Inspection on 22/05/08 for Margaret Allen House

This inspection was carried out on 22nd May 2008.

CSCI found this care home to be providing an Adequate 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

Margaret Allen House 03/09/09

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Margaret Allen House 8 Bartows Causeway Tiverton Devon EX16 6RH Lead Inspector Dee McEvoy Unannounced Inspection 22nd May 2008 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 Margaret Allen House DS0000071057.V361867.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. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Margaret Allen House Address 8 Bartows Causeway Tiverton Devon EX16 6RH 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) 01884 243169 Guinness Care and Support Ltd Mrs Margaret Elizabeth Parfect Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 15. 28th & 29th June 2007 Date of last inspection Brief Description of the Service: Margaret Allen House is a purpose built care home, comprising part of the original property and two newer extensions to the building. The home provides accommodation and personal care for up to 15 older people in single rooms. In October 2007 Devon Community Housing Society and Guinness Care and Support amalgamated with Guinness Care and Support being registered as the providers of this service in December 2007. Margaret Allen House is situated within level walking distance of the shopping centre of the market town of Tiverton and close to the public park. There is a communal lounge with a conservatory attached. Meals are taken in a separate dining room or may be served in individual rooms. One staircase is equipped with a stair lift and a passenger lift is also provided for access to the first floor. A call bell system operates throughout the home. At the rear of the building there is a small raised garden and limited car parking area. The cost of care ranges from £378.00 to £425.00 per week at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Current information about the service, including CSCI reports and The Service Users’ Guide and Statement of Purpose, is available to prospective residents and all documents can be found in reception. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home, and an assessment of what they do well and what they plan to improve upon. Before our visit to Margaret Allen House we sent a number of confidential surveys to people living there, relatives, staff and outside professionals to hear their views. We received completed surveys from five people living at the home and four relatives. No surveys were returned from staff or professionals. The comments and responses we received have helped us to form the judgements we have reached in this report. This unannounced inspection took 10 hours to complete and during this time we spent time with the people living here talking about their daily lives and how the home supports them. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and seven people were spoken with in depth to hear about their experience of living at the home. Time was also spent observing the care and attention given to people by staff. We also spoke with three staff members and the manager. A tour of the building was made and a sample of records was looked at, including medication records, care plans and assessments, staff files and fire safety records. What the service does well: People living here spoke very highly about life at the home. They told us what the service does well, their comments included, “The kindness and sense of security. I can relax here, they have taken all the worry away from me”, “I would like to tell you that I am so blessed to be in this home”, “They (staff) are interested in us elderly people. I would say its 4 star here!” and “The staff are good company” Admissions to the home are managed in a sensitive way. Time and effort is spent to ensure that the process is as personal as possible and that people considering a move to the home have the information they need to make a choice about where to live. One person who had moved in recently told us the Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 6 process had been “smooth” and they had settled in well. Another person told us, “I feel at home here”. We looked at the way the home plans and delivers the daily care for each person (see ‘what they could do better’). We found that people were well supported and very happy with care they received. People’s health needs are well monitored and they have access to a variety of health professionals. People told us they “always” received the medical attention they needed. People are treated as individuals and staff are respectful, ensuring that people’s privacy and dignity is promoted at all times. People living at the home are able to exercise choice and control over their day-to-day lives and are encouraged to maintain contact with family and links with the local community. People’ told us how much they enjoy the meals. People told us the food was “Excellent” and the cooks at the home were praised for their efforts. People feel sure that any concerns or complaints will be addressed and they are protected from abuse by staff who have appropriate attitudes towards them; systems are in place to ensure that people’s money and valuables are protected. Private bedrooms are homely and personalise, and all areas of the home were clean and free from unpleasant smells. The home is well managed. People expressed their confidence in the manager and spoke highly of her personal qualities. The manager is experienced and has an open and inclusive approach, which ensures that people are encouraged to “have their say” about how the service is developing. What has improved since the last inspection? The home has acted on all of the requirements and most of the recommendations made at the last inspection. Aspects of care planning have improved with diabetic care plans helping to ensure that people receive the care they need. More activities are being organised for people and they have been consulted about the type of activities and outings they may like (see ‘what they could do better). This will help to ensure that people have stimulating and interesting daily lives. Significant improvements have been made to ensure that people enjoy a pleasant and comfortable home. The outside of the home has been re-painted and new carpets have been laid in the ground floor corridor, lounge and dining room. Some furniture has been replace and more is being ordered. The raised beds have been planted and are an attractive feature. