CARE HOMES FOR OLDER PEOPLE
Mary Feilding Guild 103-107 North Hill Highgate London N6 4DP Lead Inspector
Mr Teferi Degeneh Key Unannounced Inspection 2nd October 2006 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 Mary Feilding Guild DS0000010712.V304191.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. Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Mary Feilding Guild Address 103-107 North Hill Highgate London N6 4DP 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) 020 8340 3915 020 8341 0295 mfginfo@dsl.pipex.com www.maryfeildingguild.co.uk Mary Feilding Guild Ms Miriam Isherwood Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th January 2006 Brief Description of the Service: Mary Feilding Guild is a care home registered to provide accommodation for 47 people over the age of 65. The homes brochure states that the service dates back to 1877, but has undergone many changes since 1985. The home is located in Highgate, North London, within easy access to local shops, places of worship, health centres and public transport. The home consists of two interconnected buildings, a large Edwardian house and a more modern house. The majority of the rooms have en-suite and kitchenette facilities. The rest will have en suite facilities added as and when they become vacant. The home also provides several bathrooms, shower rooms and toilet facilities. The communal areas consist of a large dining area, three sitting rooms, one of which is a large library room, an activity/meeting room and alcove seating areas along the corridors with views of the surrounding gardens. The home provides a laundry room and fully equipped kitchen on each floor. The managers office area and the homes main offices are situated in the basement. There are well looked after gardens in front and at the back of the building. A new summerhouse has been recently built as an additional facility for service users. The home is fully accessible to people with a mobility difficulty. Information about the home including service users’ guide and the CSCI inspection reports are available from the home by contacting the providers or the registered manager. The weekly fees depend on the assessed needs of the people who use the service and currently range from £371.00 to £590. Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection is based on the observations of a number of people who use the service and the staff who work at the home. Individual and group discussions were also held with the people who use the service and the staff. A pre-inspection questionnaire completed and returned to the CSCI office was examined as part of this inspection. Written feedback has been received from 17 people who use the service, 17 relatives and two professionals. A number of service users’ and staff files were randomly chosen and examined. The home’s other documents such as staff rotas, menus, programme of activities and health and safety records were seen. The premises and the facilities of the home were inspected through guided tour. The registered manager, ms Miriam Isherwood, was present during part of the meeting. What the service does well: What has improved since the last inspection? What they could do better:
Even though the care plans and assessments are easy to use, these have not been consistently utilized. It is important that care plans reflect the needs of the people who use the service and as to how the needs can be met. The registered manager must continuously monitor the staffing level and satisfy herself that the level of care staff on shift reflects the number and needs of
Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 Page 6 people who use the service. It is recommended that a member of the management team of the home is on duty to cover weekend shifts. 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. Mary Feilding Guild DS0000010712.V304191.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 Mary Feilding Guild DS0000010712.V304191.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, and 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. New service users are confident that their admission to the home is dependent on the ability of the home to meet their needs. EVIDENCE: A prospective service user, who was visiting the home, said that they had completed a self-assessment form as part of their application for admission to the home. They said they had known the home before making the application and their medical information had been completed by their general practitioner. The registered manager explained the process of admission. She said that the home receives information about new service users from the service users or their families and their general practitioners. The home then invites prospective service users for an assessment. New service users are admitted to the home only if the home believes that their needs can be met. In feedback forms they completed and returned to the CSCI, a number of people who use the service stated that they actively chose the home. One person wrote: “I am so thankful that I chose this place when I was looking for a residential home…” Another person stated: “I am satisfied that I made the
Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 Page 9 right decision in choosing to come to Mary Feilding Guild.” The home does not provide an intermediate care. Mary Feilding Guild DS0000010712.V304191.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service are confident that their health needs are met by the arrangements made for them by the home. The people who live at the home have benefited from the home’s processes of risk assessments. The systems of care plans and assessments can be improved. EVIDENCE: Eight service users’ files were randomly chosen and assessed. All these files contained evidence that people’s needs assessments and care plans are regularly updated. Few care plans either did not reflect the assessed needs or were not sufficiently detailed and these were discussed with the head of care who said that the home would take account of the comments made during this inspection. The home has an assessment format which is easily accessible for the staff. A number of people who live at the home are independent in travelling to places of their choice including arranging and going on holidays abroad. In conversations and in feedback cards they completed a number of people said their needs are met by the staff. Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 Page 11 The registered person and the head of care meet weekly on Monday to review incidents and accidents. Service users’ risk assessments have been reviewed. There have been six incidents where the people who use the service have been admitted to accident and emergency since the last inspection. Only one of these has been due to fall in the home. Significant progress has been made regarding the storage and administration of medication. Medication is now stored in a dedicated locked room where there is little distraction to staff. The registered person has satisfactorily complied with the last requirement. The previous incidents where medication sheet had been signed before the administration of medication and the discrepancies between the records of medicines and the actual tablets found in the containers have been investigated. About half of the people who live at the home are independent in making appointments and visiting their health professionals. Discussions with the registered person and an assessment of service users’ files showed that service users are seen by health professionals such as chiropodists, district nurses, opticians, dentists and general practitioners. On the day of the inspection a hairdresser was at the home. All the people who completed the CSCI questionnaire and who were spoken to were positive about the staff. They said the staff are considerate, kind and respectful. They said the staff always knocked on the doors for permission to enter bedrooms. Observations and discussions with the staff indicated that they interacted appropriately with the people who use the service. Mary Feilding Guild DS0000010712.V304191.