Inspection on 11/11/08 for Maxey House

This inspection was carried out on 11th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Maxey House 03/11/09

Maxey House 30/05/08

Maxey House 09/10/07

Maxey House 06/03/07

Maxey House 14/02/06

Maxey House 19/09/05

Maxey House 21/03/05

Maxey House 14/09/04

Maxey House 19/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Maxey House Lincoln Road Deeping Gate, Peterborough PE6 9BA Lead Inspector Elaine Boismier Unannounced Inspection 11th November 2008 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 Maxey House DS0000015189.V372902.R02.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. Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maxey House Address Lincoln Road Deeping Gate, Peterborough PE6 9BA 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) 01778 342244 01778 345850 Mrs Laura Louise Levin Mrs Jacqueline Watson Care Home 31 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (31) of places Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th May 2008 Brief Description of the Service: Maxey House is a large Georgian country residence standing in three acres of grounds. The home is within half a mile of the town of Market Deeping and approximately five miles from Peterborough city centre. The home consists of a main house with a modern single storey extension. Residential accommodation is provided in twenty-seven single and three double bedrooms. Twelve bedrooms have en-suite facilities. A lounge, dining room with quiet area, and conservatory form the communal areas of the home. Residents have access to the gardens. Current fees range from £405 to £415 per week, depending on the size of the room. Additional costs include those for hairdressing and private chiropody. Further information about fees can be obtained from the home Copies of CSCI reports are made available on request or from our website at www.csci.gsi.org Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This summary includes information about what we have done since our last key unannounced inspection that took place on the 30th May 2008. 14th August 2008- Meeting On the 14th August 2008, at the request of the registered owner we had a meeting with her. The purpose of the meeting was to discuss our findings during the inspection of the 30th May 2008 and for the owner to share her views about the inspection and the subsequent draft report. We had made one amendment to the report and this became a public document. 18th August 2008-Random Unannounced Inspection Two Inspectors carried out this inspection to find out how the home was progressing since our last key inspection of the 30th May 2008. We found that some areas of the home had become safer such as window closures, safe keeping of hazardous substances and checking and recording of the temperatures of the hot water provided in the baths. We also noted that a requirement had been met as the home had implemented a record of complaints and had developed a safeguarding policy. We also found that there had been some progress in risk assessments although these were not carried out on a number of areas, such as falls and walking up and down the stairs. As a result of our findings we carried this requirement forward with a new timescale for action. Due to the home’s intention to improve care plan documentation and the home’s quality assurance we considered the home should be able to improve such areas, and, as a result, this would have a positive affect on people accessing healthcare in a proactive and planned way, such as eye checks. The home was also expected to improve safeguarding awareness of the staff, the standard of the recording of the staff roster and to improve infection control procedures. We found a requirement had not been met with regards to the recruitment of staff and this was carried forward with a new timescale for action. We also made a new requirement, about staff induction training. Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 6 9th September 2008 Two Inspectors, one of whom was a specialist Pharmacist Inspector, carried out this random unannounced inspection. The purpose of this inspection was to assess the progress made in some, but not all, of the standards assessed as unmet, during our inspections for 2008. Following our inspections of 30th May and 18th August 2008 we considered that the home had not met the standard with regards to care plans. We took the view that the home would be given time to improve the standard of care plan records, without our making a requirement. We found that although there had been some progress in developing new care plans we found evidence that indicated there remained a breach of the associated regulation. We therefore made a requirement about care plans. We also found that although risk assessments had been carried out for people going up and down the stairs and walking with the assistance of a frame we found evidence of other areas of people’s activities, such as taking their own medication and the risk of pressure sores, that no risk assessment had been carried out. We therefore made a new requirement about risk assessments. It remained unclear how they actively promote the healthcare of the residents, as we had also found in our inspection of the 30th May 2008 and subsequently reported on such a finding. A requirement was considered as not met and this was carried forward with a new timescale for action with regards to the safe storage of medication, including controlled drugs. Two new requirements were made with regards to medication records and making sure that people were given the medication as prescribed. We made a requirement about safeguarding practices and for the staff to attend safeguarding training. Although there had been some improvements in the current staff roster this remained incomplete and we made a requirement. (Since our inspection the registered owner has provided us with copies of the staff rosters for the following two weeks after our inspection and these were of an acceptable and required standard). We did not assess the home’s quality assurance systems in full although we examined two of the home’s new policies and we found that there needed to be some improvement in these areas. Copies of the reports of the above random inspections are available on request from our local Cambridge office. Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 7 11th November 2008 This report includes information that we have received in surveys from residents and their representatives, and from staff. We, the Commission for Social Care Inspection, carried out this key unannounced inspection, by three Inspectors, between and 10:00 and 14:00. It took 4 hours to complete. We looked at documentation and looked around the premises, spoke with staff, including the Registered Owner and Registered Manager, and residents. We also observed staff working and residents’ activities. For the purpose of this inspection report people who live at Maxey House are referred to as “people”, “person” or “resident/s”. What the service does well: What has improved since the last inspection? There has been an improvement in the way the home intends to assess any person wishing to move in. A requirement has been met with regards to care plan documentation. A requirement has been met as risk assessments are now being carried out and any risk identified is, on the whole, being managed. People are now being weighed each month. Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 8 A requirement has been met as staff have attended training in safeguarding awareness. The home has taken action to make sure the home is safer and more comfortable for people living at Maxey House. This includes air ventilation, hot water temperatures and infection control procedures. A requirement has been met as the standard of the information recorded on the staff roster has improved. A requirement has been met as all the required information about staff was available. A requirement has been met as there has been an improvement in the induction training of the staff. A requirement has been met as the home has an improved quality assurance system. There is an improved method of recording the transactions of people’s personal allowances. People are safer as there is an improvement in the overall management of the home. What they could do better: Care plans, to include assessments of people with challenging behaviour and for people assessed to have diabetes could be more detailed to provide guidance for staff in how to meet such needs. We have made no requirement on this occasion as we expect the home to manage this issue. The care of a person with diabetes must be better managed and advice obtained, about the person’s condition, from a healthcare professional, such as the general practitioner. We expect the home to manage this issue, rather than we make a requirement on this occasion. Facilities for the storage medicines could be improved to provide a greater level of security and meet the relevant Regulations. A requirement made about this on previous inspections is still outstanding and has been carried forward with a new timescale for action. The accuracy of records made when medicines are given to residents and the stock control of medicines must be improved. A requirement made about this on previous inspections has not been met in full and has been carried forward with a new timescale for action. Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 10 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 Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 Quality in this outcome area is good. There is a good standard of information to assist people in their decision where to live and there has been an improvement in the way the home intends to assess any person wishing to move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nine of the 10 residents’ surveys were completed with regards to the question about receiving enough information about the home before the person moved in. Of those completed surveys 8 of them said that the person, or their relative, had enough information, about Maxey House, before the person moved in. One of these surveys said ” Maxey House ticked all the boxes for our needs.” At our last key inspection of the 30th May 2008 we found no record of the home’s pre-admission assessments that had been carried out. As a result of Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 12 this we were unable to fully assess the standard of the pre-admission process. We made no requirement as we expected the home to take action to improve this area of record keeping. The Manager confirmed that the last admissions to the home took place in June 2008 and since then the home has developed a pre-admission assessment tool to use for subsequent pre-admission assessments of any prospective resident. At a later inspection we will fully assess how the home uses this pre-admission tool to ensure that the home can meet any assessed needs of the prospective resident. We noted that there was information in the file of one of the most recently admitted people, and this was provided by the referring hospital. Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. People are safer due to some improved health care practices although there remains some element of risk to their health and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following our inspection of the 9th September 2008 we made a requirement about care plan documentation. We examined two residents’ care plans and we spoke with the staff about these. There is evidence that there has been an improvement in the standard of these care records and the staff agreed with our findings: the care plans identified the person’s assessed needs and there was, in most cases, an identified goal and what action the staff were to take to enable the person to reach this goal. There was evidence that the person had signed their care plans, demonstrating there had been consultation with them. We noted that, although there had been an improvement in the standard of the care records, there were some areas that needed to have more details, to provide the guidance for staff in how to meet the needs of the person. For Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 14 example, a person described to have challenging behaviour had an action plan as to how staff should interact with the person when they exhibited such behaviours. However there was no clear description as to how this person presented during such periods, how this affected them, what impact, if any, it had on any other person and any antecedents (causes) that might trigger such behaviours. Another example where the care plan could improve was for a person with insulin dependent diabetes: there was no guidance for the staff what to do should the blood sugar levels be below, or exceed, the person’s normal levels and it was not known, from our examination of the records and from a discussion with the Manager, what is the acceptable range of blood sugar for the person. A further example where a person was assessed to have treatment by a chiropodist there was no indication as to how often the person was to have such treatment. Both of the care plans we saw indicated that these had been drawn up on the 5th November 2008 and because of the overall improvement in the standard of these records, we consider this requirement has been met. Those deficiencies we have identified we expect the home to take action to ensure that the care plans improve further. Following our inspection of the 9th September 2008, whilst we had seen some improvement in the standard of risk assessments these were incomplete in areas identified such as self-medication, nutrition and development of pressure sores. Because of these deficiencies we made a requirement. Examination of two people’s care records, at this November inspection, indicated that this requirement has been met. There was an improvement in the standard of risk assessments for nutrition, moving and handling and risk of pressure sore development. The majority of the risk assessments that we saw showed evidence as to how the risk was to be managed, but one relating to a person who holds and manages their own medication didn’t adequately assess the risks involved. Cross- referencing one of the people’s daily records, with their care plan, indicated that, on the 28th October 2008, the person had a blood sugar of 3.2 mmols/litre. Records indicated that their insulin was given although the person had no breakfast and subsequently vomited. The record indicated that “Very little lunch eaten” and the person vomited again in the afternoon. There was no record to indicate if the general practitioner was contacted. The person’s blood sugar was recorded as 7.2 mmols/litre, at teatime and, although they refused their sandwiches, they were able to drink a nutritional supplement. We could find no record to see if the person’s blood sugar was checked more frequently during this interval of them being unwell. During the night the records indicated the person was given a drink of “lucozade” although there was no recorded explanation as to why the person had this sugary drink; there was no record of their blood sugar before they were given the “lucozade” and there was no care plan guidance for the staff about when this type of drink should be offered. According to the Manager she has since contacted the Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 15 general practitioner when this person’s blood sugar was 1.7 mmols/litre. (The normal range is recommended to between 4 and 9 mmols/litre for most of the time with 4-7 mmols/litre before meals and less than 9mmols/litre after meals - British National Formulary 2008). We have made no requirement, on this occasion, as we expect the home to manage this, with our advice, including seeking advice from the general practitioner about this person’s normal range of blood sugar. Talking with some of the people and examination of two people’s care records indicated that people have access to a general practitioner, a dentist, district nurses (one who was visiting when we were at the home) chiropody and hospital services. According to the Registered Owner action has been taken to actively promote the health of the people, rather than people have access to health care services in a reactive way. The home is developing a tool that will plan when a person is, with their agreement, to have health checks, for example, by a dentist or optician. All of the residents’ surveys said that the person always/usually received the care, including medical care, and support that the person needed. Comments in these surveys included “ I would say that they go over and above for the care and support received” and “Sometimes my mum doesn’t receive enough care in the fact she needs reminders to clean her teeth, wash her face etc. They always make sure she has a bath daily but ocasionally (sic) forget to change her clothes.” We saw that people were clean and well dressed. We saw a few thank you cards, which the home had received from relatives, one of these said, ”We know she (our relative) was well looked after and she was happy there.” People are now being weighed each month and records of these were kept on the person’s care file. The record of weights, that we saw, indicated that neither of the people had unintentional weight loss. A pharmacist inspector looked at practices and procedures for the safe storage, use and recording of medicines. The cupboard used for the storage