Inspection on 25/09/07 for Medlock Court

This inspection was carried out on 25th September 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Medlock Court 13/09/06

Medlock Court 06/12/05

Medlock Court 20/07/05

Medlock Court 16/02/05

Medlock Court 08/07/04

Medlock Court 25/03/04

Medlock Court 10/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Medlock Court Medlock Way Lees Oldham OL4 3LD Lead Inspector Jenny Andrew Unannounced Inspection 25th September 2007 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Medlock Court Address Medlock Way Lees Oldham OL4 3LD 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) 0161 770 5081 michelle.boote@oldham.gov.uk Oldham M.B.C. Mrs Maureen Schofield Care Home 33 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (24), of places Physical disability over 65 years of age (15) Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 24 OP, up to 15 PD(E) and up to 10 DE(E). A manager, working a minimum of 30 hours per week, must be in place at all times who has the qualifications, skills and experience necessary for managing the home and who is registered, or has an application for registration pending, with the Commission for Social Care. The ratio of care staff to service users must be determined according to the assessed needs of service users and staffing levels must be regularly reviewed to reflect service users` changing needs. 13th September 2006 3. Date of last inspection Brief Description of the Service: Medlock Court is a purpose built Local Authority home, which is situated near to the centre of Lees. It is convenient for local shops and public transport. The home provides care for up to 33 people with age related problems. Only four permanent beds remain, with the others being allocated for short stays and intermediate care. Intermediate care is provided by a range of people, including doctors, nurses, physiotherapists, occupational therapists and social workers with support from occupational therapy assistants and care assistants. Accommodation is provided on three wings, each having its own dining/lounge and kitchen area with bedrooms located nearby. One of the wings is specifically for residents who need intermediate care. Bedrooms are all single, although five have doors to adjoining rooms, which may convert into doubles for people wishing to share. There are large secure gardens for residents’ use and level access so that people in wheelchairs may also enjoy them. The home was well equipped with aids and adaptations so that people were able to be as independent as possible during their stay. The weekly fee, for respite and permanent residents, ranged from £327.00 £370.00 and was dependent upon each person’s financial assessment. No charge is made for people on the intermediate care unit but the length of stay is limited to up to six weeks. Additional charges are made for hairdressing, newspapers and magazines. A copy of the Commission’s most recent inspection report is displayed in the entrance/reception area and on the intermediate care unit. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which included a site visit to the home. The staff at the home did not know this visit was going to take place. The manager was off duty on the day and the deputy and one of the assistant officers assisted with the inspection. The visit lasted eight and a half hours. We looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly, as well as looking at how the medication was given out. The files of some of the staff were also looked at to make sure the home was doing all the right checks before they let the staff start work. In order to obtain as much information as possible about how well the home looks after the service users, the assistant manager, deputy manager, social worker, three care assistants, the cook, a housekeeper and three relatives were spoken with. Six of the service users on the intermediate care unit were spoken to in a group and four people spoken to on an individual basis. Before the inspection, comment cards were sent out to service users, staff and relatives/carers asking what they thought about the care at the home. Five service users, seven relatives, two care staff, three health care professionals and a social worker filled the cards in and returned them to the Commission for Social Care Inspection (CSCI) and this information has also been used in the report. Before the inspection, we also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The manager did not address all the key standards and on future AQAA returns, the manager needs to go into more detail in all sections of the form. Five extra intermediate care people were being accommodated due to one of the Authority’s other intermediate care units being closed due to refurbishment. During their stay, these people were sharing a unit with those people on short stays. The Commission for Social Care Inspection (CSCI) has not undertaken any complaint investigations at the home since the last key inspection. