Inspection on 27/01/06 for Mary Feilding Guild

This inspection was carried out on 27th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Mary Feilding Guild 02/10/06

Mary Feilding Guild 24/06/05

Mary Feilding Guild 11/10/04

Mary Feilding Guild 04/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Mary Feilding Guild 103-107 North Hill Highgate London N6 4DP Lead Inspector Mr Teferi Degeneh Unannounced Inspection 27th January 2006 09:30 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 Mary Feilding Guild DS0000010712.V265797.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. Mary Feilding Guild DS0000010712.V265797.R01.S.doc Version 5.0 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 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.V265797.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th June 2005 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. Mary Feilding Guild DS0000010712.V265797.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over a period of 7 hours, commencing at 9.30 am and concluding at approximately 4.30 pm. Miriam Isherwood, the registered person, was present throughout the inspection. Nine people who live at the home and four care staff were also spoken to individually and in groups. The inspection activity also included a tour of the premises, the examination of service users’ files including care records, the examination of health and safety records, the viewing of staff rotas and an assessment of the home’s diary and visitors’ book. What the service does well: What has improved since the last inspection? All the five requirements made at the last inspection have been satisfactorily met. The registered person has confirmed that there is no person with a diagnosis of dementia living at the home. Progress has been made regarding the management of falls. A range of actions have been taken to reduce falls and the registered person and head of care meet every week to monitor falls. The CSCI inspector is also kept informed monthly of the number and nature of falls recorded at the home. Records are kept of the medication received and the medicines carried forward to the next month. The temperature of the area where medicines are stored are monitored daily and maintained at below 25°C. The certificate of the gas boiler has been forwarded to the CSCI inspector. Mary Feilding Guild DS0000010712.V265797.R01.S.doc Version 5.0 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. Mary Feilding Guild DS0000010712.V265797.R01.S.doc Version 5.0 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.V265797.R01.S.doc Version 5.0 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): 1, and 4 Information about the facilities and services provided at the home is clear and is available to prospective service users through various means including advertisements and personal correspondence. These have enabled service users to have an idea about the home and make an informed decision as to whether to apply or not to apply for admission. The home has an appropriate admissions procedure. Service users are admitted on the bases of the outcome of their self-assessment and their medical assessment by health professionals. These reassured service users that their identified needs could be met by the home. EVIDENCE: At the last inspection a requirement was made for the registered person to apply for a variation to the conditions of registration in respect of two people with dementia. Following this requirement a meeting was held between the registered manager, the registered provider and the CSCI and it was established that the information provided in the pre-inspection questionnaire was not accurate in that the two people were not formally diagnosed as having Mary Feilding Guild DS0000010712.V265797.R01.S.doc Version 5.0 Page 9 dementia. The registered manager and the provider also confirmed that none of the people currently living at the home have a diagnosis of dementia and that this is reflected in the home’s statement of purpose. The home has a service users’ guide, which provides the services and facilities available at the home. There is also an admissions procedure, which requires service users to complete a self-assessment form in addition to medical form that is completed by their general practitioners. The people spoken to said they had known about the home and they had confidence that it would meet their needs even before making an application for admission. One person said they kept a piece of advertisement they saw in a paper some twenty years before applying for admission. They said they have now been at the home for a few months and they are satisfied with the home. Mary Feilding Guild DS0000010712.V265797.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): 8, 9, and 11 There is continuous progress in the management of risk of falls and provision of health care. However, the arrangements for risk assessments are not adequate with the evidence that some service users do not have risk assessments in their files. The lack of risk assessment meant that service users are not sure if they are safe in the home. While the policies and storage of medication service users, their health and safety is not fully reassured through the discrepancies in the records of medicines and the actual medicines seen in the medication containers. Service users are confident that their wishes are upheld and their families and themselves are cared for with care, sensitivity and respect at all times at the home. EVIDENCE: The files of seven service users who were prone to frequent falls were chosen for inspection. Most of the files contained evidence of current risk assessment. However, further examination of the files showed that two service users who have history of falls have not been assessed and appropriate care not put in place to manage risks. This is despite the overall progress made by the Mary Feilding Guild DS0000010712.V265797.R01.S.doc Version 5.0 Page 11 registered person to monitor falls every week and to update the CSCI every month regarding falls in the home. Discussions with the registered person showed that the home has taken a number of actions in order to minimise the risk of falls. These include the provision of exercise classes, advice about footwear, encouraging some service users to