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Inspection on 08/11/05 for Maycroft Residential Home

Also see our care home review for Maycroft Residential Home for more information

This inspection was carried out on 8th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides safe, clean and comfortable accommodation. Chairs in the main lounge are arranged in small groups, which provide more opportunity for privacy and socialisation. There are a number of safety features in the home, such as a door entry system and gates across the stairs. The mealtime was observed and this was served to service users who were seated around small tables, with no more than six to a table, the average number being four. Every effort had been made to preserve service user independence; plate guards and specialist equipment were being used. The home was adequately staffed and the staff worked as a team particularly at lunch time when all staff, be it care staff, catering staff or domestic staff provided assistance to service users. Care staff have all recently undertaken a course in dementia, to refresh their knowledge and some staff showed a good understanding of the different types of dementia and how to approach and support people with dementia. Service user`s care plans provided detailed information, specifically around their life stories and family tree.

What has improved since the last inspection?

No areas were identified.

What the care home could do better:

Staff records did not contain all the documentation required by The Care Home Regulations 2001. This was a previous requirement. Service user care plans were generally good but a number of omissions were noted. On one file a risk assessment for the use of bed sides was not seen, although consent had been sought. Weight records were in place, but evidence was not provided that weights are recorded on admission or taken as regularly as stated in the care plans. Staffing levels must be kept under review, according to the dependency levels of service users. Care staff were busy throughout the shift and commented on how hectic it was.