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 6 What the service does well: Service users and their relatives/visitors spoke well about the staff who worked there. Comments included, “Everything during my stay has been very, very good”, “I’m looking forward to another stay here as I’ve been well looked after”, “In the time I’ve been here I’ve never had to complain”, “I am very satisfied with the care I have had”, “The staff provide first class care and everything so far has been good”, “Treatment is explained and all my questions have been answered” and, “The staff are very encouraging and welcome you with open arms and make you feel at home straight away”. There was a good admission procedure in place, both for those people coming in for rehabilitation or for those coming in on respite stays. This ensured that their needs would be able to be met during their stay. The intermediate care unit was staffed with a range of experienced health and social care professionals working with the staff team in order to rehabilitate people so they could return to their own homes with the skills they needed. The menus were varied and provided choices at each meal. People’s dietary needs were being met and the following comments were made by the service users: “we always get a choice”, “plenty to eat”, “the food is very good”, “first class”, “great”, “marvellous”, “if you don’t like the choices, they will make you something else” and, “you can have what you want for breakfast”. More than half the staff had done recognised training called NVQ, which had raised their awareness in how to care for people safely and with respect and dignity. The standard of accommodation was excellent. The home was well furnished and decorated and fitted with the right kind of aids and adaptations so that people staying there would be able to be as independent as possible. One person commented, “my room is beautiful and kept very clean”. The cleanliness throughout the home was excellent and it was clear the housekeeping staff took a real pride in their work and continually tried to reduce the risk of people picking up infections during their stays. The home was well managed and effective systems were in place so that the management team could check they were offering a good service. The manager and her team had also focused on looking at raising people’s awareness of different ethnic groups and cultures so that people would be more understanding of their needs. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 8 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 Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 9 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 & 6 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Assessments were undertaken before people were admitted to the home on all of the units, to ensure their needs could be fully met. EVIDENCE: Whilst the service user guide and statement of purpose had recently been updated, copies of the revised documents had not been sent to us. The assistant manager said she would ensure this was done. In addition to these booklets, other useful information describing what intermediate care was about was sent out to potential clients whilst they were in hospital by the health and social care team. Two of the service users spoken to said they had received this information which explained clearly about the service being offered. Those coming in on planned short/respite stays were given an information leaflet setting out what to expect. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 10 Copies of the Statement of Purpose and Service User Guide were displayed around the home but were not always given to each person. In order to ensure each person has easy access to the information contained in the service user guide, a copy should be kept in each bedroom. The intermediate care unit provided a step down approach from hospital for a period of up to six weeks and each person had weekly reviews by a multidisciplinary team to assess their progress and any additional needs. Short stay beds were allocated dependent upon each person’s assessed needs. The four permanent residents living at Medlock Court had lived there a long time and had been originally assessed and referred through Social Services. Two files for people on respite and intermediate care were checked and assessment documents were in place. It was apparent that people received a very thorough assessment before moving onto the intermediate care unit. This assessment was undertaken by one of the intermediate care professional staff. The assessment detailed the client’s level of independence prior to their hospital admission and their present level of functioning. Before discharge, intermediate care clients had home assessments in order to make sure any necessary aids and adaptations could be fitted or given to them to further promote their independence. The health and social care team had a range of equipment available to them and kitchen facilities ensured that skills in this area could be promoted. The units were self-contained in respect of services and facilities, although dedicated care staff were not provided. The aim was to have staff who worked on all the units, ensuring that a suitable skill mix was available at all times to both intermediate care clients and the permanent and respite stay people. Staff spoken to felt this worked well. People spoken to on the intermediate care unit said they were fully aware that the unit had a focus to enable them to become independent and return home, and all but one felt that this aim was being achieved but acknowledged this was because of her health. One service user commented “I’d never have managed to make such good progress if it hadn’t been for the support I’ve been given”; another person said “I can now get dressed on my own and will be going home soon” and one person commented, “It’s a good thing these places are provided”. It was busy on the day of the visit, with new people arriving and one person going home. The relative of the person going home said the short stay service was really appreciated as it meant she could book to go away on holiday. She was also pleased with how her husband had been cared for whilst staying at the home. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 11 Upon one person’s arrival, it was clear that the staff tried to make the person at ease straight away by offering them a cup of tea and explaining what would be happening next. They explained about sorting out her medication, whether she had any allergies, getting details of her likes/dislikes and checking out whether she had any questions. They also showed the relative to the person’s room and took contact telephone numbers. Whilst it was a bewildering process, the staff did everything they could to make it as pleasant as possible. The management team were committed to ensuring the staff received appropriate training in order they were equipped to care for the different needs of the people who were accommodated on both the short stay and intermediate care units. Specialist training, such as dementia care, equality and diversity, nutrition and HIV, had been provided. Several staff had been booked on deaf and blind awareness training the day following the visit. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users health and personal care needs were being met. EVIDENCE: Three care files were examined in depth, one from each of the units. In the main, care plans reflected people’s assessment of need. Care plans were held on each of the units in one file so that staff would have easy access and could update as needed. One of the carers said she checked the care plans daily on whichever unit she was working. It was noted that, on occasions, significant changes noted on daily sheets were not always transferred to the care plans. This was discussed during the visit and the assistant manager said she would ensure this shortfall was addressed. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 13 Moving/handling assessments were not routinely undertaken upon admission but mobility was addressed within the care plans. The managers spoken to said that the majority of people coming into the home were mobile and did not require the assistance of staff for moving/transferring. During the visit, one short stay service user was observed being assisted to rise from a chair by two of the care staff. This person’s file was checked and whilst the care plan addressed mobility, a detailed moving/handling assessment form had not been completed. This must be addressed. A key worker system was in place. Workers were assigned to rooms on each of the units, rather than to individuals, due to the nature of the service, e.g., people coming and going on a very regular basis. Many of the staff had recently received training in the use of the Malnutrition Universal Screening Tool. The manager had not yet implemented the tool due to not having received all the necessary documentation but the assistant manager said they were chasing this up. The Authority’s own nutritional screening tool was in use and service users’ weight was regularly monitored. If a service user had a fall, this was followed up by one of the management team who did a full investigation into how it had occurred, so that, if necessary, additional steps could be taken to prevent further falls occurring. Accident records had been appropriately completed for the service users whose files were checked. There was a nominated intermediate care co-ordinator to co-ordinate all the disciplines involved in the care package for those people on the intermediate care unit and weekly multi-disciplinary team meetings took place. Two of the carers said these were a good way of sharing and updating information and that a carer and manager always attended. In addition to the weekly meetings, a management weekly meeting took place in order to review care practices and update care planning on the other units. Feedback from service users and relatives spoken to during the inspection and comments made from returned questionnaires were very positive about the care they had, or were, receiving. Comments included the following: “Everything during my stay was very good”; “There needs to be more homes like Medlock Court”; “I’m looking forward to another stay there”; “The home provides first class care”; “Everything so far has been good and I would recommend it to anyone”; “The staff are encouraging and support you” and, “The support is really good and you get help after you have left the home”. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 14 Service users’ health and personal care needs were being appropriately met on all three units. Service users spoken to stated they were enabled to access health care services and evidence of this was seen on the record of professional visits/interventions maintained in each service user’s care file. The home clearly benefited from having the multi-disciplinary team of health care specialists on site to consult and seek advice from as necessary. There was a specific doctor assigned to the intermediate care unit who visited regularly, as did the pharmacist. Other health care services were accessed as required. During the visit, one service user on the intermediate care unit was having problems with her hearing aid, which was not working. One of the carers took immediate action to sort out this problem by arranging for her to visit the clinic in a taxi before it closed that day. Such swift action was really appreciated by this service user. The manager arranged training on health care topics that related to the health care needs of people using the service and equality and diversity training had been recently done by some of the staff. Evidence of this was seen in staff training files. The managers and staff said the communication systems in place were good with shift handovers taking place. Written notes and verbal feedback were passed between the staff to ensure continuity of care for the service users. Before returning home, the people on the intermediate