CARE HOMES FOR OLDER PEOPLE
Mavesyn Ridware House Church Lane Mavesyn Ridware Near Rugeley Staffordshire WS15 3RB Lead Inspector
Wendy Grainger Announced 8 September 2005 9:00am
th 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 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. Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Mavesyn Ridware House Address Church Lane Mavesyn Ridware Near Rugeley Staffordshire WS15 3RB 01543 490585 01543 490585 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Malcolm William Hurst & Mr Frederick Hooson Mrs Sandra Margaret Black Care Home 21 21 8 6 Category(ies) of OP Old Age registration, with number PD (E) Physical Dis - over 65 of places DE (E) Dementia - over 65 Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: N/A Date of last inspection 17th January 2005 Brief Description of the Service: Mavesyn Ridware is a detached home standing in its own grounds overlooking the countryside. The home was off a public transport route and would require personal transport to access the home. Located near to the village of Armitage and Handsacre. The home retains some of its original features. Registered to provide accommodation to twenty-one older persons, six of who may have a recognised dementia and six of who may have a physical disability.The home had one large lounge and one conservatory, service users personal choice was respected, and these people remained in their bedrooms.The dining room overlooks the garden and was well presented.The laundry and kitchen were located central to the home.Mavesyn Ridware has very limited parking space at the front of the home.Bedrooms were for single occupancy, some bedrooms had an en-suite facility; access to the first floor can be via the stairs and shaft lift. Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was carried out on the 8th September 2005. Documents, records, reports and assistance from the registered care manager, residents and staff will be reflected in the report. The Commission received comment cards from relatives and residents. These were part of the feedback to the manager during the inspection and will be included in the report. Residents were waiting to go into breakfast at the commencement of this inspection. Staff were in the process of assisting other residents. At the time of this inspection the home had four vacancies; respite care was available following an assessment of needs. Six relatives had taken comment cards and returned them, four had made additional comments “ I find the staff very friendly Dad has settled in and everyone is so nice to him, they have done a lot of good for him.” “Quality of care is good Staff know the residents well” “ It is a very caring environment the quality of physical care is to a high standard. However the number of activities where staff are interacting with residents & providing activities that stimulate don’t appear to happen during the period of visits. Although one is aware of some activities that happen periodically. I am aware that my mother is happy however and she is well looked after” “ In my opinion there is not always sufficient staff on duty”. Eight of the residents had completed comment cards. Four had made additional comments. “ Only sometimes did the home provide suitable activities.” “Sometimes I would like to be involved in the decision making of the home” “ I only feel well cared for sometimes and the home did not provide suitable activities” “Pleasant surroundings but I only like living here sometimes” the main comments identified that the activity programme was not planned around the interests and hobbies of residents. A District Nurse commented that she was satisfied with the care provided by the staff for one resident she was attending to. They were doing a good job and maintained the residents condition in a satisfactory manner, following any guidelines she gave. Located in the countryside personal transport was required to access the home. Well tended gardens at the rear of the home, the front of the home was taken up with parking.
Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 6 Accommodation was located on two floors, the sample of bedrooms seen were personalised to suit individuals. The cleanliness of the home was to a high standard. Two of the staff had completed NVQ level II in cleaning No people including respite were admitted to the home unless a full assessment of their needs had been completed. Arrangements were in place for the continued care of individuals from other professional agencies when appropriate. Each resident had a plan of their care based on information provided by relatives, the individual or social worker. The plans had a number of documents that impeded the flow of information. Discussed with one of the providers representative that five different moving & handling models should ideally be reduced to one. It appears that the five were put into the plan for the staff to determine which was more suitable for the home. The system for medication was satisfactory there was a need for more formal training in this section. The programme for activities was not feasible the planned days for the month did not correspond with the diary records. It is important that any activities were realistic, constructive and based on the interests and hobbies of the individuals. Catering was based on a weekly menu, there had been an improvement in the quantity and selection of food since the previous inspection. Smaller tins of food were evidenced offering more personal choice. During the inspection of the food it was identified that five items were out of date and given to the care manager to dispose of. It is important that when new stock arrives that the person responsible rotates the dates. Staffing levels appeared adequate for the needs of the residents at the time of this inspection. The home was experiencing two staff on long term sick leave and cover from an agency was required on occasions. Staff were competent and committed to the care of the residents this was demonstrated during the inspection. Training was on going with the majority of the staff completing the mandatory training. Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 7 What the service does well: What has improved since the last inspection? What they could do better:
Mandatory training was on going; there was a need for the management to consider a course for the care of residents with a dementia/Alzheimer’s. This report made three requirements. Namely: The bath panel on the corner pink bath was unsafe and required attention. The home had a fire marshal responsible for the fire requirements the records identified that the home had not undertaken a fire drill since January 2005. There remained some staff that had not been part of a fire drill as identified in the previous report. The management were required to complete risk assessment fully prior to cot sides being fitted to any bed.
Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 8 There was a need for the care manager to have sufficient time in the office to keep the required paperwork up to date. The home has an excellent deputy who had the ability to run the home on a daily basis. 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.
Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 9 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 Standards Statutory Requirements Identified During the Inspection Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 10 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 standard(s) 1,3,4,5 Standard six was not applicable to this home. The complete documentation was made available to any person requiring a place at Mavesyn Ridware; providing details about the home and care available. Full assessment procedures were in place to ensure that the placement was appropriate to meet the needs of individuals. EVIDENCE: The Statement of Purpose and Service Users Guide remained available to any person entering the home. There had been no reason to update the documents details. The registered care manager continued to complete assessments prior to admission. This practice would also include an enquiry for respite care.
Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 11 A trial period and introduction invitation period was part of the homes commitment to meeting the needs of individuals. There was no requirement to book an appointment to visit the home in respect of a placement. Following the assessment and if the home were suitable a letter of confirmation would be sent out. Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 12 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 standard(s) 7,8,9,10 Arrangements were in place for any person to have continued care ensuring their health and personal needs were met. The care plans would benefit from streamlining enabling the staff to produce relevant detailed information contained within less documents. A full review of the risk assessments would ensure that they were in place when necessary; providing the relevant information. The systems used for the administration of medicines were satisfactory; training had been provided. EVIDENCE: Each of the residents had a care plan identifying their needs on a daily basis. The format of the care plans while detailed were over prescribed with documents. There was a need to streamline the plans. The registered care manager had commenced this process. Plans were reviewed monthly. The inspector discussed that part of the streamlining could start with deciding which Moving & Handling document the staff were to refer to.
Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 13 It is a requirement that prior to fitting cot sides a full risk assessment should be completed. The registered care manager was to review the format of the risk assessments. They needed to provide clarity of the risk and action plan required to prevent the calculated risk. Arrangements were in place for the continued care of individuals by other professional agencies this was evidenced during the inspection. Medication was stored within a locked trolley secured to the wall on the ground floor. Five of the staff had received formal training in the safe keeping/handling of medicines. The pre inspection questionnaire identified that seven staff were responsible for medicines. There was a need for the remaining staff identified to receive formal training to ensure the safety of the residents. The staff were observed to assist residents in a sensitive manner when taking them into breakfast. Staff promoted a relaxed atmosphere, the less able residents were supported in their daily routine. Staff were committed to the care of the resident group. Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 14 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 standard(s) 12,13,14,15 Residents had the option of meals from the daily menus. The life style of residents was relaxed; there remained limited evidence of a positive feasible activity programme. Contact with families was maintained via the free style visiting procedure. EVIDENCE: The programme for the activities provided remained limited; the only record was on the diary displayed in the entrance. This did not match up with the planned activity on the corresponding list. The providers’ representative had been asked by the registered care manager to draw up a list of activities that may be offered. The inspector was told that residents did not respond to any activity unless it was the movement to music and the in-house theatre. One resident told the inspector that she had not been out for ages. One resident likes to spend time in the garden. Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 15 While activities to comply with the National Minimum Standards were required, they should be realistic and based on the interests and hobbies of the residents. The residents with a mental frailty may respond to a one to one approach. A more formal record needs to be maintained as discussed. A number of residents were reading newspapers during the inspection. Free style visiting was promoted at the home, visitors were welcome at any time. The meal of the day was a cheese and potato pie, or sausage followed by home made lemon meringue. The temperatures required for the freezers and fridges were provided, some gaps in the recording was evidenced. The cook on duty today told the inspector that she was unaware that a record of food served off the menu should be recorded. This had been part of a report previously. The inspector evidenced an improvement of food supplies and storage, this had occurred when the registered care manager took over the weekly purchasing. It is important that when receiving food supplies that the dates were rotated. Five items of cakes products were handed to the care manager to dispose of. Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 16 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 standard(s) 16,17,18 The home had the complaints procedure displayed; the information was sufficient to ensure that any person could raise a concern internally or with the Commission. Training ensured the safekeeping of the residents. EVIDENCE: The programme for induction of new staff had moved forward, there were areas that could be included to further enhance the skills of new staff and which were discussed with the registered care manager. Within the programme there should be a section that confirms that the person involved in the training is signed off by the mentor to confirm they are competent to do their job. Residents spoken with were aware of whom to talk to if they had a complaint. The Commission had received no complaints about the home or care provided. Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 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 standard(s) 19,20,21,23,24,25,26 Mavesyn Ridware offered a comfortable home within a homely setting. Residents can access the gardens at the rear of the home. Parts are fenced for safety. The recently fitted radiator covers protected the residents’ health and welfare. The home was maintained in excellent hygienic standards throughout. EVIDENCE: Located at a junction of a lane, the home stands in its own grounds opposite the local church. Personal transport would be required to access the home. Residents were provided with an environment that was maintained to high hygienic standards.
Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 18 A number of the bedrooms were provided with en-suite facilities. Bathing and toilet facilities were located near to the communal area. There was a requirement to secure or replace the bath panel on the corner pink bath to protect the residents and staff. There was a need to fit a door guard to the door of the resident on bed rest instead of having the door wedged open. This was discussed with the provider during his visit to the home. The use of the door guard should be approved with the fire prevention officer. Discussed with the registered care manager was the need to have a supply of gloves and aprons available within the toilets and bathrooms. The protective equipment should be enclosed and not exposed to any infection. A number of the staff (10) had taken infection control training a further six were actively involved in the training. Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 The levels of staff at the time of the inspection were deemed adequate for the number and dependency of the residents. Appropriate staff training was evidenced by the manner in which the care of the residents was addressed. The home had proper procedures for the recruitment of staff. EVIDENCE: The staff told the inspector that the home had been under pressure due to the long term sick of two of the full time staff. Shifts had been covered and the registered care manager had been part of the working team. This had reduced her time spent in the office, which is important to maintain because of the level of management and administration duties required. Staff worked as a team during the inspection. At this time there was one care vacancy. For the morning shift there would be one senior person plus three care staff, catering and housekeeping staff supported the care staff. The ratio did not reduce until the night shift when it reduced by one. Recruitment of new staff was via local outlets.
Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 20 The registered care manager had complied with the requirements of the Standards and had employed staff after all or a POVA check had been returned. The records of staff seen were current and complied with the Schedule 2 of the Standards. Mandatory training was current and ongoing. Nine of the staff had achieved Level II or III NVQ in Care. Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,36,37,38 The registered care manager ensured that the residents were safe and secure. There was no evidence of the stakeholders survey or residents survey for 2005 relating to the feedback of the care provided. The home had in place a system for the handling of residents finances, the addition of a signature will further safeguard the manager and staff. The safety of the residents could be compromised without the requirements to complete regular fire drill with all the staff. Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 22 EVIDENCE: The registered care manager was waiting for the results of her work for her Level IV NVQ in Management and Registered Managers Award. The home was operated to benefit the residents in a relaxed style. The staff worked as a team to enhance the quality of care via training. The registered care manager works as part of the team and would not expect staff to do work she was not prepared to undertake. There was no present evidence of resident and or stakeholders’ surveys. The provider’s representative had only recently sent out the surveys. The registered care manager had completed an audit of the Standards. The homes audit was current and available. Due to the long term sickness of staff supervision had been one of the Standards that had been not followed as required. The home had a form to use when supervision was undertaken. Despite the majority of the staff having mandatory training there was no evidence of formal training for the care of older people with Dementia/Alzheimer’s. This report made this a recommendation. Three of the funds held on behalf of the residents were checked and found to be accurate. It was suggested to the registered care manager that on the weekly check of finances then a signature would be preferred to confirm accuracy. The system for the fire records identified again as in the previous report (January 2005) that not all the staff had been part of a fire drill. The last fire drill was in January 2005 no further evidence of a drill could be identified. Other records checked included; Lift 26 7 05 Hoists 29 7 05 Fire blanket replaced 2005 Pharmacy audit 9 5 05. Fire alarms 6 9 05 Fire system 8 7 05 Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 2 x 3 3 3 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 Standard No 16 17 18 Score 3 3 3 3 3 3 x 3 2 3 2 Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 24 yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 13 (4) c Requirement The registered person shall ensure that unessecessary risks to the health and safety of the service users are identified and so far as possible eliminated. Risk assessments should identify the risk and plan of action. The provision of cot sides should be risk assessed prior to fitting The registered person shall consult residents about the programme of activities arranged by or on behalf of the care home. Timescale for action on going within the month of reciving this report 2. 12 16 n 3. 21 13 (4) a 4. 38 23 (4) e The registered person shall ensure that all parts of the home to which residents have access are so far as possible practicable are free from hazards to their safety. The bath panel on the pink bath was such a hazard and should be replaced or repaired. one week The registered person shall ensure by means of fire drills and on going and practices at suitable intervals that the person working at the home are aware of the procedure to follow in case of fire including the procedure for saving life.
Version 1.40 on going within a month of the receipt of this report. one week to repair or replace. Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 12 30 33 38 Good Practice Recommendations To maintain a more detailed and accurate activity record. For the staff to sign for any training and for the mentor to sign to confirm compency on the jobs completed during induction. To resurect the programme for supervision with all the staff. To invest in traing for the care of older people with dementia/ Alzheimers disease. Mavesyn Ridware House E51-E09 s4978 Mavesyn Ridware v241813 080905 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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