Inspection on 04/04/07 for Margaret House (Barley)

This inspection was carried out on 4th April 2007.

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

The inspector 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 House (Barley) 04/11/09

Margaret House (Barley) 09/11/05

Margaret House (Barley) 06/06/05

Margaret House (Barley) 14/12/04

Margaret House (Barley) 24/05/04

Margaret House (Barley) 18/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Margaret House (Barley) Church End Barley Nr. Royston Hertfordshire SG8 8JS Lead Inspector Pat House Unannounced Inspection 4th April 2007 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 (Barley) DS0000019458.V335006.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 House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Margaret House (Barley) Address Church End Barley Nr. Royston Hertfordshire SG8 8JS 01763 848 272 01763 848 867 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) Mr T Kelly Ms Margaret Guzman Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2005 Brief Description of the Service: Margaret House is a large Victorian detached house, which has been converted to provide care for 28 elderly people. There are three floors connected by a passenger lift and staircases. The conversion and extensions to the house have been sympathetically made and the house retains elegant period features whilst being suitable for its use as a care home. All the bedrooms are single occupancy and eight now have en-suite facilities. There is parking at the front of the house, behind a large brick wall. The grounds are extensive and beautifully kept and there is a large conservatory with lovely views. The home is situated in the quiet village of Barley, not far from the town of Royston. The village has a Post Office, shop, Health Centre and Church and Margaret House forms an integral part of this community. The home’s Statement of Purpose/Service User’s Guide and last inspection report are displayed in the entrance hall. Current fees for the home range from £600 to £800 per week and include all extra costs, such as hairdressing, chiropody and outings. The only costs not included in the fees are charges for private telephones. Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day with one inspector. The manager was present during the visit and staff and residents were spoken with. All parts of the building were seen and a selection of records was examined. The mid-day meal was served and observed and residents were spoken with in the dining room. On-going maintenance work to the outside of the building was continuing throughout the day. Questionnaires for residents and staff were left at the end of the inspection and three from care staff and three from residents have so far been returned. Comments are included in this report. What the service does well: What has improved since the last inspection? More internal decoration has taken place and work has started to upgrade the laundry. The manager has completed a comprehensive Fire Health and Safety statement for the home. No fire doors were being wedged open during the inspection. Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 6 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 be made available in other formats on request. Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 7 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 (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 8 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): Standards 1,2 and 3. Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are given appropriate written information and individual assessments are completed before anyone moves into the home. This ensures that all parties can be sure that individual needs can be met by the home and informed choices can be made. EVIDENCE: The home’s Statement of Purpose and Service User’s Guide have been reviewed and are up to date. The questionnaires returned confirmed that residents had been given copies of the Guide and that written information included a contract. Copies of contracts seen during the visit included all appropriate information, including the bedroom in question and current fees and methods of payment. All residents have full assessments completed by senior staff before they enter the home and the manager obtains care summaries from referring agencies where appropriate. Copies were seen on Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 9 residents’ files. This information ensures that the manager only admits those people whose needs can be met as described in the home’s information. Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 and 11. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. All care provided by staff at the home is thorough and appropriate and the procedures in place ensure that residents are always treated with dignity and respect and have all their health needs met. Medication procedures are sound and help protect residents. All those living in the home can be reassured that at times of illness or death they will be treated with every consideration and have their wishes complied with. EVIDENCE: The care plans of a selection of residents were tracked after the individuals were spoken with during the visit. As at previous inspections, all records were detailed and had been regularly reviewed and contained appropriate risk assessments, signed inventories of possessions and wishes for death and dying. Evidence was seen that residents and families had been involved in completing the plans and that Health professionals had been involved in care at relevant times. Residents spoken with confirmed that they had regular health checks and that visits from the doctor or nurse took place in private. No Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 11 one has any pressure sores at present. Monthly weight checks are recorded and staff confirmed that residents are weighed at the same time each month to ensure outcomes can be accurately assessed. Returned questionnaires