care unit made home visits accompanied by health care professionals to assess their coping skills in the home. One person said, “I am improving slowly with the help of the staff” and another said, “you practice in the kitchen here, so that you will be able to cope again when you go home”. Aids and equipment were provided throughout the home to encourage maximum independence for all the people living there. People were encouraged to manage their own medication, following a detailed risk assessment being undertaken. Three of the intermediate care clients spoken to confirmed they did so and kept it locked away in their bedrooms. The deputy manager said upon admission, staff administered all medication for the first 24 hours until assessments had been completed. Feedback from health and social care professional questionnaires, indicated they felt that service users needed to begin self medicating sooner rather than later in their stay. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 15 The staff on each of the three units were responsible for the giving out of medication to the people in their care and they all had their own medication trolleys. We had received two notifications this year about errors in administering medication. As a result of these, the manager had sent staff on refresher medication training courses and records showed that all staff who gave out medication had received training. In addition, the management team had spent time observing practice to make sure the staff were following the home’s procedures. The manager had also ensured that a photograph of each service user was attached to their medication records for identification purposes, that the medication policy and procedures were in the front of each of the medication files and had written reminders to staff about routine good practice when giving out medication. Irrespective of this, during the inspection, it was noted that errors in medication were continuing. One person who needed medication to be given at precise times, due to their medical condition, did not receive it until staff had been reminded to do so, following the person alerting us to the problem. In one instance the medication was three quarters of an hour late and on the second occasion it was over an hour late. The management team addressed this with the people concerned during the visit. On one medication administration record (MAR), there was nothing recorded about what dosage needed to be given of a specific drug, although the correct dosage was being given. The deputy manager said she had been awaiting a phone call from the clinic, following blood tests, as she was aware there would be changes made to the prescribed level. All labels must contain details of the dosage to be given. The storage and disposal of drugs was satisfactory. No controlled drugs were being administered at the time of the visit but a controlled drug book and a controlled drug cabinet were in place. Staff had a good understanding of the physical and emotional needs of people in respect of maintaining their privacy and dignity. Observations made included: staff knocking on doors, staff arranging for a visiting GP to see someone in the privacy of the treatment room and people being sensitively assisted to the toilet. The service users spoken with all confirmed the staff’s attitudes were respectful and all five returned questionnaires confirmed satisfaction with the way staff listened to them and acted upon what they said. A comment card from a GP said, “staff promote service users’ dignity and care” and one returned from a social worker commented: “staff respect individuals right to self determination”. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 16 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. This judgement has been made using available evidence, including a visit to this service. Service users were encouraged to make daily choices and follow their preferred daily routines, as far as their rehabilitation programmes would allow. EVIDENCE: There were only four permanent people living at the home and, due to mental frailty, were unable to discuss what activities were offered to them. The other people were in for varying periods of time and therefore could only comment upon what had been offered to them during their stays. Feedback was mixed in respect of social activities and this was also the case on comments received on the returned questionnaires. Two people said activities were always offered, two said they were sometimes arranged and one person said there were never any arranged. Several of the people spoken to said they had played some games, watched a musical DVD and taken part in a quiz but that usually, staff spent time chatting with them. Several enjoyed reading newspapers, doing puzzles or watching television and some had made friends with each other. Three people felt the staff could arrange more activities in the afternoons as they felt time passed more slowly at this time of day. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 17 Those people on the intermediate care unit said some part of the day was spent following their rehabilitation programme and fully appreciated the importance of this. The assistant manager said they were currently addressing the identified shortfall. An activity co-ordinator had recently been employed to visit several of the authority’s homes and over a two-week period, she spent a three-day block at the home. Her first visit had only recently taken place. From checking her file notes, it was evident that she was looking at the needs and abilities of the people currently living there, having carried out individual needs assessments so that she would know the kind of activities they might enjoy on her next visit. In addition, the management team had made excellent progress on promoting equality and diversity within the home in respect of themed social events. In May this year, two events had been held, a European and a Hawaiian day. An “Introduction to India” day had been held in August when Indian food was also on offer. Following these, feedback questionnaires had been circulated to those taking part and from reading the comments, it was evident these events had been really enjoyed. People in the home spoke about the daily choices they were able to make which included; rising and retiring times, choice of food, whether or not to use their rooms or remain in the communal areas and whether or not to join in with activities or pursue their own hobbies. One resident said she enjoyed helping to set the dining tables and she was seen to do so during the visit. In order to try and obtain a pen picture of each person’s individual needs/ preferences for those people coming on respite stays, staff spent time upon admission, completing a preference sheet that included questions such as “what time do you prefer to get up and go to bed?”, “Do you like a rest in the afternoon?”, ‘”What are your interests?”, “Would you like a visit from the local clergy?” These forms made sure that people were treated individually and could continue to follow their normal routines. Discussion took place about completing this type of form for those people coming in for rehabilitation. Whilst it is acknowledged some minor changes would be necessary to take account of individuals’ programmes, this would ensure a more person centred approach for everyone. The assistant manager said that the local vicar called in to give communion on a monthly basis and that the priest could be contacted if anyone requested a visit. Throughout the day many visitors called in and were made welcome by the staff on duty. Those spoken to all felt they were free to visit at any time, provided this did not disrupt the person’s rehab programme. Returned feedback comment cards also indicated satisfaction in the way they were made to feel welcome when visiting the home. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 18 Three-weekly menus were in place, which were rotated. The Cook had not worked at the home very long and was making the odd changes to the menus to find out if people liked different foods. She said she usually asked residents if they had enjoyed their meals and also asked if they would like to see anything different on the menus. When changes were made, they were recorded in her folder. The menus were varied, nutritious and choices were offered at each meal. A menu board, outside the kitchen, showed what the daily choices were. The service users spoken with were very positive about the food. On the day of the visit, the lunchtime choices were: beef casserole or sausage and onion gravy with mashed potatoes, baby carrots and cabbage. This was followed with rice pudding. We sampled the beef casserole. The meat was tender and very tasty and the vegetables were soft but not overcooked. The rice pudding was thick and creamy, having been made with full fat milk. In order to cater for people with diabetes, the cook had used sweeteners for some portions of the pudding. Any special dietary needs of new clients coming into either unit were passed to her and they were catered for appropriately. Food allergies were also noted and this was observed during the visit. The service users on each unit had their own dining facilities and small kitchens where they could make themselves drinks or snacks. Those on the intermediate care unit practiced making meals under supervision. The dining rooms were attractively set and small teapots enabled people to help themselves and remain as independent as possible. Medlock Court DS0000035503.V348011.R01.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. This judgement has been made using available evidence, including a visit to this service. An effective complaints system was in place which service users were familiar with and staff training and good recruitment practices ensured that, as far as possible, residents were protected from abuse. EVIDENCE: A formal complaints procedure was in place, which was displayed in bedrooms in all three units. All seven returned visitor questionnaires commented they were clear about how to make a complaint and service users also said they would know who to complain to. Responses on returned questionnaires were also positive in this area with all five service users stating they felt staff listened to them and acted on what they said. A complaints file was in place where any complaints were recorded together with action taken to address the problem. The Annual Quality Assurance Assessment form, completed by the manager, recorded that over the last 12 months two complaints had been received, one of which was still ongoing, but out of the hands of the management team. Discussion took place in respect of this and advice was given for the manager to be pro-active in getting an outcome so the complaint could be finalised without any further delay. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 20 We had not been involved in the investigation of any complaints at the home over the last 12 months and no safeguarding referrals had been received. Records showed that the majority of the staff team had attended Protection of Vulnerable Adult (POVA) training and that the home had a copy of the Oldham MBC Inter Agency Protection of Vulnerable Adult policy. The manager should ensure that as part of supervision, she checks which staff have undertaken the training and arranges for those who have not completed it to do so as soon as possible. The home had a range of policies and procedures in place for staff to follow in respect of service users monies/gifts/wills, etc. Staff training records showed that staff were not starting work until two satisfactory references and full Criminal Record Bureau checks had been received. This helped to ensure that the people recruited were safe to work with vulnerable people. Medlock Court DS0000035503.V348011.R01.