of medicines in the office is adequate and secure. The temperature of the storage area is monitored and recorded regularly and is satisfactory. We watched some of the residents being given their medication at lunchtime and saw that medication was left unattended in communal areas as there is no lockable facility provided. There is no dedicated storage or recording for controlled drugs despite there being some controlled drugs in use. The requirement made on previous inspections for people’s health and welfare to be protected by the safe storage of medication has not yet been met and has been given a new timescale for action. The management confirmed during the inspection that suitable storage facilities have been ordered. The quantity of medication is stock for residents was, in some cases, higher that would be expected, some having been supplied in March 2008. It is Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 16 important to keep supplies of medication to a minimum to prevent unnecessary wastage and ensure all medication is used within the manufacturer’s expiry date. In one case a medicine had been provided and given to a resident but this did not carry a label identifying the medicine. The manager has been working to reduce the quantity of medication in stock and we expect this to continue rather than make a requirement on this occasion. Records were made when medication is received into the home and when they were disposed of. The quantity of medication carried forward from previous months is not recorded and so an audit of medication is difficult. Records were made when medication was administered to residents but there were some problems with these records: • Medication given to a resident but no record made of this. • Where medication is given in variable doses e.g. “one or two tablets” the actual quantity given is not recorded. This could result in residents receiving too much or too little medication. A requirement was made on previous inspections for the records made when medication is administered to residents (or not) to be accurate and complete. This has therefore not been met in full and new timescale for action has been given. Care staff have received a good standard of training in the safe use of medicines but there is no documented assessment that they can competently put this knowledge into practice. We expect the home to manage this rather than make a requirement on this occasion. We watched the staff interacting with the residents’ in a kind and respectful way. One of the people we spoke with said that they had nothing to complain about and were “Very happy living here.” Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is excellent. People have opportunities to live an excellent quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Seven of the 10 residents’ surveys said the person considered that the home provided activities that the person could always/usually take part in. Two of these surveys said that sometimes such activities were provided. The remaining survey said that the home never provided such activities although qualified this statement saying the person chose to stay in their room. One of the comments in the surveys said that there were “A few more (activities) than when I first arrived.” Discussion with some of the residents and examination of the minutes of the last two residents’ meetings and the activities programme indicated that the home provides a range of activities from bingo to outside entertainers “Sporting Chance”. There was also a visit from “Zoolab”, a visiting company that brought in a range of species from the animal, reptile and insect kingdoms, as part of an educational programme. People told us, and confirmed by the Manager, that people who have a visual impairment have the opportunity to attend a group meeting/club, in the local Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 18 town of Market Deeping, to meet with other people with similar sensory difficulties, and to have a meal. Peoples’ choices of when they like to get up and when they like to go to bed were recorded in the care plans that we examined. A record of visitors to the home was seen and this indicated that people can receive their guests at any time. All of the 10 residents’ surveys said the person always/usually liked their meals. One person commented, “The food is exceptionally good and the variety first class.” People we spoke with said that they enjoyed their meal of smoked haddock and (home made) prawn sauce. The day’s menu was on display in the dining area and this was available in response to an action outcome of one of the residents’ meetings. Menus for two weeks were seen and these indicated there is an option of a cooked breakfast; biscuits and a hot drink are available at mid morning; for a lunch time course, we saw options including fish and chips, sweet and sour chicken and traditional roast dinners followed by a dessert. At teatime there are cakes and biscuits and a hot option at tea time followed by a dessert. Supper is a choice of biscuits and a hot drink. The two care plans that we examined provided information about what the person liked, and did not like to eat and any special diet that they were on. We noted that, since our inspection in May 2008, there has been an improvement in that people’s cold drinks were no longer poured before the people sat at the dining table but poured at the time of their meal, thereby reducing the risk of stomach upsets and cold drinks becoming warm. Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. People are safe from any risk of abuse and are listened to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since our last key inspection there is now a record of complaints and we again examined this. Evidence suggests that the improvement in keeping this record has been sustained. The two complaints that have been received, since we last visited the home in September 2008, have been responded to in a timely, listening and active manner. All of the 10 residents’ surveys said that the person knew who to speak to if they were unhappy about something and all of these surveys said the person knew how to make a complaint. One of these surveys said “I do now!” (in knowing how to make a complaint). Another person commented, “Have not had a need to complain during my time at Maxey House”. Eight of the 10 residents’ surveys said that the staff listened to what was being said and acted on this. Two of the remaining surveys said that this did not always happen: one of the surveys said “Depends on whot (sic) it is(sic).” Another of these two remaining surveys said “Some staff seem to forget the age of some residents and that people have different needs.” Both of the staff surveys said that the member of staff knew what to do if any concern was made to them, from a Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 20 resident or visitor to the home. One of these surveys said that if they were not satisfied with the response from the management team they would report any such concerns to us, or to the safeguarding team. We made a requirement for staff to attend safeguarding awareness, as we were not confident that all of the staff had such awareness about what constitutes abuse and what to do in the event of any such untoward incident. Discussion with the staff and examination of their training records indicated that they had attended such training and knew what to do if they had witnessed any incident of abuse against a resident. Information for people and visitors was available in the home and this information included the contact details of the local safeguarding team. Following our inspection of the 9th September 2008 the home has made a referral to the safeguarding team and took the advice about safeguarding residents from any further risk of abuse, and acted on this advice. This requirement has been met. Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 Quality in this outcome area is good. People live in a safer and more comfortable home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following our key inspection, in May 2008, the home has taken action to make sure the home is safer and more comfortable for people living at Maxey House. This action included checking of hot water temperatures in baths, the installation of thermo-regulating valves for hot water, making sure that windows have approved restrictors and the air flow throughout the home was improved by ensuring any window that was fixed in a closed position, could now be opened safely and with ease. Records of temperatures of hot water were seen and these included when a person had a bath and monthly checks of the temperatures. These records Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 22 indicated that the hot water is delivered at a safe temperature. The two people’s care plans that we saw indicated at what temperature the person liked to have their bath water. During our inspection of the 18th August 2008 we found evidence that the home’s infection control procedures could be better. We noted that this has now improved as bins for disposal of waste were provided with a lid and there were disposable paper towels and dispensers of hand wash solution in those bathrooms and the toilets that were visited. All of the 10 residents’ surveys said the home was always/usually clean and fresh. One person wrote “In the time I have been here the curtains have never been cleaned and the window inside also.” Another person said that the home could do better as the “Windows need cleaning inside in my room. Never had a change of curtains since coming to the home.” We noted windows being cleaned in the conservatory area and according to the Registered Owner all of the internal windows are cleaned. We were also told that the home has an ongoing programme to ensure that the carpets, especially those of the corridors and of the dining room, are deep cleaned by an external contractor. We observed no offensive smells on entering the home or in any other part of the building that we visited. Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. People are safer due to the improved staff recruitment procedures and increased training of the staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following our inspection of the 9th September 2008 we made a requirement for the staff roster to be improved upon. Since our inspection we have received copies of the following two weeks rosters, and we saw that the current staff roster was of a satisfactory standard. This requirement has been met. Staff we spoke with said that they were very happy working at the home. In the residents’ surveys we received the following comments,” The staff are approachable and understand what is being said to then. At the moment there seems to be quite a high turnover of staff, but the care is still good” and …”I appreciate Maxey House for their kindness and care.” Eight of the 10 residents’ surveys said that the staff were always/usually available when the person needed them and both of the surveys, from staff, said that there was enough staff on duty to meet the needs of the residents. The two remaining residents’ surveys said that sometimes staff were available when the person needed them. The staff we spoke with, and from our observation of the staff working, Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 24 we considered that there was enough staff on duty to meet the current needs of the residents. According to the Manager there is 56 of care staff with a National Vocational Qualification in Care, level 2, with 6 other care staff working towards this qualification. A requirement was made as the home had employed people to work at the