confirmed that care staff support residents to be as independent with personal care as is possible. One resident who had a recent fall had a risk assessment completed and, as a result, has moved to a ground floor room and has weekly visits from a physiotherapist. All residents have a named “key worker” who ensures that all individual health needs are met for the residents they are responsible for. Residents spoken with confirmed that all visitors were made welcome at the home, at any time and that staff always respected their privacy. Most residents have their own telephone but can also use a phone from the home in private if they wish. At the last inspection visit, it was recommended that the G.P surgery, which supplies medication for the home, send pre-printed record sheets for each resident receiving medication. The manager has discussed this with the surgery but this change has not been possible and so pre-printed labels continue to be sent for each drug supplied for residents at the home. The system was checked during the visit, and, as at previous inspections, no errors were found and the procedure does appear to work well. The home also has a visit from a local pharmacist twice each year, and no problems have been identified at these visits. All written instructions on medication records will continue to be signed by two members of staff. Only senior staff administer medication, although all staff complete in-house medication training. The senior staff are currently booked on a certified medication course. The manager also completes spot checks on those administering medication and details are then recorded. Some residents in the home administer their own medication and procedures are regularly monitored. Risk assessments for this self-medication are being completed. Recently, a lady of 105 years had died in the home. This resident had lived in the home for many years and had been spoken with at several previous inspections. Records of events and family involvement in the terminal care provided were seen. The family of this lady had asked that, as Margaret House was the lady’s home, her ashes be buried in the gardens. This wish was complied with and two rose bushes have been planted to commemorate this special resident. Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are happy with their daily lives at the home as they have the level of activity they want, can see any visitors they choose to see and enjoy a variety of nutritious meals. EVIDENCE: Residents spoken with during the inspection confirmed that a variety of activities are provided by staff at the home. Different events are planned for each day and include visiting entertainers and trips out. Residents had gone out to a local pub for lunch recently and board games were being played during the visit. Returned questionnaires confirmed that residents were satisfied with the level of activities provided. People from the local village are always invited to special events at the home and residents are able to go to the village Church, which is next door to Margaret House. Currently none of the residents have special cultural needs but the manager said that any such needs would be met if this were the case. During the inspection it was good to see that the chairs in the lounge were not all spread around the edge of the room and that the television was not on. Residents Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 13 spoken with said that they were happy with these arrangements. Some residents said they enjoyed staying in their own rooms and had the equipment they wanted such as music and electronic goods. One person, who has little sight said that care staff always assist them to join in the activities and that he has a male carer to shave him, as he prefers. Another person said they choose to get up very early, although staff have told them that they do not have to. Currently one resident has chosen not to see particular relatives, and staff are supporting this wish. The manager had involved the Local Authority in these arrangements and an advocate from Age Concern was also involved. The mid-day meal was served during the inspection and residents said they enjoyed the meals. This was also confirmed in the returned service user questionnaires. Drinks are always available in communal rooms and in bedrooms and juice, wine or beer are available with the mid-day meal. The four-weekly menus were displayed and residents said they chose what they wanted, in advance, for every meal. The cook has worked at Margaret House for a number of years and regularly asks the residents about their food preferences. A separate weekend cook has also now been appointed and all staff have completed Food Hygiene training. Currently two residents have mild diabetes and food consideration for this condition is incorporated into the regular menus. For the fourth year running, an inspection by the Environmental Health Officer has resulted in no requirements being made. Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures in place ensure that residents are protected from abuse and can be confident that any concerns will be listened to. EVIDENCE: Written policies on Safeguarding Adults (Adult Protection) and Whistle Blowing are in place, staff spoken with said they were fully aware of these and had received training about the associated implications. The manager has made two appropriate referrals under the Safeguarding of Adults scheme since the last inspection, although neither involved staff from the home. Returned questionnaires confirmed that staff were aware of the complaints procedure and policy. Residents spoken with also said they were aware of procedures and would not hesitate to make a complaint or voice a concern if they had one. The complaints book was seen, but no complaints had been made. Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy living in a home which is always well maintained and kept clean and hygienic so that the risk of infection is minimised. EVIDENCE: There is an on-going programme of maintenance and decoration. Most of the communal areas have been recently decorated and the dining room has recently been refurbished. In general the home has a high standard of presentation. The gardens also looked beautiful on the day and residents said how much they enjoyed the grounds. The laundry has, however, needed upgrading for some time and work has now started to do this. Margaret House is a listed building and its age does present some problems in keeping to current requirements for the windows. One or two window restrictors had worked loose and some window frames really needed replacing. The maintenance person was repairing the window restrictors identified, while the Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 16 inspection was still taking place and will consult with the Proprietor about what improvements can be made to window frames. This area will be checked at the next visit. The manager was also waiting for a spare part to arrive, as a bath hoist had not been working properly and said she would put the room out of use until repairs were completed, to ensure the safety of residents. All areas of the home were clean and returned questionnaires from residents confirmed this was always the case. All bathrooms and toilets had liquid soap and soft paper towels in dispensers to promote infection control and staff said there were always plenty of disposable gloves available. Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by robust recruitment practices and benefit from having care provided by a sufficiently well trained and professional staff team. EVIDENCE: Residents spoken with said they felt there were always enough staff on duty and that call alarms were always answered quickly, both during the day and at night. Residents also said they felt that the care staff were well trained and felt they acted professionally at all times. Although there have been one or two new staff appointed in the last year, there is a low turn over of staff at Margaret House, which benefits the stability of care provision for residents. The manager gives a high priority to staff training and records showed that all staff had completed up to date mandatory training. Domestic staff spoken with said they were included in staff training and all staff meetings. Questionnaires returned confirmed that care staff felt the induction training they had received was comprehensive. Currently, six care workers have completed NVQ level 2 training and the deputy manager has completed level 3. Three more staff are starting NVQ training and the manager hopes that the whole staff team will have achieved at least NVQ level 2 by the end of the year. A selection of recruitment records was examined during the visit and all contained evidence that all recruitment checks had taken place before new Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 18 staff started work at the home. All staff have written contracts, which contain details of their terms and conditions of service. Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 19 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): Standards 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures followed ensure that residents live in a home which is well managed and run for their benefit and which promotes the welfare and safety of both residents and staff. EVIDENCE: Residents spoken with praised the management of the home and said the manager was always available and approachable. Questionnaires from staff also confirmed that the manager was held in high regard and said they always received relevant information and that there were good levels of communication. The manager has almost finished the Registered Manager’s Award and is registered with the CSCI. Throughout various inspections the manager has demonstrated that any issues raised where improvements could Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 20 be made, have all been quickly addressed. During the inspection, discussions took place about the changes that have taken place regarding guidelines for care provision and the manager clearly updates procedures in the home where appropriate. It is strongly recommended that the manager now has access to the internet, as part of her role, as there will be continuing information and guidance forthcoming in that medium, both from the CSCI and other professional bodies and it is important that all managers of care settings are able to keep up to date with these. The manager operates a good quality assurance system where questionnaires are sent out annually to service users, families and other stakeholder in Health and the Local Authority. Results are monitored and summarised and the need for any changes are then recommended to the Proprietor for funding or action. Questionnaires from staff also indicated that they were fully aware of the home’s policies and procedures and had their views listened to. Service users’ finances are handled by themselves or by families or advocates. The manager does not handle any money for the residents. Any accidents, incidents or issues in the home have been notified appropriately by the manager to the CSCI and this information was cross-checked during the inspection. The accident records were seen and were well documented and fire records showed that checks and drills regularly took place. There had been a Fire Officer’s visit in January and all points raised in the subsequent report had been addressed. The manager has completed a comprehensive Fire Health and Safety statement for the home. No doors were being wedged open during the inspection visit. Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 21 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 22 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. Refer to Standard Good Practice Recommendations Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Margaret House (Barley) DS0000019458.V335006.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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