CARE HOMES FOR OLDER PEOPLE Maycroft Residential Home 73 High Street Meldreth, Royston Hertfordshire SG8 6LB Lead Inspector Shirley Christopher Unannounced Inspection 8th December 2005 10:10 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 Maycroft Residential Home DS0000047648.V254208.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. Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Maycroft Residential Home Address 73 High Street Meldreth, Royston Hertfordshire SG8 6LB 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) 01763 260217 01763 260217 Aermid Health Care Limited Joan Ogden Care Home 25 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (20), Old age, not falling within any other of places category (25) Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. There must be no more than 20 of the 25 registered places occupied by service users with a formal diagnosis of dementia One named service user under the age of 65 with diagnose dementia may be admitted 12th April 2005 Date of last inspection Brief Description of the Service: Maycroft is situated in the High Street in Meldreth, and within walking distance of the village amenities. The home is on 2 floors, with a passenger lift to the upper floor. The service users have a variety of sitting and dining areas, and sufficient space to move around the home. All rooms are single occupancy and there are currently no en-suite facilities. There are extensive gardens where service users can sit or walk, weather permitting and access has been improved recently, allowing more service users to enjoy the gardens if they choose. The home offers care to older people and to older people with dementia. Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken on the 8 December 2005 at 10:10 am and was unannounced. The inspector spoke to nine service users, seven staff and one relative. A tour of the home was conducted and some records were looked at including, three staff files, three resident care plans, medication records, complaints/compliment book, health and safety policies and procedures, water temperatures and fire records. These were found to be mostly satisfactory. The home has one service user vacancy and several staff vacancies including a post for a cook and an activities coordinator. A social work student who works most days is providing some activities. What the service does well: What has improved since the last inspection? No areas were identified. Maycroft Residential Home DS0000047648.V254208.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. Maycroft Residential Home DS0000047648.V254208.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 Maycroft Residential Home DS0000047648.V254208.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): 3,4 The home completes a detailed assessment to ensure that they are able to meet the identified needs of the service users. Care staff showed a good understanding of service user’s needs. EVIDENCE: A copy of the statement of purpose has already been sent to the CSCI. A number of service user files were inspected and provided evidence of an assessment of need completed before admission. Some service users are admitted for a period of respite care, which is a good way to be introduced to the home. The majority of service users at the home have a type of dementia. Care staff have had recent training and showed a good understanding of their needs. Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The social care needs of service users are well documented. Health care records must be improved. EVIDENCE: Three service user care plans were inspected and included two service users recently admitted. Neither file had a photograph. The care plans were comprehensive documents and included a life story and family tree. Evidence of monthly reviews was provided on one file. This was a comprehensive and covered every area. Two care plans for the new service users had not been reviewed because they had lived at the home for less than a month. Nutritional assessments, risk assessments, manual handling charts and skin care assessments were seen. Daily notes are kept and there is a record of social activities undertaken by service users. A number of records were not seen or were incomplete. No record of weight was made on admission and one care plan identified that the lady needed to be weighted every two weeks because of a high nutritional score. Evidence of this was not seen. No evidence was seen of the action taken in response to notable Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 10 weight loss, although records showed the service user put the weight back on. One care plan was seen of a service user with a pressure sore. The district nurses visit and treat the wound. The senior carer stated that the district nurses have taken photographs of the wound and leave the notes they write, in at the home. These were not seen. No specific care plan was seen for the pressure sore and records, which record visits from other health care professionals, had not been updated. Consent was seen for the use of bedrails, but there was no risk assessment in place. Medication was checked in respect of the three service users whose files inspected. These were adequate. It was noted that if medication is not given or refused it is recorded appropriately on the medication-recording sheet. An explanation should be provided on the back of the sheet. Most staff has undertaken medication training, and a refresher course has been booked for 3 January 2006. Care staff were observed treating service users with respect and addressing them by their preferred name. It was noted that staff knock before entering bedrooms and keys are provided. Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Evidence was provided of choices being offered to service users and the provision of meaningful activities. EVIDENCE: The senior care staff on duty told the inspector that the manager had just interviewed for an activities coordinator. In the meantime a range of activities are provided by care staff and a student social worker who visits the home most days. A Christmas party is planned for the Saturday after this inspection and the home was nicely decorated for Christmas. There was evidence of a raffle to be drawn and some musical instruments had just been delivered. The home has a designated music room, a main lounge and a smaller lounge. Care staff record the activities service users participate in. These range from bingo, quizzes, and outside entertainers. Only one relative was met on this occasion and she stated that visitors are always made to feel welcome at the home, regardless of the time they visit. She stated that it was a very homely atmosphere and all the staff were very nice. The administrator stated that relative meetings are held every eight weeks, and the senior carer said that service users are able to attend. Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 12 The home have been advertising for a cook for about a year, which puts a strain on the present cook who works full time including weekends. She is supported by care staff, which takes them away from care duties. All staff spoken to stated that they pull together and help each other. This was particularly evident at the mealtime. The main meal is served at lunchtime and service users are offered a choice. On today’s menu there was liver and bacon casserole or vegetable lasagne served with potatoes and vegetables, with banana and custard to follow. Service users were appropriately supervised and their independence facilitated. The cook stated that meals are generally cooked from fresh including soups and cakes. Some service users needed encouragement to eat and this was provided. Snacks were said to always be available. Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home has an adequate complaints policy. All staff must have training in the protection of vulnerable adults. EVIDENCE: The home has an adequate complaints procedure and the home record compliments, as well as complaints. All the latter had been responded to appropriately. No complaints have been received since the last inspection. Most staff have undertaken training in the protection of vulnerable adults and the manager completed a more detailed course at the beginning of the year. Evidence of POVA 1st checks and CRB checks was provided on the staff files inspected. Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 14 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): 19,20,21,22,23,25,26 The home provides a comfortable, homely environment for the service users accommodated. EVIDENCE: The home provides spacious, clean, and comfortable accommodation and has large external grounds. There are a number of safety measures in place designed to provide service users with a greater level of protection, such as sensor alarms and stair gates. Water temperature records and tests for legionnaires disease were seen and were satisfactory. Specialist equipment is provided as required and included a specialist bath, hoists and reclining chairs. Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 15 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): 27,29,30 Care staff interviewed had worked at the home for some years and had considerable experience, but some of their training had lapsed. EVIDENCE: On the day of inspection both the head of care and manager was off duty but there was a senior carer and three other care workers, an administrator, a laundry assistant, a cook and two domestics. The rota showed these levels are maintained and some staff said staffing levels are less than they use to be as the number of staff in the morning has reduced from 5 to 4. This figure should be kept under review to ensure that it remains appropriate to the needs of the service users. Staff were interviewed and all stated what training they had received since being employed at the home. Some training gaps were identified. Staff confirmed that they had recently undertaken an in house dementia course, two staff were doing NVQ 2 and 3 respectively. Some staff had completed all the statutory training although they did say it needs updating. Several staff were keen to undertake first aid training and this is a statutory course. Domestic staff had done food hygiene, but not health and safety. Evidence of staff training updates must be sent to the CSCI. Staff confirmed that they are appropriately supervised and evidence was seen of the supervision schedule. Staff commented on how supportive the manager Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 16 is. Staff meetings are held when the need arises. Staff generally felt happy in their work and said they worked well as a team. Three staff files were inspected and provided evidence of an up to date CRB and POVA 1st check, which were in place before staff are employed. Two written references, an application form and medical declaration were also in place. Two out of the three files (both were staff recently employed) had no form of personal identification and no photographs. The application forms gave a work history, but some of these were not current. For example according to one application the staff had not worked since 1993 and no written explanation was provided for this gap. Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,36,37,38 Adequate measures are in place to ensure the health and welfare of service users. EVIDENCE: The majority of these standards were not inspected, but a number of records were seen and were mostly satisfactory. A number of gaps were identified. Service user weights on admission were not recorded, a record of weights as indicated in the care plan were not on file, (in relation to frequency), no risk assessment for bed sides were seen, or a care plan for a pressure sore. Staff files did not fully comply with the Care Home Regulations 2001. The complaints/compliments book, the fire records, and the water temperature records, including tests for legionnaires disease were satisfactory. Care plans were generally of a high standard and staff were cooperative and helpful during the inspection. Supervision of staff was appropriate. Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 18 Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 X 3 3 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 2 3 Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 20 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 3 Standard OP8 OP29 Regulation 17(1)(a) Schedule 3 13(4) c Requirement The Registered person must ensure that all records required by Schedule 3 are in place. The registered person must ensure that all staff have received training in first aid. All mandatory training must be up to date. The registered person must ensure that staff files include photographs, personal identification and a written explanation for gaps in employment. (A previous requirement was made in respect of staff files) Timescale for action 31/01/06 31/01/06 3 OP29 19(b)(i) 1-9 of sch2 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Any discrepancies/refusal of medication should be recorded on the back of the MAR sheet. DS0000047648.V254208.R01.S.doc Version 5.0 Page 21 Maycroft Residential Home Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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 Maycroft Residential Home DS0000047648.V254208.R01.S.doc Version 5.0 Page 23 - 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!