CARE HOMES FOR OLDER PEOPLE
Mandalay Residential Home 10 Julian Road Folkestone Kent CT19 5HB Lead Inspector
Justine Williams Key Unannounced Inspection 5th November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Mandalay Residential Home Address 10 Julian Road Folkestone Kent CT19 5HB 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) 01303 258095 F/P 01303 258095 mandalayresidential@hotmail.co.uk Stargate Partnership Ltd Post Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. MD is restricted to two residents whose dates of birth are 22/06/1944 And 13/07/1949 2nd August 2006 Date of last inspection Brief Description of the Service: Mandalay is registered to provide residential care to 40 older people. The Registered Providers have applied to the Commission for a variation of the category of registration to include 6 places for individuals requiring nursing care. The home has recently been extended and the whole of the premises has been refurbished and redecorated. All bedrooms are single and have en-suite facilities. Communal space consists of a dining room and lounge and there are plans to build a conservatory in the future. Accommodation is over 3 floors and there are 2 shaft lifts. There are local shops and the main bus route into Folkestone runs close to the home. The statement of purpose gives information about the service. A copy can be obtained from the home. The most recent inspection report can be seen in the home. Currently the scale of fees is between £312.81 and £365.00. Hairdressing, chiropody, transport, papers, toiletries and holidays are at an additional charge. Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced key inspection was carried out on 5th November 2007 between 10.00 am and 3.00 pm by regulatory inspector Justine Williams. During that time residents, staff and the manager agreed to speak with the inspector both in public and privately. This report contains assessments made from observations, conversations and records, case tracking and a tour of the premises. Feedback was given during and at the end of the inspection. As part of the inspection process surveys were sent to service users, GP’s, health care professionals, care managers and relatives of residents. “since the new manager has been appointed things have improved a lot” “one feels very much at home and get on well with the staff” “my relative is very happy” “rooms are very clean and smart” What the service does well:
The home has good admission processes, which help new residents make the difficult transition into living in a home. The resident health needs are well managed though they are not always documented in the designated places, making tracking and progress difficult. The home’s medication practices are safe and comply with relevant legislation and good practice guidelines, and further improvements will be made when the home has a more appropriate and roomy medication store. The privacy and dignity of residents is a priority at the home. Residents are made to feel at ease and say they never feel embarrassed especially when being helped with personal care due to the professionalism of the staff. Residents are enabled to exercise control over their lives and make choices. Residents said their visitors are made welcome and can visit any time. The home has been extensively refurbished to a very high standard, further improvements are planned as the owners plan to build a conservatory for residents use. The bathrooms have been fitted with a good range of moving and handling equipment and yet remain comfortable and homely. The manager has implemented robust recruitment procedures to ensure the relevant checks re carried out on all new staff prior to their working at the
Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 6 home. Staff have undergone several training updates recently and the home has achieved around 75 of staff with NVQ. What has improved since the last inspection? What they could do better:
The manager has organised training which staff have just completed into the new care planning system. The care plans used currently are inadequate, they do not contain sufficient details of how residents’ needs are to be met and are very narrow in scope. The daily events documentation does not describe how residents spent their day or if their care needs have been met. The residents’ individual risk assessments are similarly narrow in scope and insufficiently detailed. The manager is aware of this and is addressing these issues. The privacy and dignity of residents could be improved by providing residents with a private area in which to make and receive telephone calls, as at present the payphone is in a hallway. Improvements in the planning, frequency and type of activities held at the home could be made. Residents said activities are limited and they are sometimes bored. Improvements in the documentation would allow staff to demonstrate that residents’ needs have been met and leave them less vulnerable to complaints and adult protection allegations. An improvement in staffs’ knowledge of adult protection procedures is needed as well. Some health and safety issues were identified, though the manager rectified some immediately. The manager must discuss the use of stair gates with the fire officer as a matter of urgency, as they could provide an unnecessary obstruction to in the event of fire. The unfixed toilet frames should be fixed or
Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 7 an alternative piece of equipment found to reduce the risk of falls. The storage of clean linen in the laundry room needs to be reviewed, and all COSHH substances must be locked away when not in use. 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. Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and prospective residents have the information they need to make a decision about moving into the home. EVIDENCE: The home’s statement of purpose needs to be updated to include the new manager. The service user guide has been updated, and is given to prospective residents. Residents who have moved to the home recently said they had their needs assessed prior to moving in, and their relatives had visited the home on their behalf. The home requests a copy of any assessments carried out by social services. The pre admission assessment includes all the information in standard 3.3, and assessments carried out were reasonably detailed. The home does not provide intermediate care.
Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 10 Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ personal care needs will be better met with more comprehensive care plans. Residents’ health needs are met and residents are treated with respect. EVIDENCE: The care plans are very brief, and do not contain adequate detail of how staff are to meet residents needs. These are being urgently reviewed and added to by the staff and manager. The daily records do not reflect how residents spend their days or what care they have been given. Care plans had been regularly reviewed but remained insufficiently detailed. Residents were not aware of their care plans and had not signed them to indicate their involvement and agreement. Residents’ risk assessments are also being reviewed by the staff, as they recognise that these are not adequate.
Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 12 Residents’ health needs are adequately managed by the home and a record of visits by health care professionals is kept though not always completed by the staff. The manager is monitoring this as staff tend to record the visits elsewhere. Residents said they had access to their GP whenever they wanted and the home is served by several GP practices allowing local residents to keep their GP. The manager described good working relationships with the district nursing service who visit daily and carry out screening assessments on all new residents and those with deteriorating health. The screening includes waterlow, for pressure sore development, continence, and nutrition. The home has purchased some pressure relieving equipment and accesses other equipment through the district nurses. The home has purchased some electric beds for its less mobile residents. Medication was being stored appropriately and medication administration records were up-to-date and accurate. The manager conducts regular medication audits to improve and monitor practice. Further improvements to the medication storage are planned when the refurbishment work is complete. This will include fitting a sink and providing a fridge specifically for storing medication. The home uses the monitored dosage system; all staff responsible for administration of medicines have completed medication training. Residents said they feel the staff treat them appropriately with due regard and respect for their privacy and dignity. Staff were observed knocking and waiting for permission before entering resident’s bedrooms and residents said they are called by their preferred name. Residents do not have access to a private payphone; the payphone is situated in a hallway. Residents may have a telephone installed in their bedrooms but for those who do not have a private line there is no provision of a private area in which to make or take telephone calls. Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents find the frequency and type of activities limited. Residents are helped to exercise choice and control over their lives. Residents said the quality and variety of the meals were improving. EVIDENCE: The home does not employ any staff to run and organise activities though staff endeavour to run some activities, when time allows. The manager is in the process of recruiting someone to co-ordinate activities. There is no planned programme of activities on display. The manager organises external entertainers to visit the home, some of which visit monthly to sing or play music. Residents enjoy armchair aerobics but due to illness have not had this for some time. The manager plans to hire a minibus every couple of months to take residents on trips out, as the home’s minibus is in poor repair. One resident remarked on her disappointment on moving in that the home had no pets, the manager said she would look into what pet the resident would like.
Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 14 Several resident spoken with said they would like more activities to be run, as they were sometimes bored. The manager is also planning to re- establish the open access library. Residents said their visitors are made welcome and can come at any reasonable time. Residents said they had been given the opportunity to bring in personal items including items of furniture, and rooms had been personalised to resident’s individual tastes. Residents said the meals had improved recently as their had been occasions where plates were cold and meals were not very hot. Residents also said the variety of food had been limited with lots of mixed vegetables being served. Residents said there is always a choice and plenty of fresh fruit is now available. The manager said the home is changing its suppliers and anticipates that once the teething problems are resolved residents will be very satisfied. The cook prepares breakfast and lunch and care staff are allocated to the kitchen to prepare the evening meal. Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents feel confident any complaint they may have would be listened to and acted upon. Residents would be better protected from abuse, by better documentation in care plans, and improving staff understanding of abuse protocols. EVIDENCE: The home has a complaints policy in place, and has received 1 complaint since the new manager has been in post. Information on complaints prior to this was not available. The complaint file contained a record of the actions taken to address the complaint and copies of correspondence. Residents felt comfortable to make a complaint and said the manager and staff were approachable. The home has also introduced a comments and suggestions book recently. The home has had 3 adult protection alerts raised by social services in the last 4 months.1 has been resolved and the manager has recently attended a meeting for the 2 recent alerts, which are open currently. Staff spoken with had some grasp of what actions they must take if they were alerted to alleged abuse, however this knowledge could be improved upon. The manager said the allegations made were difficult to dispute due to the home’s poor record
Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 16 keeping. Addressing this and staff lack of knowledge will improve resident’s safety. The home has an adult protection policy. Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a well-maintained environment in which to live. EVIDENCE: The home is not purpose built but has been extensively refurbished and altered to make improvements. The home is light and airy throughout with furnishings and fittings of a high standard. The grounds were tidy though some hazards were present due to uneven ground where footings have been dug for the conservatory. The manager confirmed that the home complies with the requirements of the fire department and environmental health; although 2 areas of the home have stair gates fitted which are obstructing fire escapes, this must be urgently reviewed.
Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 18 Residents do not have door locks fitted to their bedrooms doors, and whilst lockable storage is provided, residents are unable to secure their rooms. One resident spoken with is unable to have a bedside table and bedside light due to the narrowness of her room, alternative bedside lighting should be provided. The home has grab rails and assisted bathrooms, as well as other equipment to help promote residents independence, skandia and other toilet frames should be fixed to the floor or alternative grab rails provided as they present a hazard. Radiators are covered and rooms are individually heated and ventilated. The home was clean and pleasant smelling throughout. The laundry is sited in an out building. Clean laundry such as bedding and towels are stored here due to lack of storage space in the home, the circulation of dirty laundry must be closely monitored and documented in the infection control policy to minimise risk of cross infection whilst clean laundry is being stored here. Foul laundry is dealt with appropriately. Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents are cared for and supported by properly recruited and trained staff. EVIDENCE: The manager is in the process of increasing the number of care staff on duty following the increase in numbers of residents and changing dependency. This should allow for staff to run more activities, allow for more trips out and facilitate improvements in documentation. The staffing rota shows what staff are on duty and in what capacity. The home has achieved around 75 with NVQ, and staff receive good support from the home to undertake NVQ. New staff receive a thorough induction in line with good practice guidance. The manager is responsible for recruiting staff and all new staff have submitted application forms, all had 2 written references, CRB and POVA checks, proof of identity etc. the manager is in the process of managing the staff training, by finding out what training staff had and when and booking relevant and timely updates. Staff are up to date with the majority of core training, although as stated in standard 18 adult protection updates would be useful.
Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 20 Recent training undertaken by staff includes fire awareness, first aid, dementia awareness, care planning and palliative care. Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home, which is improving as the new manager implements changes. EVIDENCE: The manager has been in post since August and has recently submitted her application to the Commission to become the registered manager. The manager has attained the Registered Managers Award and has managed care home for some years.
Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 22 The manager is implementing some quality assurance systems, surveys have been sent out recently and some audits have been started. Regular staff meetings are being held and resident’s and relative’s meetings are also planned. The home manages small amounts of money for residents who are not able to manage their own finances. Money is kept separately for each resident, with individual balances and receipts. The manager does not keep more than around £40.00 for residents. The money is kept locked away but not in a safe. The manager plans to purchase a safe to improve the security of resident’s monies. The manager ensures the servicing and maintenance of equipment is carried out when required and electrical systems, call bells lifts and hoists are safely maintained. Staff are receiving planned training updates to maintain their skills. An item of COSHH substance had been left in one of the bathrooms. The maintenance shed containing some COSHH chemicals was unlocked and open. Both issues were addressed immediately by the manager. Some sauces in the fridge had not been labelled with the date of opening. The manager has completed fire and environmental risk assessments and does a regular walk round check of the premises. As mentioned in standard 19 the use of stair gates must be urgently reviewed with the fire officer. The unfixed toilet frames should also be fixed in place to reduce the risk of residents falling. The manager is aware of the requirement to notify the commission of incidents and accidents under regulation 37. Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 2 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) Requirement The registered person shall after consultation with the service user prepare a written plan as to how the service users needs are to be met, the plan will be made available to the service user. Comprehensive risk assessments must be carried out that are individual to each service user and identify specific risks for them, action to be taken and the outcome to be achieved. This is part of a requirement made, and carried forward from, the last inspection. Repeated from the last inspection A programme of activities must be arranged and service user must be consulted about these activities. The registered person shall make suitable arrangements by training staff or by other measures to prevent service users being harmed or suffering abuse or being place at risk of harm or abuse. The registered person shall make
DS0000056632.V352616.R01.S.doc Timescale for action 05/01/08 2 OP7 13(4) 05/01/08 3 OP12 16 (2)(n) 05/01/08 4 OP18 13 (6) 05/12/07 5 OP19 12 (1) 05/12/07
Page 25 Mandalay Residential Home Version 5.2 6 OP38 16(2)(g) proper provision for the health and welfare of service users -in that • The use of stair gates in front of 2 fire exits be reviewed with the fire officer. • Unfixed toilet frames be fixed or alternative moving and handling equipment such as grab rails be fitted. • The permanent storage of clean linen on the laundry room be reviewed. • COSHH items must be stored safely at all times. Jars of jams, sauces etc., must 06/11/07 be dated when opened to avoid food poisoning. Repeated from the last inspection 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 3 Refer to Standard OP1 OP10 OP22 Good Practice Recommendations As planned the statement of purpose must be updates to reflect the home’s current situation. It is strongly recommended that private facilities be made available for residents to make telephone calls. It is strongly recommended that the provision of a suitable bed side light be looked into for a resident who is unable to have a bedside table due to the layout and shape of the bedroom. It sis strongly recommended that the manager submit her application to become registered with the Commission as soon as possible as planned. 4 OP31 Mandalay Residential Home DS0000056632.V352616.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local 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
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