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 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The home provided high quality accommodation that was homely, spotlessly clean, well decorated and maintained and designed to promote the independence of the people staying there. EVIDENCE: The home was purpose built and had been designed to provide small group living. It was divided into three wings, each with its own lounge, dining room and kitchen area. This allowed people to enjoy maximum independence in a non-institutional setting. The atmosphere within the home was welcoming and friendly and a care manager also commented upon this. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 22 Accommodation in the home was provided to a high standard. It was beautifully decorated and furnished throughout and the colour schemes in the bedrooms were different. Although there were no en-suites in bedrooms, toilets and bathrooms were situated close to bedrooms and communal areas. Since the last inspection, the short stay and permanent wings had been further upgraded in respect of the following: new commodes, two new rise and fall beds, fireproof curtains, sink chairs, easy chairs, new corridor carpet fitted in one unit, new chairs for the intermediate care unit and three bedroom carpets. Bedrooms were fitted with locks and lockable cupboards were supplied in which people could keep medication or private possessions. In the intermediate care unit, a specially adapted kitchen was fitted which included a domestic washing machine, dryer, fridge, gas and electric cookers and height adjustable worktops. This enabled people to practice carrying out their normal domestic tasks, as they would need to do upon discharge home. There was a good assortment of bathrooms/shower rooms enabling people with differing needs/abilities to have baths, assisted or unassisted. These rooms had the necessary aids and adaptations fitted, as had the toilets, many of which were suitable for people to use who were dependent upon wheelchairs. Whilst the bathrooms were suitable for purpose, they had been decorated and personalised so that the overall appearance was domestic rather than institutional and this is commended. The home also provided a laundry room, an impressive and domestic looking hairdressing salon and treatment/therapy room. People who were staying in the home were very complimentary about the environment. One person said, ‘My room is lovely”, and other comments included “Very satisfied with the facilities”, “Really nice place to come to” and “Can’t fault the home, its homely and comfortable”. At the last inspection, a requirement was made for the exterior lighting in the car park to receive attention as the faulty lighting was making it an unsafe area. This had been done. Safe accessible garden areas were provided so that people could enjoy going outside when the weather was good. Since the last inspection, the Environmental Health Officer had visited the home. The cook and assistant manager confirmed that the requirements had been met and almost all the recommendations had also been addressed. The cook said that additional work was yet to be done to the kitchen, which would be taking place in the next few weeks. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 23 On the risk assessment file, it was noted that the new no-smoking rules had been implemented within the home. The home had a no-smoking policy but arrangements had been made for service users who smoked to go into one of the enclosed gardens where they could use a small greenhouse type shed which had seats in. Bedrooms, bathrooms, lounge and dining areas on all three units were spotlessly clean and free of malodours. The housekeeping staff should be commended upon the high standard attained throughout the home. The arrangements in place in respect of resident’s laundry were satisfactory. All the service users spoken to were complimentary about the cleanliness throughout the home, as was feedback from returned comment cards. The following comments were made: “The home is cleaned scrupulously and all my clothing is laundered and to a high level,” “The home is kept really clean” and, “Everywhere is spotless”. The infection control policies/procedures were being followed. Disposable gloves and aprons were in stock and being utilised, liquid soap and paper towels were in place and notices reminding staff to wash their hands were displayed. The recently purchased new commodes were fitted with lids under the seats, to try and reduce the risk of spreading infection. One observation was made where at meal times, staff assisting with meals, did not change into different coloured disposable aprons or wear tabards over their clothing. The assistant manager said that staff did change into clean white disposable aprons after assisting with personal care tasks, but this would not easily be able to be evidenced, hence the need for a different colour to be worn. Many of the staff had attended training courses in respect of infection control and there was a rolling programme in place for those who had not yet been. The housekeeping staff used different coloured buckets, cleaning cloths and had an excellent cleaning regime for accidents and spillages and this was evidenced during the visit. There were no unpleasant odours anywhere in the home. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 24 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. This judgement has been made using available evidence, including a visit to this service. Sufficient experienced staff were working on each of the units to ensure the needs of the people living and staying there were being met. EVIDENCE: According to information recorded on the AQAA, the majority of the staff team were, all white British, but this reflected the current service user group. The home had an equal opportunity policy in place, which was adhered to when recruiting staff. Whilst the majority of the staff were female, there were two male care assistants employed and a male carer had recently been interviewed with a view to joining the casual register. The AQQA showed that over the past 12 months only two part-time staff had left. This low turnover of staff ensured that the people using the service could build up relationships with the staff in the knowledge they would still be working there when they returned for future short stays. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 25 From discussions with the management team and inspection of staff rotas, it was clear that since the last inspection, staffing within the home had significantly improved. As previously stated, five service users from another home were presently staying at Medlock Court and some of the staff from this home had also been transferred there. The individual units always had two staff working during the day but recently an additional two staff from the other home had been working across the units, dependent upon which unit needed the additional help. At night, three staff were on duty and a manager was oncall in case of an emergency arising when staff may need to seek advice. Feedback from the returned questionnaires and from speaking to staff indicated they felt they worked well as a team and that staff morale was good. They also felt that adequate staffing levels in the home were maintained but that holidays and sickness were sometimes problematic. Communication methods in the home were said to be good and specific mention was made about how working alongside a health and social care multi-disciplinary team enabled them to increase their skills and knowledge. Service users confirmed they felt well cared for, safe and supported and that their differing needs were being met. It was clear that staff training was prioritised with 57 of the care staff achieving NVQ level 2 or above. In addition, the four members of the management team had achieved NVQ level 4 in care, which brought the overall percentage of trained staff to 62 . One carer was currently undertaking NVQ level 3 and four of the domestic staff had started their NVQ level 2 in housekeeping. The Local Authority had good recruitment and selection policies and procedures in place, which were being adhered to. Equal Opportunities policies were also in place. From checking staff files for two of the most recently employed staff, it was clear that staff did not start working until two satisfactory references and a full enhanced Criminal Record Bureau check had been received. One of the care assistants spoken to confirmed she had not commenced work until all the relevant checks had been done. Skills for Care training was in place for all new staff but in the two files examined, the booklets were missing. One of the carers was spoken to and she said her work booklet was at home as she had not quite completed all the units. She confirmed she had at first worked alongside an experienced carer in order to learn about her role and responsibilities. She had commenced working at the home in January 2007 and the Skills for Care training should be completed within the first 12 weeks of employment. The other carer, whose file was examined had started working at the home in April and again, the workbook should have been signed off and proof of completion, held on her file. The management team should ensure that as part of supervision, the Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 26 Skills for Care induction training is followed up within the 12 week timescale. One of the files contained evidence that all the necessary mandatory training had been completed as part of their induction. The other file contained evidence of the person having previously undertaken her NVQ level 2 and since working at the home, having attended training for medication, dementia and a full days induction in June 2007. It was difficult to determine whether all the staff working at the home had attended all the required mandatory training, as there was no single up to date training matrix in place. Training had been recorded on numerous documents. It was clear however, that ongoing training courses were being run by the Social Services training department and staff names were being submitted for all the future courses. Evidence of this was seen during the visit. The manager should ensure that the training needs of all staff are collated and recorded on a single training matrix so that it is easily evident when training or refresher training is due. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 27 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. This judgement has been made using available evidence, including a visit to this service. The home was being well managed, resulting in good outcomes for the people living and staying there. EVIDENCE: The registered manager was experienced and had completed NVQ Level 4 in care, and the Registered Manager’s Award. A management team supported her that consisted of a deputy manager and three assistants, all of whom had successfully completed their NVQ level 4 in care. There were clear lines of accountability within the team. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 28 From speaking to members of the management team, it was identified that one of the team’s objectives was to better meet the equality and diversity needs of the service users. Training records showed that several staff had undertaken equality and diversity training. An equality and diversity file was seen which showed some of the improvements that had already been made, e.g., welcome signage in different languages displayed at the front door, more cultural events to raise people’s awareness, social activity feedback sheets to obtain the views of people about such events, the introduction of pictures and ornaments from other ethnic backgrounds. Staff feedback indicated regular meetings took place, e.g., monthly wing meetings, full team meetings and management weekly meetings. The care staff also confirmed that they received regular one to one meetings with their managers, as did the management team. An effective quality assurance system was in place, which assisted the management team to measure the quality of the service they were offering. As previously stated, feedback sheets about themed activity days had been circulated, questionnaires are given to people before they are discharged from the short stay and intermediate care units and this information is collated into a graph clearly showing the outcome of the surveys. This was displayed in the home and showed that service users were well satisfied with the service they had received. Where any ideas or negative comments are received, they are looked at and efforts made to resolve or improve them. An example was given where one person had made some minor negative comments about her stay. The manager had written to her to say the issues had been addressed and would be in place for any future stays. Quality monitoring health and safety audits took place as well as Regulation 26 visits, which are made to check that the service is running well. The manager ensured that any requirements and recommendations made by us are met within the agreed timescales. People coming onto the short stay and intermediate care units were encouraged to manage their own personal monies. However, where requests were made for money to be safely held on their behalf, a system was in place, providing the sums were not excessive. The money being held for three service users was checked and income and outgoings were accurately recorded together with receipts. During the visit a request was made by a visitor for a large sum of money to be held on behalf of one person. The assistant manager explained this would not be possible due to the limit they were insured to hold on the premises. Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 29 As stated in the staffing section above, it was not possible to identify exactly which staff had undertaken or required refresher training but we were satisfied that training needs were being identified and staff names being put forward for future relevant courses. According to information provided on the Annual Quality Assurance Assessment form, all safety equipment was regularly serviced in accordance with the manufacturer’s instructions. A random sample of maintenance records were checked and found to be in order. On the Annual Quality Assurance Assessment form, the manager had recorded that fire training was due. She should ensure this is arranged as soon as possible. Accidents were being accurately logged and full undertaken into any falls, which occurred in the home. investigations being Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 30 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 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 13(5) Requirement Where service users are assessed as being reliant on carers for moving/transferring, a full moving/handling assessment must be undertaken so that it is clear to staff how they should safely assist people. Medication must be given out at times as prescribed by the GP and all printed labels must state the accurate dosage to be given to each person. This will ensure the persons health care needs are met during their stay. Timescale for action 02/11/07 2 OP9 13(2) 19/10/07 Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 32 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 OP1 Good Practice Recommendations A copy of the service user guide should be given to each person who uses the service so they will know all about what the home offers. As there is such a high turnover of people, a guide could be kept in each of the bedrooms. Where recurrent medication errors are made by staff, the home’s disciplinary procedure should be followed. The manager should ensure that all complaints are followed through as quickly as possible so that the complainant can be advised of the outcome. Care staff involved in serving or preparing food should wear protective tabards or a different coloured disposable apron. Skills for Care induction training should be completed within the first 12 weeks of starting work, which should include all the required mandatory training. Training records should be condensed into one up to date matrix so that the management team can see at a glance which staff have undertaken training and/or require refresher training. 2 3 4 5 6 OP9 OP16 OP26 OP30 OP30 Medlock Court DS0000035503.V348011.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU 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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