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 7 The recruitment practice at the home has improved, ensuring that people are protected from unsuitable staff. The manager has completed the Registered Manager’s Award, which will help to ensure that the home continues to be well managed. Several aspects of health and safety have improved. Staff have received fire safety training and fire doors are no longer wedged open, posing a fire hazard. Risk assessments are agreed and completed when a person decides they do not want to have their window restricted. The manager is now informing the Commission of events, which adversely affect the well-being, or safety of people living at the home. What they could do better: 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 Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 9 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 Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 10 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, 2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information about the services offered here is available to people to help them decide if the home will suite their needs. People benefit from a good admissions process, which ensures that the home is able to meet individual needs. EVIDENCE: The majority of people responding with surveys (4 of the 5) told us they had been given enough information about the home before deciding to move in. There is a guide to the home, the Statement of Purpose, which gives people an idea of what to expect of the home. An information booklet about the home has recently been made available, and contains lots of photographs of the home and information about the staff and facilities. A copy of this and the most recent inspection report is available in the hallway for people to look at. We also saw copies of the Statement of Purpose in individual bedrooms. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 11 The manager encourages people to visit the home to enable them to get an idea of what it is like and to help them decide if it will suit their needs. Several people told us they had visited the home before making a decision to move in. One person told us they had visited friends at the home in the past and knew it would be the right place for them when they needed more support. We were told, “I always told my daughter that if I had to move from my flat, this was where I would like to be”. Another person told us, “I looked at several homes in the town. When I visited here I really liked it. There is a happy friendly atmosphere”, and another person told us, “I came to visit and liked it here. It is terrific and a good choice for me”. The manager has a sensitive approach to admissions and understands how difficult this time can be for some people. She will visit people who are considering a move to the home to get to know them, to provide information about the home, to answer questions, and to carry out an assessment. Admissions are not made to the home until a full needs assessment has been undertaken. We looked at the assessment of need for 3 people during this inspection. Care files showed that lots of information is gathered before people decide to move in, including assessments carried out by health and social care professionals in some cases. The detail of information in the home’s assessment has improved since the last inspection and enables the manager to make a decision about whether the home can meet individual needs. We spoke with two people who had recently moved to the home about their experience. One told us, “They made me feel very welcome. I feel lucky to be here…”, another said, “It all went smoothly. I am settled here and very happy”. One relative wrote, “My husband has settled well and reports feeling supported”. Although the care files we looked at contained contracts outlining the terms and conditions of people’s stay at the home, they had not been renewed since the new provider took over the service. Up to date contracts will ensure that people’s rights are protected. Margaret Allen House does not provide intermediate care. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 12 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. The care planning system in place and staff knowledge generally ensures peoples’ personal care needs are met, but unless people receive their prescribed medication their health needs may not be met. The ethos within the home promotes respect and ensures the privacy and dignity of people at all times. EVIDENCE: People told us they “always” or “usually” receive the care the need, comments from people living at the home included, “Very good care and help if needed”, “The care and attention you get is excellent…”, “I am getting the care I need” and “Nothing is too much trouble for the staff”. Relatives responding to CSCI surveys were confident that the home was meeting the needs of their family member. Comments from them included, “Are willing to look at different ways of supporting my husband” and “They are very caring”. We looked at three care plans to help us judge how care is planned and delivered to people. Information included relates to individual daily routines, Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 13 assessments of risks, including falls, nutritional needs and those presented by the some conditions, such as mental health needs. There is a lack of specific detail though, which could result in people’s needs not being fully understood or met by all staff. For example, when describing people’s mental health needs the care plan instruct staff to “ensure receives support to help cope with condition”. There is no detail about the exact support to be provided. However, the manager and staff were able to tell us about people’s individual support needs and preferences. Two people whose care we looked at had skin conditions, which required monitoring and treatment. Daily notes show that people were supported to use creams, but care plans did not contain any information about either condition, how it should be monitored and any action staff should take. Information relating to peoples’ previous interests or preferred activities is not consistently recorded to ensure that people can be engaged with social activities they enjoy and prefer. When care plans are not well completed people’s individual needs and preferences may not be met. The manager felt that the current care planning format was not entirely suitable for the people living at the home. She is keen to develop more person centred care plans. We saw that some people had signed their care plan to indicate they had been involved in the process. Some people told us they had not seen their care plan, one person told, “I haven’t seen it but they seem to know my needs”. One relative had given the home detailed and useful information to help with planning care but they told us they had not seen the care plan and didn’t feel involved in the care planning process. Since the last inspection diabetic care plans have been introduced, which is good practice. These detail some of the care required to ensure people with diabetes receive the support they need. We spoke with staff about the extra care and monitoring people with diabetes may need and they demonstrated a good understanding of the condition and how to monitor people’s overall health. People have access to a range of healthcare services that meet their needs including chiropody, opticians, dentists and specialist services such as, mental health professionals and diabetic specialist nurses. People living here told us they “always” received the medical support they needed. One person told us, “They call my doctor when needed and he comes to visit me”. There was evidence in daily notes that people’s health is monitored and that staff contact outside professionals promptly when needed. An example of this was the monitoring of one person’s medication. Staff were quick to pick up on problems, which were reported to and addressed by the GP. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 14 Nutritional assessments were completed for people to ensure that these needs are met, and regular weights are kept for most people. Those looked at show that people either maintain or steadily gain weight following admission. We looked at the way the home stores and administers medicines. We met with one person currently managing some of their own medicines. An assessment of risk has been completed and indicates that a locked cupboard or drawer is provided for safe storage. When we visited this person we were told that she didn’t have any secure storage for the medicines, which we saw on a shelf in the room. This could pose a risk to others. We looked at the Medication Administration Records (MAR). These records showed that one person had not received medication as prescribed on a number of occasions. This person is prescribed a weekly medication and records showed that this medicine had not been given for a whole month. Looking a MAR charts from previous months it was evident there were significant gaps in the administration of this medicine. Codes had been used on another MAR chart to indicate that the drug was ‘out of stock’. However, when we looked at in the stock cabinet there was sufficient stock to ensure that this medicine was given as prescribed. The storage of medicines is generally good; the storage and management of controlled drugs is satisfactory and medicines needing refrigeration are kept at the appropriate temperatures. Senior staff told us they had received training about how to manage medicines safely but records show that some staff have not had up-dated training since 2004. The manager should regularly assess staff to ensure they remain competent to undertake the task expected of them. We also looked at how well this home ensures that the privacy and dignity of the people who live there is protected. Staff treat people with great respect at Margaret Allen House. The manager is thoughtful and compassionate and provides a very good role model for the staff. One person told us, “Staff are polite and friendly”, another said, “The staff are respectful. They are really nice people” and a third said, “Staff couldn’t be more considerate and kind”. During our visit staff were observed to be friendly and sensitive when responding to peoples’ needs or requests. Staff addressed people respectfully, using their preferred name. Staff were seen to knock on people’s door before entering. