Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 22/05/07 for Michaelstowe Hall Residential and Nursing Home

Also see our care home review for Michaelstowe Hall Residential and Nursing Home for more information

This inspection was carried out on 22nd May 2007.

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

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

There is a friendly and relaxed environment despite the size of the home. The home is safe and door entries are secure. Care plans are well written and contain detailed information to enable the staff to deliver a service that meets the assessed needs of the residents. The home has good working relationships with health care professionals and staff training has been accessed with their support.

What has improved since the last inspection?

A manager has been registered with the CSCI. A new unit for dementia care has been established and refurbished to meet the proposed client group. This is to be staffed when residents are admitted to the service. The statement of purpose has been reviewed to include dementia care. Substantial training has taken place including dementia care for all staff. The home has been substantially refurbished with new carpets and furnishings provided in part. Staff receive regular supervision and ongoing support is provided. Contact with multi-disciplinary teams has improved with advice from health care professional where appropriate. The standard of care plan writing has improved and there are regular audits undertaken. Medicines administration has improved as demonstrated by recent audit undertaken by the PCT pharmacist. Recruitment practices have improved and several staff have been employed over the last 12 months and agency staff are no longer required.

What the care home could do better:

Staffing levels are not always sufficient to meet the dependency needs of residents and are not flexible to enable provide appropriate supervision in communal rooms. Staff training had not been provided in care of residents who are prone to seizures. Healthcare professionals have provided clear instruction to meet individual residents needs, which have not been followed, placing residents at risk of harm. There is a lack of attention to detail when providing personal care to residents that sometimes compromises their dignity. Hoists are not being regularly maintained.

