CARE HOMES FOR OLDER PEOPLE
Michaelstowe Hall Residential and Nursing Home Ramsey Road Ramsey Harwich Essex CO12 5EP Lead Inspector
Diana Green Unannounced Inspection 13th January 2006 09:55 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 Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 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. Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Michaelstowe Hall Residential and Nursing Home Address Ramsey Road Ramsey Harwich Essex CO12 5EP 01255 880308 01255 880907 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) Handylodge Limited Manager post vacant Care Home 96 Category(ies) of Old age, not falling within any other category registration, with number (61), Physical disability (10), Physical disability of places over 65 years of age (50) Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged 40 years and over, who require nursing care by reason of a physical illness/disability (not to exceed 10 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical illness/disability (not to exceed 50 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 46 persons in Oakland Unit) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 15 persons in Greenland Unit) One person, under the age of 40 years, who requires care by reason of a physical disability, whose name was made known to the Commision in January 2004 The total number of service users accommodated in the home must not exceed 96 persons 7th June 2005 6. Date of last inspection Brief Description of the Service: Michaelstowe Hall provides personal and nursing care with accommodation for up to 96 older people and can accommodate 10 service users aged 40 years and above with a physical disability. Michaelstowe Hall is owned by a private organisation named Handylodge Ltd.The home is located in the village of Ramsey, Harwich, Essex. The home was opened in 1995 and is a 3 storey Victorian building. The home is divided into 2 separate units: Oaklands, which provides personal care only and Greenlands, which provides personal and nursing care. There are 64 single rooms including 60 with en-suite toilet facilities and 14 shared rooms, all with en-suite toilet facilities. There is a passenger lift. The home has large attractive gardens overlooking open countryside and a courtyard garden accessible to wheelchair users. Michaelstowe Hall is accessible by road and has good bus links. Parking is available in the car park. Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 13/01/06 lasting 5.5hours. Two inspectors including a pharmacist inspector undertook this inspection. The inspection process included: discussions with the proprietor, the nurse in charge, the administrator, monitoring officer, seven care staff, five service users, two visitors/relatives and feedback from district nursing staff; a tour of the premises including a sample of residents’ rooms, bathrooms, communal areas and the laundry; and inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). Fifteen standards were inspected, five requirements and one recommendations were made. This report also makes reference to findings of additional visits made on 4/08/05 and 13/10/05. The proprietor and staff were welcoming and helpful throughout the inspection. What the service does well: What has improved since the last inspection?
The manager had continued to make improvements in care planning, personal care, health care and wound care and since appointment of a monitoring officer, staff compliance with a number of initiatives was well monitored. This included communication between staff with written handover, record keeping on admission, completion of care plans and other records. Residents appeared well cared for and more stimulated and social activities had been increased.
Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 6 Whist enabled a choice, residents were now encouraged to take part in activities and to interact with each other rather than stay in their rooms. Refurbishment of the premises had been made with new carpeting in several areas of the home and security of the building had improved. The premises were cleaned to a satisfactory standard, infection control standards had improved and there were no malodorous smells. New carpeting was noted in several areas of the home. Improvements had been made in the organisation and standard of laundering. A fire safety risk assessment had been undertaken and the required action was in progress. Notable improvements in the control, administration and recording of medicines had been made although some remaining poor practices still needed attention. Residents’ monies were well managed on their behalf and excessive amounts of cash were no longer kept but held in their personal bank accounts. Staff recruitment checks were now obtained prior to appointment as required. 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. Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 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 Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 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): 6 This home does not provide intermediate care EVIDENCE: This home does not provide intermediate care Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 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 Improvements in care planning have been sustained but further development is required to ensure care staff have adequate information to satisfactorily meet residents’ needs. The health care needs of residents are generally well met but without sufficient numbers of staff also employed during the night, residents continue to be at potential risk. The standards for storage, administration, and recording of medication, have notably improved but further and sustained improvement is necessary to ensure residents are not placed at risk. EVIDENCE: New care documentation was being introduced and some residents’ care plans had transferred to the new system. These contained a revised assessment together with new care plans some of which were detailed but others had not yet been completed. Risk assessment for falls, skin integrity, moving and handling and nutritional assessments were undertaken and reviewed. However some risk assessments did not detail sufficiently how the risk was to be minimised and there was insufficient instruction for care staff for moving and handling. There was some confusion with staff as to which forms to use as
Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 10 some files contained both old and new forms. Daily statements were recorded in detail and there was evidence that care needs were being monitored and appropriate action taken as required. Some initial training had been provided for care staff but further training was needed as some care staff were not following the care plan. Discussion with some care staff indicated they relied on handover reports and discussion with colleagues for how to provide care to individual residents and did not consult the care plan for instruction. Residents were observed to have their personal care needs met in a sensitive and dignified way. One relative said they found that standard of personal care provided had improved since their loved one moved to the nursing unit. The records confirmed that residents were enabled access to GP’s, health care professionals including chiropody, audiology, and dentists and through outpatient appointments. Feedback from district nursing staff was positive with regard to wound care and also indicated that prompt referrals were generally made on behalf of residential service users. Several residents had problems with swallowing and required assistance with feeding. Staff would therefore benefit from further training on management of residents with dysphagia. On arrival in the medicines storage room on Oaklands Unit at 10:15, there was a small pot containing medication, which had been assembled for a service user some time previously. These had not been administered to the service user and had been retained for later administration. The administration record, however, had already been completed to indicate that they had been administered. An immediate requirement notice was served to ensure medication procedures and recording is in accordance with the Regulations and National Minimum Standards. The medication referred to above was offered to the service user who again declined to accept the medication. The senior carer on duty altered the previous record, which had been completed and attempted to return the medication to its original packaging. On questioning, the member of care staff involved was unsure of the correct procedure to follow when medication is assembled and not administered. On previous inspection it has been noted that records of the receipt and disposal of Controlled Drugs made in the Controlled Drug Register did not carry the name and address of the supplier or recipient on disposal. A requirement was made following the previous inspection. It is evident that this requirement remains outstanding since there were a number of entries in the register on Greenlands Unit, which simply stated “brought in from home” or “given to patient on discharge. Supplies of temazepam for two service users had been removed from the Controlled Drug cabinet and stored, awaiting disposal, with other medication. The register entries relevant to the medication for these two service users indicated that the medication has already been disposed of. Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 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, 15 Progress has been made to provide more social, cultural, religious and recreational activities. The Activities Coordinator planned training should provide her with the knowledge and skills to further develop a programme that enriches residents’ lives. The meals in this home provide choice and variety to meet the culture and lifestyle expectations of residents. Efforts have been made to ensure the nutritional needs of residents are well monitored. EVIDENCE: The social activities programme had developed to include regular entertainment that was observed at the inspection on 13/10/05 and was clearly enjoyed by residents. Those residents spoken with said they had recently enjoyed a birthday party arranged on behalf of one resident and were notably stimulated by the function held that day. A range of group and individual activities were displayed on a notice board for residents’ information and one relative spoken with said they had observed various activities taking place when they visited. Training on social and therapeutic activities for older people to include dementia care had been arranged for the activities’ coordinator to attend during February. It is expected this positive initiative will provide her with the skills to establish an innovative programme that will develop to meet all residents’ needs.
Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 12 The menus comprised homely type food and special diets were catered for. There was evidence that nutritional and fluid intake was well monitored and recorded with detailed checks for residents who were nutritionally at risk. Residents and relatives spoken with said the food was very good. Residents were observed to enjoy the lunchtime meal of fried fish and chips with a choice of chips or mashed potato and peas followed by steamed fruit sponge or fruit salad and custard. Alternatives were also provided as residents had chosen. The home had only one heated trolley that was used in Greenlands Unit. Most residential clients chose to eat in the dining room and were served directly from the kitchen. The home should consider the purchase of an additional trolley to ensure residents who have their meals in their own rooms receive their food sufficiently hot. Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 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): 18 Appropriate policies, procedures and practices were in place to promote the protection of residents from abuse. The manager actively promoted awareness of protection issues through staff training and recruitment practices. EVIDENCE: Michaelstowe had a whistle blowing procedure place for staff guidance. The Essex Guidelines on the Protection of Vulnerable Adults (POVA) was available. The manager and staff had received training on the protection of vulnerable abuse and were clear on the procedures to be followed in the event of any allegations. Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 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, 26 Michaelstowe Hall was safe, well maintained and had a homely environment; residents’ rooms were individually furnished and equipped for their safety, comfort and privacy. The home was clean and hygienic with safe infection control practices evident. EVIDENCE: A partial inspection of the premises was made that included communal areas, bathrooms, sluices, toilets, a number of residents’ rooms and the laundry. The home had been redecorated throughout to include all communal rooms and some residents’ rooms. New carpeting had been laid throughout and some new furniture provided. Despite being large the home now had a more homely atmosphere and provided residents with a comfortable place to live. However a temperature of 17.8°Centigrade was noted in one toilet opposite the dining room in Greenlands Unit and was brought to the attention of the senior nurse. There was an ongoing programme of maintenance in place and action had been taken to address all shortfalls previously identified. Security of the building had improved and both main entrances were locked and visitors’
Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 15 books were available to record all visitors to the home. The gardens were well maintained and provided a pleasant outlook with good access for residents. Records provided evidence that the building complied with the requirements of the local fire and environmental health department. The home was clean and hygienic throughout with no malodorous smells. Staff hand washing facilities were now provided in all en-suite rooms and safe practices in infection control were evident. The laundry was large but was evidently better organised than at previous inspections. Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 30 The staffing levels have increased but do not meet those required by the commission during the night. Without the provision of adequate staffing levels at all times, the needs of residents cannot be appropriately met. There has been considerable progress made in improving the standard of vetting and recruitment practices; checks to ensure the protection of residents are now carried out effectively. EVIDENCE: Staffing levels were confirmed as one registered nurse and 6 care assistants for twenty-two residents in Greenland Unit and one senior care assistant and three care assistants for nineteen residents in Oaklands Unit. Staffing levels at night were two on each unit, which in Greenlands Unit, is below that required for the dependency needs of residents. One resident spoken with said there were only two staff in the evening until midnight and they had to wait to receive assistance with personal care. Staff training had improved considerably in the past year. Statutory training in manual handling and fire safety were provided as required and updated training on care planning and care issues including care of diabetes, drug administration and infection control had been provided. The manager had assessed the competency of staff in drug administration and referred some staff for additional training. Five staff had attended induction training to Skills for Care standard.
Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 17 The personal files of two recently appointed staff were inspected and all the required checks had been obtained prior to appointment. Induction and training had also been provided as required. Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36 38 The management of Michaelstowe Hall has improved considerably since the appointment of a manager who is supported well by senior staff. Once registered by the CSCI, and formal staff supervision is established, residents and their relatives can be further assured the home will be run in their best interests. EVIDENCE: The manager had been in post for seven months. She is a registered nurse, registered midwife, district nurse and community practice teacher/assessor and had considerable experience in management. An administrative assistant supported the manager, monitoring officer and the proprietor was also in regular attendance at the home. Considerable progress had been made since the manager’s appointment to address requirements and to raise standards. Feedback from staff indicated they felt supported by the manager and senior nurse and felt able to discuss any issues with them.
Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 19 There was no formal system of supervision. However communication between staff had notably improved with regular and recorded handover evident. Some problems with staff performance were discussed and it was evident that appropriate action was taken to ensure standards were improved. The home had a health and safety policy and the manager aimed to ensure the health and safety of residents and staff as far as possible. Arrangements need to be made to have the weighing scales maintained to include calibration for accuracy of weighing. A fire risk assessment of the premises had been undertaken and action was in progress to address all issues identified. Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x 2 x 3 Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 21 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 7 Regulation 15(1) &15(2) Requirement The registered person must ensure that all care plans are sufficiently detailed to meet residents’ personal and health care needs. Emphasis must be placed on care staff to ensure they are familiar with individual residents’ care plans. The registered person must ensure that staff adhere to the written policy and procedures for the receipt, recording, storage, handling, administration and disposal of medicines The registered person must ensure that The registered person must ensure that medicines controlled under the Misuse of Drugs Act 1971 are stored and recorded in accordance with the Act and Regulations. The registered person must ensure that night staffing levels are provided to meet the needs of residents. This is a repeat requirement The registered person must ensure that a system of formal
DS0000015326.V278385.R01.S.doc Timescale for action 28/02/06 2 9 13(2) 13/01/06 3 9 13(2) 13/01/06 4 27 18(1) 13/01/06 5 36 18(2) 31/03/06 Michaelstowe Hall Residential and Nursing Home Version 5.1 Page 22 supervision is provided for all staff. 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 8 Good Practice Recommendations The registered person should provide training in care needs e.g. dysphagia Michaelstowe Hall Residential and Nursing Home DS0000015326.V278385.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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