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Service users are engaged and their needs with regard to the control over their lives, and contact with families are met. The processes of consultation have enabled service users to choose food that meet their needs. EVIDENCE: There is a four weekly rotating menu, which is regularly reviewed with service users’ consultation. The registered person and a number of people spoken to confirmed that they have been consulted about the food and the menu. As a result of the consultation, changes such as the provision of soup for dinner, and varieties of food items have been introduced. The people spoken to felt that supper has significantly improved since the consultation. Even though the majority of the people spoken to and who completed the CSCI feedback cards are happy with the meals provided at the home a few people commented that the “lunch menu could be improved”. Discussions with the people who use the service and observations showed that service users have an opportunity to request what they want for lunch. The registered person confirmed that the cook has worked at the home for over five years. There are two assistant cooks. Quite a number of people prepare their breakfast and supper in the kitchenettes in their rooms. The people who live at the home are supported with food shopping if that is what they wanted. Fresh fruits were available in
Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 Page 13 the dining hall for people to help themselves. There are adequate number of staff during lunchtime to support people. The food provided for lunch on the day of the inspection was in line with the day’s menu. All service users have telephone lines in their rooms and can contact their families and friends. The people who were spoken to said visitors can see them privately in their rooms or in one of the common rooms. One person explained how they enjoyed visiting their son and daughter over the weekend. People who do not have relatives are visited by members of the house committee, which is set up by the home for this purpose, among others. Service users have an opportunity to have meal at the home with their guests. The home has dedicated rooms for overnight stays for guests who travel long distances to visit service users. Service users’ social, cultural and health needs are recorded in their plans. A number of people who use the service are independent in travelling and accessing community based facilities. All people who live at the home are registered on the electoral roll and many exercise their voting rights either by postal voting system or by going to the polling stations. One person talked about how they travelled to cities outside London to participate in social and political activities. Many people make their own decisions about their finances. One person stated how they managed to deal with their money. All people who live at the home are provided with bedroom keys. Through discussions with the people who live at the home it was evident that the people who use the service choose furniture for their rooms. The activities provided at the home are discussed in meetings and through satisfaction surveys undertaken by the home. The list of activities provided at the home is displayed. Records and discussions with the registered person showed that service users have participated in a number of activities including art and exercise classes, tai chi class, scrabble group, concert trips, daily tea in library, Anglican weekly communion, and weekly pets (two dogs) as therapy visits. Mary Feilding Guild DS0000010712.V304191.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, and 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people who use the service are reassured by the home’s complaints procedure. The home has satisfactory systems in place to ensure that service users are protected from abuse. EVIDENCE: The relatives and the people who use the service confirmed in the CSCI feedback card that they know how and who to complain to. The registered manager said that people who use the service and their relatives are given information about the home’s complaints procedure together with other documents such as terms and conditions and service users’ guide. They all ticked “NO” against the question that asked them if they had complained. The pre-inspection record and the complaints book showed that six complaints have been recorded and satisfactorily resolved by the registered manager. The people who were spoken to said the management and the staff are approachable and they can talk to them. The home has a policy on elder abuse and all the staff have attended training on how to protect vulnerable people from abuse. The members of staff who were spoken to gave satisfactory descriptions of what an elder abuse is and the actions they take if there is a suspected or an allegation of abuse. The home has obtained a copy of the local authority’s policy on the protection of vulnerable people from abuse. Mary Feilding Guild DS0000010712.V304191.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have benefited from the spacious, safe and well-maintained environment in which they live. EVIDENCE: The people who use the service and their relatives are satisfied with the home. For example, a relative wrote in a CSCI feedback card: “The place is always absolutely spotless and pleasant and the whole family feel very lucky that my mother should be living there.” The home was clean, bright and spacious. Handrails are provided in the corridors, and call alarms are fitted in the bedrooms, toilets and bathrooms. Laundry and washing facilities are provided on each floor. Large items such as bed linens and curtains sent away for washing and cleaning. The home is conveniently located for shops, public transport, places of worship and other local amenities. Written and verbal feedback from the people who use the service is positive about the home. A service user said: “This is the perfect place”. Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 Page 16 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, and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have benefited from the home’s satisfactory recruitment procedure and the availability of trained and experienced staff team. EVIDENCE: There are seventeen care staff, eight domestic assistants, four kitchen assistants, two housekeepers, a handy man, two cooks, a head of care, an assistant manager, a bookkeeper, an office secretary, and a manager. The rotas are organised on a flexible basis allowing the registered manager to increase the number of care staff when needed. The manager knows that the number of staff allocated should reflect the needs of the people who live at the home at all times. Normally, there are five care staff in the morning and three care staff in the evening. Domestic assistants are available seven days a week and the handy person lives on site. The home has a recruitment procedure, which requires applicants to undergo interviews, CRB checks and to submit two written references. An assessment of the records showed that all people currently employed at the home have undergone CRB checks. Discussions with the registered person revealed that all staff have attended training on elder abuse. The service users and their families wrote positive things about the staff. For example, one service user wrote: “Excellent, helpful, cheerful staff.” Another service user stated: “Very supportive environment. Staff are very caring and friendly.” A relative of a service user commented in a CSCI feedback card: “The staff are concerned, compassionate and kind and could not do more for my mother.”
Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 Page 17 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, and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management structure and the quality of the management are good. However, the management arrangements in the home can be improved by making additional provisions for a manager to cover weekend shifts. Service users can be more reassured from a physical presence of a manager on weekends. Good progress has been made in terms of the home’s quality assurance. Even though the facilities, equipment and the building are well maintained, service users’ health and safety is not reassured due to the shortfalls identified during the visit to the home by the environmental health officer. EVIDENCE: The registered manager started work at the home as an assistant manager before taking up the manager’s post about nine years ago. She is currently supported by an assistant manager, a bookkeeper, an office secretary, and a head of care. The manager is accountable to the management committee. The
Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 Page 18 manager, assistant manager, head of care and the bookkeeper all work Monday to Friday between the hours of 8:00 am and 5:00 pm. The majority of the people who use service and who were spoken to were satisfied with the way the home is run. However, some people commented that they would be more reassured if there were a manager working on weekends. The relatives of service users are satisfied with the management of the home. One person wrote: “The management of the home cannot be faulted. This is due to excellent management skills and caring staff.” The manager said that she was a qualified nurse but did not keep her registration as she pursued further education to obtain a BA degree in environmental studies. She also confirmed that she has completed NVQ level 4 in care management. The staff and the people who use the service commented that the manager is approachable. The registered manager confirmed that service users, staff, families and friends, and professionals have been consulted as part of the home’s system of quality assurance. A Catering Forum has been setup as a result of the home’s quality assurance exercise. The registered manager said that this was to address some of the points raised by the respondents regarding the meals. From discussions with the people who use the service it was evident that they are able to attend residents’ meetings and give feedback about the quality of services and facilities. The registered person said she has an open door policy for people to talk to her if they have concerns. The home does not manage people’s finances but keeps personal allowances for about eight people. It was stated that the families or relatives of the people pay about £100.00 at a time to the home for personal expenses such as hairdressing, toiletries, etc. Records and receipts of the transactions as well as remaining money are kept for each person in a separate envelop in a locked cabinet. The registered person confirmed that all the people who live at the home have their families, friends or other arrangements for their financial management. The people who live at the home can bring to the home personal possessions. The relatives and the people who live at the home confirmed through CSCI feedback cards that the home is clean and tidy. There is adequate lighting throughout the home. There are appropriate adaptations in the corridors, bathrooms and bedrooms. The documents seen confirmed that regular services and safety checks have been carried out on electrical appliances. The corridors are spacious and the passenger lifts are serviced monthly and inspected once every six months by the engineers from the insurance company. The assistant manager said fire officers have recently visited the home. The fire officers’ assessment of the home or the purpose of their visit was not clear on the day of the inspection. However, the registered manager confirmed in a subsequent email that they visited the home for a routine check and there was no recommendation from the visit as the officers were satisfied with arrangements in the home. Records showed that an environmental health officer visited the Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 Page 19 home on 27/07/06 and made recommendations regarding a number of issues including: • Periodically cleaning of canopy hood and filters • Some spilt food debris rear of chest freezer • Leaking tap serving the sink • Potential contamination of food • Absence of guard fitted to electrical mixing machine/equipment The registered person confirmed that all these issues have been complied with and would be verified by the EHO when they visit the home next time. Also during the tour of the premises it was observed that an electric hoist in one of the bathrooms was out of order. An email from the registered manager subsequently confirmed that this has been immediately fixed. Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 4 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 2 Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 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. 1 Standard OP7 Regulation 15(1)(2) Requirement The registered person must ensure that service plans, which are based on the assessed needs of service users and which show as to how the service users’ needs in respect of their health and welfare, are met are prepared and regularly updated. Timescale for action 30/11/06 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 OP27 Good Practice Recommendations The registered person should continuously monitor the staffing level to ensure that care staff are provided in sufficient number to meet the needs of the people who use the service. The registered person should ensure that there is competent and experienced person to run the home at all times including weekends. 2 OP31 Mary Feilding Guild DS0000010712.V304191.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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