Inspection on 13/09/06 for Margaret`s Rest Home

This inspection was carried out on 13th September 2006.

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`s Rest Home 22/08/07

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Margaret`s Rest Home 32 Kingsley Road Kingsley Northampton Northants NN2 7BL Lead Inspector Irene Miller Unannounced Inspection 13th September 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`s Rest Home DS0000067708.V311343.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`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Margaret`s Rest Home Address 32 Kingsley Road Kingsley Northampton Northants NN2 7BL 01604 710355 01604 792789 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) Hollyberry Care Limited Ms Kathryn Emma Clarke Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23), of places Physical disability over 65 years of age (5) Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. No service user in the category of OP may be admitted when there is already a total of 23 service users accommodated in this category. No further service users in the category of DE (E) may be admitted when there is already a total of 23 service users accommodated in this category. No further service users in the category of PD (E) may be admitted when there is already a total of 5 service users accommodated in this category. The number of service users accommodated must not exceed 23. Date of last inspection Brief Description of the Service: Margarets Rest Home is a private care home for older people. The home is registered to accommodate up to 23 older people, and can cater for people with dementia-related conditions, and up to five people over the age of 65 who have a physical disability. Margarets Rest Home is a large Victorian house situated in central Northampton opposite the racecourse, local shopping and leisure amenities are close by and the home has good access to local transport facilities. The accommodation is mainly single bedrooms with en-suite facilities, and two shared bedrooms without en–suite facilities. On the ground floor there is a lounge with a dining area. A stair lift provides access to the first floor and there is a pleasant garden and parking area to the rear of the property. Weekly fees range from £350.00 to £380.00 Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This inspection was a ‘Key Inspection’ that focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. Prior to the inspection taking place the Commission for Social Care Inspection sent out to the home a pre-inspection questionnaire and comment cards for completion by residents, visitors/relatives and general practitioners who have contact with the home. The pre-inspection questionnaire was returned to the Commission for Social Care Inspection along with four visitors feedback cards the feedback provided information on management systems within the home and outlined the general satisfaction of residents living at the home. The primary method of inspection used was ‘case tracking’ that involved selecting three residents, reviewing their individual care plans (that sets out how the home aims to meet their personal, healthcare, social and spiritual needs), and tracking the care they receive through discussion with residents, staff and management and observations of care practices. Policies, procedures and records in relation to staff recruitment, complaints, medication and general maintenance and upkeep of the home were look at. The registered manager Kathryn Clarke was available at the home throughout the inspection, and the registered providers Mrs and Mrs Robinson were also available. The inspector spent two hours planning the areas to focus on at this inspection, based upon information gained from reviewing the homes service history, the last two inspection reports and information from the pre inspection data collection systems. The inspection took place over a period of approximately six and a half hours. Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The care plans and risk assessments for residents with dementia and those who have limited verbal communication would benefit from having more detailed instructions for staff to follow. The care plans and risk assessments need to be ‘live’ and the information available within them updated as and when residents needs and circumstances change The receipt of medication needs to be closely monitored to ensure that prescribed medication is available for residents. Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 7 Assessment of the premises by an occupational therapist could be beneficial in seeking a solution to residents moving and handling constraints that the buildings design creates. The Registered Manager is advised to consult with the fire authority in seeking a safer alternative to door wedges, such as the fitting of door hold open devises that would automatically close in response to the fire alarm being activated. To ensure that any concerns and complaints that residents or visitors may have are dealt with confidentially, records needs to be kept in line with the Data protection act 1998. Two written staff references must be obtained before appointing members of staff. 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`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Standard 6 is not applicable to this service Quality in this outcome area is good. Prospective residents are provided with information on the range of services that the home can offer to enable them to make an informed choice as to whether the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes Statement of Purpose and Service Users Guide (that sets out the homes aims and objectives and the range of facilities and services it offers to residents living at the home) was made available to prospective residents, however through discussion it was established that prospective residents and relatives were not given individual copies of the Statement of Purpose or Service User Guide. Pre admission needs assessments were available within the care plans and residents feedback confirmed that information was made available, prior to Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 10 moving into the home about the range of facilities and services that the home offered Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. Residents could be at risk of their healthcare needs not being fully met due to the information within the care plans and risk assessments not being updated as their needs change. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans contained brief information, one of the dementia care plans seen had an entry within the eating and drinking section of the care plan stating that the resident ‘required additional support’ this left little instruction for staff to follow on the actual level of support required to ensure that the residents individual needs were being fully met in this area. For one resident who was at risk of falls, the information within the care plan and associated risk assessment did not reflect their current needs. For residents that required full assistance with eating and drinking and at risk of dehydration, records of dietary and fluid intake were in place. Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 12 For residents at risk of developing pressure ulcers there were instructions available of staff to follow on the frequency of when the resident required turning in bed, and pressure relieving equipment was seen to be in use. There was evidence within the care plans of the involvement of the district nurse with the care of the residents. The medication storage and administration systems, were in general well managed, however on closer examination of the homes Medication Administration Record Sheets (MAR) sheet, one resident had been prescribed eye ointment five days prior to the inspection taking place on speaking with the staff and Registered Manager it was established that the prescribed medication had not been received at the home from the dispensing pharmacy and therefore the resident had not commenced their eye treatment as prescribed. Feedback received via the residents questionnaires returned to The Commission for Social Care Inspection the residents indicated that the residents were pleased with the care provided at the home, and residents spoken with on the day of inspection said that the staff were very helpful that they were pleased with the care they received at the home. Observations showed that staff ensured resident privacy and dignity were maintained. Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. Social interaction, activities and meals are well managed to provide daily interest and variation for the residents, however for residents that are in poor physical health their social and spiritual needs could be at risk of not being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a programme of daily activities for residents to join in with such as going for walks, cookery, reading the daily newspaper, gardening and potting. Outside entertainers were welcomed into the home and provided activities such as reminiscence sessions, music and movement, piano and musical entertainment. Planned outings had taken place to the local park, the Northampton Balloon Festival, pub lunches, visits to a local school to watch Irish dancing and school plays, church services and afternoon tea at a local hotel. Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 14 A church service takes place each fortnight and parishioners from a local church visit the home regularly and residents were supported to maintain contact with families and friends. On the day of inspection new dining room furniture had been delivered to the home, the residents and staff were both involved with the unpacking the furniture and residents were keen to express their opinion of the quality and design of the furniture. Later in the afternoon staff were observed to spend time with the residents looking through the daily newspaper and talking about current affairs. During recent residents meeting the residents had said that they would like a cooked breakfast mid-week, the home had accommodated this request. Residents were observed moving around freely expressing their emotions, and were observed interacting with each other very well, some had struck up friendships with others and were seen to be enjoying each other’s company. One resident that was case tracked that resided on the first floor was unable to socialise with the other residents due to their poor physical health, the home does not have a central lift and the resident was unable to safely use the stair lift. The Registered Manager was aware of the risks of the resident being socially isolated and discussion took place on the possibility of involving an occupational therapist in assessing the residents care and mobility needs. Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Residents can be assured that any complaints or concerns that they may have will be listened to and acted upon by the provider, however the system for recording complaints or concerns could be improved to ensure residents confidentiality is respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure was available within the service user guide and a suggestions box was available within the front entrance of the home. On checking through the complaints book, several entries had been recorded consecutively on the same page and was not in line with the Data Protection Act 1998. This was discussed with the Registered Manager who agreed that to protect confidentiality each entry should be logged separately. The Commission for Social care Inspection had not received any complaints about the home prior to this inspection taking place. Residents spoke highly of staff and said that if they were unhappy with any aspect of their care that they would speak to the registered Manager and staff. Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 16 Residents meetings take place regularly and provide the opportunity for residents to raise any concerns they may have directly to the home manager. Staff induction and training records demonstrated that staff are trained on recognising differing types of abuse, and the home had a copy of the Northamptonshire Inter Agency Policies and Procedures to follow should there be any instances of abuse reported. Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. Residents live in a home that is, pleasant clean and comfortable, however the residents safety could be placed at risk due to the common use of door wedges. This judgement has been made using available evidence including a visit to this service. EVIDENCE: New dining room furniture had been delivered on the day of inspection, and furnishings within the private and communal areas were of a good standard. During a limited tour of the building, all bedrooms viewed had been individually personalised and shared bedrooms had privacy screening available. One bedroom viewed had denture cleaning tablets available within the ensuite, the occupant of the bedroom had a diagnosis of dementia, and discussion with the Registered Manager surrounding the risks of the resident Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 18 coming to harm due to either mistakenly swallowing the denture cleaning solution or the tablet had been assessed as low risk, however no formal risk assessment had been implemented. Records of building maintenance were available. The main kitchen was viewed, records of daily fridge and freezer temperatures were retained, however no records were available of food temperature readings. The laundry was viewed, one washing machine had been out of order for approximately three weeks, the engineer had been out to attend to the machine and the home was awaiting parts to have the machine repaired. There were laundry management systems in place to prevent the risks of cross infection. Plans had been drawn up for with a view to extending the premises and should they be approved would provide additional communal space, the re-sitting of the kitchen and provision of en-suite facilities in some bedrooms and the installation of a much needed lift. The stair lifts in situ presented a hazard when in use and staff need to be mindful of any potential accidents, doors at the top of stairs gave protection to residents from falls. However many of the doors within the home were seen to be held open with the use of door wedges, whilst it was recognised that this practice is not satisfactory, to have all doors closed within the building could in itself create hazards for residents such as increased disorientation, confusion and frustration and impractical for those that require the use of a wheelchair. The Registered Manager was advised to consult with the fire authority in seeking a safer alternative to door wedges, such as the fitting of door hold open devises that would automatically close in response to the fire alarm being activated. Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. Residents are cared for by a trained staff team, however recruitment procedures need to be more thorough to provide better protection for Residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection there was sufficient staff available to meet the current needs of residents, staff were observed spending time sitting and socialising with the residents. Three staff recruitment files were viewed and the recruitment documentation, containing evidence that Criminal Records Clearance (CRB) and Protection of Vulnerable Adults (POVA 1st). However there were inconsistencies in obtaining two written references, as required in Schedule 2 of the Care Standards Act 2000. From three staff recruitment files viewed one had obtained three references, one had a written reference and a telephone reference, and another had obtained one written reference. The home had a member of staff that was trained as a National Vocational Qualification Assessor, this member of staff had the responsibility of ensuring Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 20 that mandatory training was provided to all staff on induction and that refresher training was provided. Training records evidenced that staff receive mandatory induction training on moving and handling, food hygiene, fire procedure, health and safety, first aid, protection of vulnerable adults, control of substances hazardous to health and infection control. In addition to the mandatory training, there was further training provided to meet the needs of the residents, such as management of medication, and dementia care training. Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. The management and administration at the home promotes the health safety and welfare of residents and staff, however shortfalls in obtaining staff recruitment documentation could place the residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans and risk assessments required reviewing and updating, and the inclusion of more detailed information that would ensure that the care plans were more individualised and person centred. Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 22 Residents meetings provide a forum for residents to express their views, and the home conducts bi-annual surveys to gain feedback from residents, staff and stakeholders on the care that the home provides. Confidential records in relation to residents and staff were stored appropriately. There was good staff support and supervision systems in place 1-1 supervisions take place regularly and records of these meetings were retained. Staff expressed satisfaction at working at the home and of the support provided from the homes management. The registered manager is suitably qualified, competent and experienced to manage the home. Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 24 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 The registered person must ensure that prescribed medication intended for residents use is available at all times. The registered person must ensure that two written references are obtained before appointing a member of staff. Timescale for action 30/09/06 2 OP29 19 (5) (d) 31/10/06 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 Refer to Standard OP38 Good Practice Recommendations The registered manger should ensure that risk assessments are regularly reviewed and that the information and instruction available within the risk assessment is current. To protect the health safety and welfare of residents and staff, the registered person should consult with the fire safety authority to seek a safer alternative to using door wedges within the building. 2 OP38 Margaret`s Rest Home DS0000067708.V311343.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 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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