home before the required information about them had been obtained. This requirement has been met, as all the required information was available. It was also noted that action had been taken in obtaining a third reference, which was satisfactory, when one of the two required written references was not satisfactory. There was also recorded evidence of the supervision of a member of care staff whilst waiting the return of the results of their criminal record bureau check. We made a requirement for the staff induction training to be improved upon and this requirement has been met. The home has taken action to obtain the Skills for Care Induction training standards and the two staff training records that we saw indicated that these standards are now being used by the home. The staff we spoke with said that they had noticed an improvement, within the last 6 months, in the opportunities provided for staff to attend ongoing training. Staff told us that they have attended health and safety training (see Standard 38 of this report) and how to care for some one with dementia. Both of the surveys, from staff, said that the person had received an induction training that covered very well/mostly the areas that prepared the person to do their job. Both of these surveys said that the member of staff attends ongoing and up to date training to ensure that their practice was in date and they were able to meet the individual needs of the people they were looking after. Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. People are safer as there is an improvement in the overall management of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following our key unannounced inspection, of the 30th May 2008, we assessed the home to have poor quality outcomes for the people living at the home. This was because we found clear evidence that there had been breaches of regulations that posed risks to the health and safety of the people living at the home. One of the surveys, completed by a member of the staff said “The home has not been so good with the paperwork but have been trying hard to put the Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 26 problem right.” During this inspection, of 11th November 2008, there has been an overall improvement in the standard of management of the home as the number of requirements made has been met. We informed both the Registered Owner and the Registered Manager that we expect such improvements to be sustained by the home, rather than any reliance on our inspection and regulatory activity. Examination of the Registered Manager’s training and supervision records indicated that she has attended refresher training in medication practices, safe moving and handling, care of people with dementia, health and safety, food hygiene and safeguarding awareness and has an increased understanding of her responsibilities of a registered person. According to her she has made enquiries about attending the registered manager’s award. A requirement was made for the home to improve its quality assurance systems. We acknowledged that the home has made a considerable effort in improving the policies and procedures, as part of the home’s quality assurance systems. We looked at two of these policies at our last inspections, on the 9th September 2008, and we duly reported on our findings of these, in the random inspection letter. As part of the home’s quality assurance three surveys received from relatives were available for inspection and these provided their views about the home. These included “Excellent” for the standard of care and “Excellent” for the overall impression of the home. Copies of the last two regulation 26 monthly visits, made by the Registered Owner, were seen and these provided evidence that the home has now a quality assurance record, to include an audit of health and safety records and residents’ views about the home. It was noted that where peoples’ less than positive views had been obtained, about the standard of the pastry and the standard of the cooked breakfast, the home’s complaints procedure was put into action. This requirement has been met. Two people’s monies were counted and the amount reconciled with the record of balances. There has been an improvement in the standard of record keeping of people’s monies, since our last key inspection, of 30th May 2008. Records for the temperatures of food fridges and freezers, fire alarms and emergency lighting checks and staff training in safe moving and handling and fire evacuation procedures were seen and these were satisfactory. The staff we spoke with confirmed that they had attended training in fire evacuation, safe food handling and safe moving and handling practises. According to the Manager further training has been arranged for staff to attend first aid training and safe moving and handling and the staff we spoke with confirmed this was the case. Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 27 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 x 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x 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 3 x 3 x 3 x x 3 Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement People’s health and welfare must be protected by the safe storage of medication. This included medication controlled under the Misuse of Drugs Act and associated Regulations. Timescales of 21/08/08 and 15/11/08 not fully met. 2. OP9 13(2) 17(1)(a) Records made when medication is administered to resident (or not) must be accurate and complete. This is to demonstrate that residents receive medication as prescribed. Timescale of 30/09/08 not fully met. 30/11/08 Timescale for action 31/12/08 Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Maxey House DS0000015189.V372902.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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