use walking frames or walking trolleys and the provision of handrails in corridors. Records and discussion with the registered person indicated that health care appropriate health care is provided to service users. It was evident from observations and discussions with the people who live at the home that general practitioners come to the home every week and as needed. Medication is kept in a locked cabinet in the office. Senior staff who have relevant training administer medication. Some people who self-administer their medication have signed to confirm that they have the ability and wish to selfadminister their medication. The registered person has satisfactorily met a requirement regarding the temperature of the area where medication is stored. It was evident from records that the temperature of the room where medication is kept is daily recorded and the records showed that it is below 25oC. The medicines and the medication administration sheets (MARS) were checked and some discrepancies were found. One discrepancy was the signing of the MARS by the staff before medicines were actually administered. Another issue was the discrepancy between the amount of medicines (tablets) recorded and the actual tablets available in the containers. The registered person said the home would look into these issues and come up with a system that is safe and easy to manage. The home has policies in relation to death and dying, and lifetime care. The policies state that the home will continue to care for terminally ill people in their own rooms and will provide an environment, which remains homely and comfortable. The home’s policies underline that the home communicates with families and friends following service users’ wishes. The registered person stated that a form titled “Residents’ wishes in the event of serious illness or death” is sent to all prospective service users together with the documents of conditions of offer. She said that the form is completed, signed and kept in each service user’s file. Mary Feilding Guild DS0000010712.V265797.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 and 15 The home has appropriate activities that meet the needs of people who live at the home. This is evidenced by the variety and number of activities the service users’ enjoy in the home and in the community. The availability and high standard of facilities and atmosphere in the home have enabled service users to maintain contact with families, friends and representatives. The quality, quantity, variety and presentation of the meals are of high standard and service users are satisfied. The home also provides opportunities for service users to make light meals and hot drinks of their choice in their rooms when and if they wish. EVIDENCE: Arrangements are in place to enable service users to write daily what they would like to have for their lunch. There is also a four weekly rotating menu, which is developed with consultation with the people who live at the home. There are kitchenettes in most of the rooms and a fully equipped kitchen on each floor for service users to make breakfast or supper if that is their wish. The people spoken to said they are satisfied with the quality, presentation and variety of the meals provided at the home. A number of people who live at the home are able to travel independently to shops, libraries and to various Mary Feilding Guild DS0000010712.V265797.R01.S.doc Version 5.0 Page 13 communities based leisure places. There are various activities, which people can participate in. These include art group, exercise class, watching videos and DVDs, going to shops and concerts. The registered person said a vicar comes to the home once a week. Some people were observed reading books in the home’s library while some others were busy watching television or reading newspapers in their rooms. Each person who lives at the home has a telephone line, which they use to contact friends and relatives. There are also two pay phones provided in two small rooms with doors to ensure privacy. Those people who were spoken to said they are able to have visitors in private in their rooms. The home has a separate bedroom and washing facilities for visitors who travel long way and who would like to stay overnight when visiting service users. Mary Feilding Guild DS0000010712.V265797.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, and 18 There are satisfactory policies and procedures on complaints and adult protection. These have reassured service users and relatives that their concerns can be listened to and action taken by the management and the staff and that they are protected from abuse. EVIDENCE: A copy of a complaint made to the home had been forwarded by the complainant (a relative of a person who used to live at the home) to the CSCI. At the time of the visit this complaint was being investigated by the registered person. The home has a complaint procedure with details of how people can complain and the timescale by which a response would be made to a complainant. At the previous inspection a number of the people who completed comment cards confirmed that they knew how and who to complain if they had concerns. The people who were spoken to at this inspection said they are aware of the home’s complaints procedure. They said they could talk to the staff if they have issues and the manager is approachable and is a good listener. There are satisfactory policies and procedures on elder abuse. The registered person has received a copy of the Haringey Council’s policy and procedures on the protection of vulnerable people from abuse. The staff spoken to were able to give satisfactory descriptions of what constitutes abuse and how they can take appropriate actions to deal with real or suspected abuse by reporting to their managers or relevant authorities including the CSCI. It was evident from discussions with the staff and the registered person that the staff have attended training on abuse. Mary Feilding Guild DS0000010712.V265797.