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. Routines are flexible and people are supported to exercise control over their daily lives, and the opportunity for people to enjoy social activities is improving. People benefit from contact with their family and friends, which is supported by the home. The food is good, providing a balanced diet which takes into account the likes and dislikes of individuals. EVIDENCE: We talked to people living in the home about daily life. They told us routines within the home were flexible, one person said, “They try to suit me and what I want”. People’s preferred daily routine is recorded to ensure staff are aware of favoured times for getting up and going to bed. Some people at the home enjoy a busy and fulfilling social life, people have been able to continue with past hobbies and interests, and visit the town regularly and independently and attend day centres and clubs. Since the last inspection the home has tried to develop more activities for those people who may be unable to get out independently. Resident’s meetings have given people an opportunity to talk about the kind of activities Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 16 they would like. People returning surveys told us that suitable activities were “usually” arranged for them to take part in. One person wrote, “There are more activities than I want or need. Personally I am quite happy without activities but I recognise the hard work put into these by staff”. People we spoke with told us about the activities they enjoy. One person told us they “get involved” with the games, such as bingo, and enjoyed coffee mornings. Another said, “I enjoy the get togethers”. One relative commented that, “More in-house activities/shared communal life and better use of communal lounge” would be an improvement. The manager told us that two staff now have responsibility for developing and delivering activities within the home. People are given a monthly programme of activities, which include, film night, race day, bingo, quizzes, pampering sessions and coffee mornings. Since the last inspection there has been an occasional trip out for lunch. Minutes of the last resident’s meeting show that they have expressed an interest in outings during the summer. The manager told us she is exploring ways of organising transport to enable visits to local places of interest. We looked at the record of activities undertaken for May 2008. Records show that eight activities, such as games, bingo and nail painting had happened with some people taking part. Information received from the manager before this inspection states that the home will be arranging more outings for people. There is no restriction on visiting times and throughout the day visitors came to the home and were made welcome by the manager and staff. People told us they could see visitors when they wanted to and they could choose where they spent time with their visitors, either in the privacy of their rooms, the conservatory or in the lounge. Some people enjoyed the company of other people living at the home, strong friendships have developed which are very important to people. One person told us, “I have met old friends and made new ones here”. Relatives told us they were “always” kept informed of important issues relating to their relative at the home. One relative thought the home was particularly good at “Communication with me”. People are supported to make decisions about their daily lives; we saw that people were free to choose how and where to spend their day. Several people have a key to the front door and come and go as they please. One person told us, “I am free to come and go, which is very important to me”. People were given choices throughout the day, for example what they wanted to eat and drink, where they sat, what clothes they wore. People said that they were able to choose when they got up or went to bed. People responding with surveys said that staff “always” listen to them and act on what they say. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 17 Everyone returning surveys and all those spoken with during our visit said they liked the food at the home. Comments included, “Very good food”, “The meals are excellent”, “The cook is a wonderful cook”, and “Cook does a wonderful job”. The home has made a point of consulting with people about menus to ensure likes and dislikes are taken in account. People told us they could always have an alternative to the main dish of the day if they wanted. Two people require special diets. Both told us they were well catered for, with the home providing them with nutritious and varied meals. We joined people in the dining room for lunch. The dining room was pleasantly laid for mealtimes, with nice attention to detail, for example place mats and flowers were on the tables, and condiments were available. Mealtimes are always a sociable and unhurried occasions at Margaret Allen House, with people chatting and catching up with the day’s news. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. People are confident that their complaints will be listened to and staff understand the principles of adult protection, which helps to protect people from abuse. EVIDENCE: The home has received one complaint since this the last inspection. Records show this was dealt with in an appropriate and timely way. No complaints have been raised with the Commission about this service. All people responding with CSCI surveys and those people spoken with during our visit said they knew who to speak with should they have a concerns or a complaint. One person told us, “I would have no hesitation in speaking with the manager should I have any complaints, but I don’t”, another said, “I would speak with the manager. She is very good and would listen” and another told us, “They (staff) are easy to talk to about any worries”. People living at the home told us they felt “safe”. One person told us, “I was very nervous living in my home. I feel safe here”. Another said, “It’s a nice place. It’s home”. People living at the home told us they were treated with respect and that staff were “kind and friendly”. Training records showed that staff had attended abuse training and were able to describe what is considered poor or abusive practice. Staff confirmed they Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 19 would not hesitate to report any issues or concerns to the manager or a senior member of staff. The manager is aware of her role when a concern or allegation is brought to her attention and uses necessary policies and procedures for reference and guidance. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 20 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, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made and are being made to ensure that people enjoy a good standard of accommodation that is attractive, clean, homely and well maintained. EVIDENCE: There have been a number of improvements to enhance the general environment since the last inspection. The outside of the building has been repainted and now looks bright and clean. New carpets have been laid in the lounge and dining room and through the hallway. The dining room has been redecorated, and new curtains have been hung and old dining chairs have been replaced. The AQAA tells that the home intends to continue with the refurbishment of the home by replacing old and dirty furniture in the lounge and conservatory, and a new carpet is to be laid in the conservatory. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 21 We were invited to visit several people’s bedrooms. Individual rooms were homely, personalised and were clean and fresh. People are encouraged to personalise their rooms with furniture and other possessions that are precious to them. Concerns about the overheating and poor ventilation in the kitchen have been identified at two environmental health visits and the past three CSCI inspections. The home’s development plan for 2006/07 aimed to resolve the problem but no date for action has been established and this has yet to be achieved. Staff said the kitchen temperature “can be very uncomfortable to work in at times”. The kitchen is small but it was generally clean and well organised. We saw that the cupboard that contains the bin does no close properly, which could cause a hazard. We also noticed that the tiles around the widow near the sink were cracked, grimy and lifting in places. This could compromise good food hygiene standards. The home was clean and free from unpleasant odours throughout. People living at the home told us it was always like this. One person told us, “The cleaning staff were very good and the home is spotless”. Records show and staff confirmed that they had received training to help them maintain good infection control standards. Staff spoken with were able to describe actions to prevent cross infection and how they maintain good hygiene. Gloves and aprons are available and communal bathroom and toilets have access to soap and hand towels. This helps to minimise infection. Staff told us the tumble dryer had been repair since the last inspection, which has improved things. The laundry is small but generally well organised and clean. On this occasion we found some heavily soiled washing soaking in a basin in the laundry. This is not idea. People told us that they were happy with the way the home looks after their personal laundry, i.e. clothing. They told us that all laundry is carefully washed and returned to them promptly Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 22 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. Staffing levels are sufficient to ensure that peoples’ needs are met in a timely way and experienced and friendly staff support people well. People are protected by the robust recruitment practice followed at the home. EVIDENCE: Several people spoke highly of the staff. Comments included, “I find staff very good. Can’t fault any of them. We get on very well”, “They know what they’re doing”, and “We couldn’t find a kinder group of people”. Two people told us the night staff deserved a special mention, as they always had time to listen and chat. One relative told us, “All staff caring & supportive & willing and friendly”. The staffing levels remain as they were at the last inspection. However the manager and staff told us, and the AQAA shows that the overall number of people with significant care needs had reduced. During the morning from 08.00 to 14.00 there are usually three care staff and the manger on duty. From 17.00 staffing levels reduce to two care staff until 22.00. The majority of people returning CSCI surveys told us staff were “always” available when needed. People we met during our visit told us, “If I have to ring, they come really quickly”, and “They are there when you need them”. People told us staff had time to listen and chat with them. One relative felt that increased staffing levels would ensure that more one to one time could be spent with people. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 23 The manager and staff told us they felt the staffing levels were currently meeting people’s needs. The manager also said she has more time to ‘manage’ now. One new member of staff has been recruited since the last inspection. Records show that necessary checks were made before this person started working at the home. This ensures that people living her are properly protected from harm. The AQAA shows that 57 of staff hold a nationally recognised qualification in care, helping to ensure that good standards of care can be achieved and maintained. The home’s development plan 2008/09 shows that a variety of mandatory training is available for staff to attend. The home has an induction training programme that new staff complete within the first 12 weeks of their employment. Records show that staff have completed mandatory training including fire training, manual handling, basic food hygiene, infection control and first aid. This ensures they are given the right information to be able to do their jobs well. Some staff have received additional training to help them understand people’s specific needs, such as diabetes. However, staff have not received training relating to mental health needs, which would improve their understanding and practice. The majority of relatives returning CSCI surveys felt that staff “always” had the skills and competencies to meet people’s needs. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence including a visit to this service. The home is well managed, with good systems in place to ensure that people’s views are sought and acted upon. Health and safety within the home is promoted meaning people live in a safe environment. EVIDENCE: The manager has many years of experience caring for older people and works hard to ensure everyone at the home is happy and safe. Since the last inspection she has completed the Registered Managers’ Award. People living at the home and the staff expressed their complete confidence in the manager. People told us, “Maggie is approachable and very kind”; another said, “Her door is always open. She is full of fun…a lovely lady”. Staff felt well supported by the manager and her approach is inclusive and hands on. The Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 25 manager’s approach has created an open, positive and inclusive atmosphere. People appeared totally relaxed in the home and could make suggestions and requests freely. A variety of people’s views are sought about the quality of the service provided. People who live at the home, their relatives, staff and outside professionals are all given an opportunity to ‘have their say’. Meetings and surveys are used regularly to formally get people’s views of the service. Survey findings are made available and minutes from meetings are displayed. Responses from the home’s last questionnaires were very positive, with people particularly happy with the staff attitude and approach, food, laundry and the general standard of care provided. Responses showed that people felt “valued as an individual” and that their views were considered. The home does not deal with any financial affairs of the people living there other than to hold, if required, small sums for personal items. Records are maintained of money held and safeguards are in place to ensure balances are checked. The accounts for two people were checked and found to be in good order. All staff receive mandatory training such as manual handling, infection control, fire safety and where appropriate food hygiene. The manager told us that all staff had received the required fire safety training since the last inspection. Training records given to us appear to confirm this. Fire safety is generally well managed, for example fire equipment such as fire extinguishers and fire alarm are serviced and tested regularly. Windows on the first floor have been fitted with window restrictors to prevent people falling out accidentally. Where people have requested not to use window restrictors, a risk assessment is completed. The manager is now informing the Commission of events, which adversely affect the well-being, or safety of people living at the home. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 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 3 2 X X X X X 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement You must ensure that people are given their medication as prescribed and within the correct timescale. You must provide secure storage for people who manage their own medication. You must ensure all staff are up to date with training relating to the safe administration of medicines. You assess staff’s competencies regularly to ensure they remain safe to administer medication. Timescale for action 20/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP7 Good Practice Recommendations In order to protect people’s rights fully, people should have individual written contracts/terms and conditions with the home. It is recommended that information in care plans set out in DS0000071057.V361867.R01.S.doc Version 5.2 Page 28 Margaret Allen House 3. OP12 4. OP19 5. 6. OP26 OP27 detail the action which needs to be taken by care staff to ensure that all aspects of people’s health, personal and social care needs are met. Care plans should include details of peoples’ interests and hobbies, and social & personal needs to ensure that needs and expectations can be planned for and meet. It is recommended that particular consideration be given to the continued development of stimulating and meaningful activities for all people living at the home, which meet with their preferences and capabilities. It is recommended that a programme of routine maintenance and renewal of the fabric and decoration of the premises continue so that can people live in a pleasant environment. Reparis should be made to the kitchen cupboard and tiles around the sink and windowsill. It is recommended that safe systems for dealing with soil laundry be put into practice; to ensure good infection control is maintained. It is recommended that the number of staff on duty be monitored and adjusted when required to ensure that people’s needs are met. Margaret Allen House DS0000071057.V361867.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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