CARE HOMES FOR OLDER PEOPLE
Margaret House 221 Manchester Road Burnley Lancashire BB11 4HN Lead Inspector
Mrs Marie Dickinson Unannounced Inspection 25th January 2006 10:30 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 House DS0000009578.V271650.R01.S.doc Version 5.0 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 House DS0000009578.V271650.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Margaret House Address 221 Manchester Road Burnley Lancashire BB11 4HN 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) 01282 423804 Mr Gordon Fell Care Home 11 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number disorder, excluding learning disability or of places dementia (5), Mental Disorder, excluding learning disability or dementia - over 65 years of age (6) Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Within the overall total of eleven, a maximum of 5 named service users who fall into the category of Mental Disorder Within the overall total of eleven, a maximum of 6 service users who fall into the categories of either Mental Disorder Elderly or Dementia Elderly Should any of the named service users referred to in condition 1 above be no longer the resident in the home or reach the age of sixtyfive, registration should revert to the original registration of the home. 11MD(E), 11 DE(E) Date of last inspection Brief Description of the Service: Margaret House is registered with the Commission for Social Care Inspection to provide personal care and accommodation for 11 people, whose main care needs are mental health difficulties. The home is located in a residential area of Burnley and is adjacent to Scott Park. There are pleasant accessible garden areas to the front and sides with a lawn area to the side and rear of the home. There is a bus stop near the home, on route to the town centre. Accommodation offered is in single and one double room, fitted with an emergency call system. The home was furnished and decorated to a domestic style. Mr Fell the owner manages the home on a day-to-day basis. Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on the 25th January 2006. It is the second required statutory inspection carried out this year. The inspection involved getting information from staff records, care records and policies and procedures. It also involved talking to residents, staff on duty and Mr Fell and a tour of the premises. Areas that needed to improve from the previous inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Older People. Not all standards were assessed and this report should be read with the inspection report dated 8th September 2005 for the reader to have a complete overview of the home. What the service does well:
To make sure all residents’ needs were met, care staff had clear guidance in what each person needed. This included managing any risk to the well being of residents. Regular reviewing of needs helped residents receive proper care that sometimes involved medical professionals. Medication was managed safely. Activities were special for residents because they included what they wanted to do, and therefore different from usual organised types. They sometimes went out with the owner Mr Fell and staff. Residents said staff were ‘very good’ and ‘caring’ and they were satisfied with the care they were given. Staff were considerate in how they cared for people with dementia, by including them in everything involved in ‘life at the home’. Special occasions such as Christmas and birthdays were celebrated. Visiting arrangements were satisfactory. Residents were happy with the catering arrangements. They were offered choices and had a say in menu planning. They were involved in shopping for groceries. The complaints procedure was clear. To protect residents, staff were trained to identify and report any form of abuse. Residents living at the home expressed general satisfaction about their accommodation. There is a continuing investment in improving these standards. Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 6 The percentage of staff trained to a National Vocational Level 2 and above was above 80 . Other training was provided for staff that included topics such as first aid, medication and infection control. Sufficient staff were employed. They were supervised in their work. Teamwork was evident and staff said they enjoyed their work. They were professional in their approach to care. A good standard of hygiene was maintained. Residents considered their accommodation to be good. There is a continuing investment in improving these standards. The percentage of staff trained to a National Vocational Level 2 and above was above 80 . Sufficient staff were employed to meet the needs of residents. They were supervised in their work. Teamwork was evident and staff said they enjoyed their work. They were professional in their approach to care. The views of residents and other relevant people influenced the service provided. Residents and staff had regular meetings with Mr Fell. Group decisions were made that benefited everyone. Accounting and record keeping was managed properly. Policies and procedures gave staff guidance in best practice for work. What has improved since the last inspection? What they could do better: Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 7 The carpet in the corridor on the ground floor would benefit from cleaning to remove the discolouration. The hot water in the bathroom sink requires regulating to a safer temperature. 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. Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 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 Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed. EVIDENCE: There were no new admissions. All these standards were assessed during the previous inspection and were satisfactory. Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Care plans were used to help staff to care for residents in a proper manner. Because they were reviewed this allowed for residents changing needs being dealt with promptly. Residents were satisfied that their needs were met and they considered staff respected their privacy. Medication was managed properly. EVIDENCE: Care plans referred to residents assessed need. These included health, personal and social care needs. There was evidence that residents were involved in regular reviews. Staff said they were involved with care planning and work to a key worker system, whereby they take on particular responsibilities for individual residents. Senior staff monitors this. Care notes of two residents showed how healthcare and mental health care needs were met. This involved staff support in daily living and other professionals. This included visits from a chiropodist and their doctor when necessary. The staff and Mr Fell went with residents for outpatient appointments at the hospital. Individual support was given for continence management.
Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 11 Difficulties residents had in daily living were looked at in detail and risk assessed. These assessments were of a good standard with clear instructions for staff to follow to help overcome difficulties safely, and for residents to manage risks with the support of staff. How staff respected residents right to privacy was observed throughout the inspection as they helped residents with personal care. They were polite and respectful. Residents who had difficulty in expressing themselves were treated with respect. Staff helped them to be involved in the inspection as much as possible. Medication records were up to date. Medication was managed correctly by staff who had received proper formal training. Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Activities were provided for each resident in a personal way. Weekly planners were used for this purpose. Resident’s lifestyle experience of living in the home was generally to their liking. Visitors were made welcome. Catering arrangements were to the resident’s satisfaction. EVIDENCE: Activities for residents were arranged individually for each resident. These were recorded on a weekly planner Monday to Sunday and included morning, afternoon and night. Some of the activities were organised activities such as attending social clubs and outings. Staff took residents regularly to Church on Sunday, and one resident said her friend took her to the Catholic Church. All the residents said they enjoyed Christmas. They celebrated birthdays according to what they wanted. One resident said he was having a party ‘with champagne’. Staff helped residents individually to enjoy what they wanted to do. This care and attention was given to residents who had dementia. They were involved in group and individual activities. Staff were observed as being thoughtful including everyone in conversations and activities during inspection. Residents said they went for a ‘pub lunch with their carer’ ‘shopped in Blackburn’ or just ‘went to the pub for a drink’. They had holidays away from the home at their request, and were planning to go to Pontins at Blackpool this
Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 13 year. Residents also said they enjoyed being involved with household routines such as grocery shopping. Visitors to the home were made welcome and staff helped residents keep in contact with their family. One resident said he was going to visit his sister later in the day. Mr Fell was going to take him and pick him up later on. Residents also said the general routine in the home suited them. There were no unnecessary rules to follow. One resident said she liked it at the home because ‘she could please herself’. Comments from residents indicated the food was good. Staff took turns to cook and residents said they discussed menus at their meetings. They could ‘have what they wanted’. One resident said her favourite was ‘potato pie’. Others liked lamb, fish, chicken and puddings.’ There were ample supplies of groceries and fresh produce to use. Residents were involved in grocery shopping. They were given choices at meals and records showed alternatives were also given. The mealtime was relaxed and although mealtimes were set times they were also flexible to suit individual needs. Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The complaints procedure was clear and accessible for residents and visitors to the home such as relatives. There were policies and procedures in place to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: A complaints procedure for residents to use was given to them when they came to live at the home. There were no recorded complaints since the last inspection. Staff were instructed in abuse procedures and whistle blowing. Training had been given to them. A condition of employment for staff in the home prevents them having any financial gain from residents. Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,24,26 The home was maintained to a good standard, and residents lived in a comfortable and homely environment. Resident’s bedrooms were to their satisfaction. They had aids to suit their needs that promoted independence. A good standard of hygiene was achieved. EVIDENCE: The home was comfortably furnished and maintained to a relatively good standard. Carpet tiles had been purchased for the upstairs landing and Mr Fell said these were to be fitted when the upstairs bathroom had been upgraded. Residents said they had all they needed in their bedrooms. They were comfortable and furnished to their satisfaction. Aids in use were for individual residents to help them with independence. Since the last inspection a stair lift had been fitted.
Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 16 The carpet in the corridor on the ground floor would benefit from cleaning as it was showing a discoloured pathway to a bedroom. A good overall standard of hygiene was observed in the home during inspection. Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 The level of staffing was good and maintained. Staff received regular supervision. Residents had confidence in the staff working at the home. All staff had training. The training provided and attended by staff was good and related to their work as carers. EVIDENCE: There was sufficient staff on duty to attend to the needs of the residents during the inspection. Rotas showed good staffing levels were kept. The staff employed at the home had worked there for a long time and relationships between residents and staff appeared to be good. Residents spoke highly of the staff and made positive comments about the staff team. Staff were described as ‘kind’, ‘caring’, ‘very good’ and ‘friendly’. Staff had continuing training, and the percentage of staff having completed a national vocational qualification in care level 2 and above had exceeding the 50 target. Staff said they enjoyed training and were supported to develop their career in care. They confirmed they received supervision regularly. Records were kept. Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,35,36,37 The home was well organised and managed efficiently. Residents and staff had influence on how the home was managed and to their advantage. Proper accounting and financial procedures protected residents. Guidance and support was given to staff, which contributed towards the resident’s quality of life experience in the home being positive. Policies and procedures and record keeping were satisfactory. EVIDENCE: Mr Fell works in the home and is in contact with residents, staff and visitors daily. During inspection residents discussed how they had agreed changes in the home, such as ‘no smoking in the home’, and how this would work. They said they were consulted over all issues that concerned them and could have their say. Mr Fell and staff listened to them. Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 19 Listening to residents and staff views about the home were both formal and informal with one to one discussions and meetings. Records of formal meetings were kept for reference. Staff confirmed they received routine formal supervision. They felt supported in their work, and supervision gave them the opportunity to discuss and raise work related issues. Residents and staff expressed general satisfaction regarding how the home was run. Routines for staff were established, and good teamwork was evident. Proper accounting systems and insurances for the home were in place. All records required by regulation were kept in good order. Policies and procedures for staff guidance were available for reference. Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 20 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X 3 3 3 X Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 21 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. Standard Regulation Requirement Timescale for action 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 OP19 OP21 Good Practice Recommendations The carpet in the ground floor bedroom corridor would benefit cleaning. It is recommended the water temperature in the bathroom sink be regulated to a safer temperature. Margaret House DS0000009578.V271650.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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