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, and 26 This home provides a high standard of accommodation and facilities that made service users feel that they live in a safe, clean and comfortable environment. EVIDENCE: There are six domestic staff who keep the home clean and tidy. All rooms and communal areas are spacious, bright and clean. Handrails are provided in corridors, and call alarms are fitted in each of the rooms. There are lifts for going up and down the floors. Laundry and washing facilities are provided on each floor. Large items such as bed linens and curtains are sent out for washing and cleaning. The people spoken to said they are happy with the rooms, facilities and the gardens. A number of service users and relatives commented in the feedback they completed and sent to the CSCI at the last inspection that they were more than satisfied with the atmosphere and the physical comfort of the home. The home is located in a residential area within easy access to local shops, churches, health centres and public transport. Mary Feilding Guild DS0000010712.V265797.R01.S.doc Version 5.0 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, and 29 Service users’ needs are met by there being a number of experienced, skilled, and trained care staff who are also supported by a number of administrative and domestic workers. The way the staff are assigned on the rotas can be improved by, for example, reviewing the number of staff on the late shifts. EVIDENCE: There are seventeen care staff and twenty-two domestic and administrative staff employed by the home. Five care staff and head of care cover morning shifts and three care staff and a senior work in the afternoons. There are a cook and two kitchen assistants available for preparation of meals. A number of the people who live at the home are independent with their personal care, cleaning and carrying out laundry tasks. The registered person said she is satisfied with the current staffing level. She said during peak hours or when there is a need, the number of staff on shift can be increased. There is a recruitment policy, which states that the home aims “to recruit the best persons for each vacancy, regardless of gender, religion, or political belief, family circumstances, sexual orientation and other irrelevant distinctions”. New staff are employed after being interviewed and after all the necessary documents such as written references and CRBs are obtained. At the time of this inspection a new caretaker is waiting for their CRB to start work at the home. There are no agency staff working at the home. It was evident from discussions with the registered person and the assessment of records that the staff had induction programmes and have undergone training in areas such as fire safety, basic food hygiene, and adult protection. Ten care staff have Mary Feilding Guild DS0000010712.V265797.R01.S.doc Version 5.0 Page 17 completed NVQ level 2 (care) and three staff are currently undertaking training programme to achieve a similar qualification. Mary Feilding Guild DS0000010712.V265797.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): 31, and 38 There is a strong and good management structure with a commitment to provide a high standard of care in a homely environment. Service users feel that the manager is open and considerate to listen to their concerns and to take satisfactory actions. The health and safety arrangements are satisfactory and service users are confident that they live in a safe home health and safety risks are well managed. EVIDENCE: The manager started work at the home as an assistant manager before taking up the manager’s post about eight years ago. An assistant manager, a bookkeeper assistant, secretary, and a head of care currently support the manager. The manager also works closely with the Chair of the Trustees. The manager stated that she was a qualified nurse but did not keep her registration as she pursued further education to gain a BA degree in environmental studies. Mary Feilding Guild DS0000010712.V265797.R01.S.doc Version 5.0 Page 19 She also confirmed that she has completed NVQ level 4 in care management. The staff and people spoken to spoke positively of the manager. They said she is approachable, good listener and supportive. The home was clean, tidy, bright and spacious with a range of adaptations to meet the needs of the people who live there. Certificates and documents were available to confirm that regular services and safety checks have been undertaken to ensure that the equipment used at the home are safe. Certificates showed that the gas boilers were checked on 22/09/05 and 19/10/05.The passenger lifts are serviced monthly and inspected once every six months by the engineers from the insurers. The emergency lights were last checked on 27/11/05 and the call alarms were checked on 26/01/06 and were found to be in good working order. The fire alarm system is checked quarterly by a fire maintenance agency. There is a detailed fire risk assessment. The registered person and head of care meet every Monday morning to monitor reports of falls during the previous week. Mary Feilding Guild DS0000010712.V265797.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 3 X X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 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 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 Mary Feilding Guild DS0000010712.V265797.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. 1 Standard OP8 Regulation 12; 13; 14 (2)(a) 13(3); 17 Requirement Timescale for action 31/03/06 2 OP9 The registered person must ensure risk assessments are completed and reviewed for each service user at the home. The registered person must 15/03/06 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. The registered person must investigate the incidents where the medicine sheet had been signed before administration and the discrepancies between the records of medicines and the actual tablets found in the containers. A copy of the outcome of the investigation together with the actions taken must be forwarded to the CSCI inspector. Mary Feilding Guild DS0000010712.V265797.R01.S.doc Version 5.0 Page 22 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 review the rota with a view to increasing the number of staff on the afternoon shift. Mary Feilding Guild DS0000010712.V265797.R01.S.doc Version 5.0 Page 23 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 © 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 Mary Feilding Guild DS0000010712.V265797.R01.S.doc Version 5.0 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!