipment to see what condition it was in and if replacement was needed. The AQAA states that a number of safety issues that were outstanding when the home was purchased have been addressed already e.g. defective sluice, inadequate plumbing, poorly fitting fire doors. A number of routine servicing and maintenance documents and the fire log book were examined and found to be up to date. Mr Jackson (one of the providers) carries out ongoing in house and outdoor routine maintenance tasks and manages the ongoing refurbishment and redecoration programme. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 All care plans should be reviewed and updated regularly to ensure staff have the most up to date information when providing care and support to people. All medication administration record (MAR) sheets should be fully completed following administration of medicines to indicate a person has had their medication or if not why not. The manager should ensure that information about peoples past and current interests and hobbies is recorded. This helps to ensure individual person centred care and support is maintained. 2 9 3 12 Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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