CARE HOMES FOR OLDER PEOPLE Michaelstowe Hall Residential and Nursing Home Ramsey Road Ramsey Harwich Essex CO12 5EP Lead Inspector Diana Green Key Unannounced Inspection 22nd May 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.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. Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 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) none Handylodge Limited Mr Mark Morray Adjorlolo Care Home 84 Category(ies) of Dementia (15), Dementia - over 65 years of age registration, with number (15), Old age, not falling within any other of places category (46), Physical disability (10), Physical disability over 65 years of age (23) Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. 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 23 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, who require care by reason of dementia (not to exceed 15 persons in Woodlands unit) The total number of service users accommodated in the home must not exceed 84 persons. Persons of either sex, aged 55 years and over, who require care by reason of dementia (not to exceed 15 persons in woodlands unit) The registered person must not admnit persons subject to the Mental Health Act 1983 or the Patients in the Community (Amendment) Act 1995 Staffing levels to be reviewed within 6 months of registration. Date of last inspection 12th December 2006 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. CSCI inspection reports are made available to prospective service users at their request to the manager. The fees range from £374.50-£635.81. Additional costs apply for hairdressing, newspapers and chiropody. This information was provided to CSCI on 4/07/07. Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was undertaken on the 22/05/07 and lasted 7.5 hours. The inspection process included: discussions with the manager, administrator, the cook, care staff, the laundry assistant, two domestic staff, seven residents, three visitors and feedback from relatives and health and social work professionals; a tour of the premises including a sample of residents’ rooms, bathrooms, communal areas, the kitchen, the laundry, clinical room and the sluice-rooms; an inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). The outcomes for people living in the home were inspected against twenty-seven standards and three requirements and three recommendations were made. The manager and staff were welcoming and helpful throughout the inspection. What the service does well: What has improved since the last inspection? A manager has been registered with the CSCI. A new unit for dementia care has been established and refurbished to meet the proposed client group. This is to be staffed when residents are admitted to the service. The statement of purpose has been reviewed to include dementia care. Substantial training has taken place including dementia care for all staff. The home has been substantially refurbished with new carpets and furnishings provided in part. Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 6 Staff receive regular supervision and ongoing support is provided. Contact with multi-disciplinary teams has improved with advice from health care professional where appropriate. The standard of care plan writing has improved and there are regular audits undertaken. Medicines administration has improved as demonstrated by recent audit undertaken by the PCT pharmacist. Recruitment practices have improved and several staff have been employed over the last 12 months and agency staff are no longer 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. The summary of this inspection report can be made available in other formats on request. Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 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.V341194.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate based upon sampled standards 1, 3, 4, 5 & 6. Residents were in the main well informed and had their needs assessed prior to moving in to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a statement of purpose and service user guide that met regulatory requirements. The statement of purpose had been reviewed to include care of people with dementia and a copy provided to the Commission for Social care Inspection (CSCI). The manager said that copies of the statement of purpose and service user guide were made available prior to admission. Relatives surveyed said they usually received enough information Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 9 but one said they had not received enough information to enable them to make decisions about the home. Four care records were inspected. Pre-admission assessments had been completed in detail with the resident’s care needs that were used to develop care plans. Care management assessments were also obtained from social workers prior to admission and held on file. A resident with dementia had recently been admitted to the home. Concerns were raised by social worker and a visitor that staff were unable to manage effectively with the challenging behaviour sometimes displayed by the resident and this was having an adverse effect on the other residents. The manager confirmed that staff had received training in dealing with challenging behaviour. Evidently they were not competent or low staffing levels did not enable them to manage the behaviour well. Reference also standard 8. The home does not provide intermediate care. Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is adequate based upon sampled standards 7, 8, 9, & 10. Residents health and personal care needs are in the main well met at the home but instructions from health professionals are not always followed placing individual residents at risk. Residents are safeguarded by procedures for administration of medicines that are well adhered to. The dignity of residents is sometimes compromised by a lack of person centred care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four care files were inspected. These contained care plans that covered the key needs and had been regularly reviewed and agreed with the resident and/or their relative as evidenced by signature. Relatives spoken with said they were aware of the care plan and feedback received from others also confirmed this was discussed, where relevant, with them. A consent form had Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 11 been developed to confirm the residents’ agreement to their care. Considerable improvements had been made to the standard of care planning since the previous inspection. The manager stated that all staff had received training and regular audits were undertaken. Assessments for moving and handling/mobility, risk of falls, pressure areas and continence needs were recorded in all of the files inspected. Whilst these had been reviewed there is a need to undertake reviews more regularly as needs change. Care plans were comprehensive in detail. Daily records were detailed with evidence of monitoring of residents’ needs and action taken as required. There was no reference to provision of social activities in the daily records. One social activity care plan indicated the need for outdoor activities but there was no evidence that this was provided. The home is supported by the local GP practices that attend the home on request. Records showed referrals to health professionals and GP’s. Feedback received from health care professionals was generally positive. However some concerns were raised that staff did not follow instructions and this had a detrimental effect on the health of one of the residents. One resident had seizures but care staff spoken with had not received training in this area of care. Controversial feedback was received from relatives with most stating that staff usually had the right skills and usually met their needs, but one stating this was never the case. Residents spoken with said that care staff were friendly, helpful and provided personal care in a way they wished and were respectful to them. However feedback was also received that residents sometimes had to wait a long time to receive assistance with personal care. From observation it was evident that more attention was needed to meet personal care needs (care of fingernails, hair etc.). Concerns were also raised that staff are not meeting the sensory needs of residents. The medication system for Greenlands Unit was inspected. Registered nurses administered medication. A list of staff signatures and initials was available but this needed to be updated as some staff were no longer employed at the home. Medication was stored in a locked drug trolley that was secured to the wall and stored in a locked clinical room. Controlled drug storage and a drug fridge were also available. Room and fridge temperature monitoring was undertaken daily and recorded. No residents were self-medicating but lockable facilities were available in the event of someone self-medicating. The medication and administration records for three residents were checked and found to be accurate. The manager reported that a recent audit undertaken by the local pharmacist who supplied medicines and a PCT pharmacist found no issues of concern. Medication administration records (MAR) were viewed and were completed to an acceptable standard. Administration of temazepam was monitored and recorded as controlled drugs, as recommended as good practice. Action had been taken to record the name and address of the supplier or recipient on disposal as is required for the receipt and disposal of Controlled Drugs (made in the Controlled Drug Register). Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 12 Residents spoken with said that staff were respectful towards them, always knocked before entering their rooms and upheld their dignity when providing personal care. Staff were observed to interact with residents in a friendly and respectful way. However one resident had been assisted to dress wearing a shirt with no fastening on the sleeve and was clearly distressed until staff eventually sewed a button on the cuff. Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good based upon sampled standards 12, 13, 14 & 15. Social activities are provided by skilled and experienced staff meeting residents needs but additional outings would further enhance their daily lives. The home provided residents with a well-balanced and nutritious diet with choices acommodated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employed a social activities coordinator who had undertaken NVQ training in provision of activities and dementia care. Records sampled confirmed that residents were assessed on admission and their choice of activities reflected in their profile. The programme of activities was displayed on the notice board. Group and individual activities provided comprised bingo, monopoly, ten-pin bowling, videos, and quizzes. However the number of hours provided was not adequate to fully meet residents’ needs in both Greenlands and Oaklands. Entertainment was provided regularly and comprised old thyme music and entertainers. Gazebos had been provided in the garden for residents Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 14 who were able to sit out in the warm weather. Outings were arranged regularly in the home’s minibus (e.g. Kessingland, Clacton etc.) but these relied on staff taking their own time to act as escorts. Residents spoken with indicated they could choose whether to take part in activities or not. One resident appreciated the activities available and said “ she is very good at getting things organised”. One resident said they would like more outings but was very happy at Michaelstowe. Relatives said that they could visit at anytime but staff were not always available to let them into the home. Residents said that their friends and relatives could visit at any time. Two relatives were spoken with on the day of the inspection and feedback was received through surveys distributed to them. Mixed responses were received from residents’ representatives who returned surveys as part of the inspection process with approximately 50 stating they were kept well informed on the care of their loved ones and approximately 50 stating they were usually kept informed. One stated they were not kept informed apart from hospital admissions. Some residents were observed to have choices about their daily life in the home (i.e. where they spent their day, where they ate etc.). Most of the rooms seen were well personalised, showing that people could bring their own possessions into the home with them (subject to space). One resident spoken with had various memorabilia that they treasured and was clearly excited that the manager had made time to facilitate contact with a museum for this to be displayed. The home had a menu that was rotated over a four-week period. Residents’ food preferences were discussed on admission and recorded. Arrangements were made for specialist diets to be provided. Records of nutritional intake were available and fluid balance charts were maintained for residents who were at risk. However these were not always completed in full. Residents spoken with were positive about the meals served at the home. Three meals were provided daily and alternatives offered. Fresh and frozen vegetables were provided. The main meal served on the day of the inspection comprised minced beef or Cornish pasty, mashed potato, carrots and sprouts followed by a choice of chocolate pudding with chocolate sauce or fruit and cream. Residents were observed to enjoy their meal. Hot and cold drinks were seen being served during the day, however feedback from relatives indicated that this was not always the case and sometimes only cold drinks were given during the day. Residents spoken with said they had plenty to eat and drink and they enjoyed the meals at Michaelstowe. Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good based upon sampled standards 16 & 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, recruitment practices and respecting individual rights. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure that was included in the statement of purpose and service user guide. Information received from the provider stated that advocates were arranged where residents were unable to make decisions themselves. Feedback received from relatives indicated they knew there was a complaints procedure and who to refer to if they had a complaint. Most indicated that they received an appropriate response but two stated this was only sometimes. Residents spoken to said that they felt able to tell someone if they had any concerns and were confidant that the manager would deal with any issues. Two complaints had been received by the home in the previous twelve months with regard to lack of food choices and limited access to protective gloves for care staff. Both had been investigated and appropriate action taken. Concerns had also been raised directly with the commission by three health and social care professionals concerning the care of two residents that were being discussed with the manager to find a resolution. Two Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 16 anonymous complaints had also been received by the CSCI regarding staffing levels and equipment maintenance (reference standards 27 & 38). The home had a protection of vulnerable adults policy and procedures and a whistle blowing policy. The records confirmed that all staff had received training in protection of vulnerable adults since the previous key inspection. There had been no allegations or incidents of abuse. Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate based upon standards 19, 22 & 26. Michaelstowe Hall is generally clean and hygienic and aims to provide a safe, well-maintained and homely environment but residents are sometimes placed at risk by inadequate cleaning of facilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A partial inspection of the premises was made in Greenlands, Oaklands and Woodlands Units that included communal areas, bathrooms, a number of residents’ rooms, the kitchen, sluices, clinical room, the laundry and the garden. The home had been substantially refurbished and redecorated (80 ) with new carpets provided throughout Oaklands. A new lock had been fitted to the entrance door and to the rear of Greenlands Unit. Residents spoken with Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 18 said they felt safe and secure. Information received from the provider indicated that action required as a result of a fire inspection had been actioned The home had a well-maintained passenger lift. There were grab rails, and aids in bathrooms, toilets and some communal rooms. Ramps were provided to enable access to the garden from Oaklands and Woodlands. The home had assisted baths and some new equipment had recently been purchased. Call systems were provided throughout all individual rooms and communal rooms. Pressure relieving equipment was available and services as required. District nurses provided pressure-relieving equipment for residential clients as required. The home was generally clean and hygienic, however some toilets and bathrooms in Greenlands unit had not been adequately cleaned. There were broken tiles in one bathroom and a hoist had also not been cleaned to a satisfactory standard. Hand washing facilities (liquid soap and paper towels) were provided throughout. The laundry room is large and there were two washing machines (one in working order), and a drier fitted. Systems were in place to minimise risk of infection via the use of red bags for any laundry soiled by body fluids, placed directly in the washing machines; washing machines had the capacity to carry out sluice wash cycles. Infection Control Policy and the staff training records confirmed all staff had received training on infection control. Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate based upon sampled standards 27, 28, 29 & 30. The staffing levels (skill mix, number and competence) were not always appropriate to the needs of residents. Recruitment practices were thorough and promoted the protection of service users. Staff receive training to develop skills and qualifications but this does not meet all residents needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The following staffing levels were in place at inspection: Greenlands: 1 registered nurse 3 care assistants 1 care helper for 15 residents. Oaklands: 1 senior care assistant 2 care assistants 1 care helper for 18 residents. Woodlands was not staffed as there were no residents apart from one who slept overnight in a room next to Greenlands. The home does not currently employ agency staff. The manager, administrator, 4 domestic staff, 1 chef and 2 kitchen assistants and a gardener were also on duty. There were times during the day when it was noted that there were no staff in lounge areas with residents. Feedback had been received from representatives that one resident with dementia was Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 20 wandering and their behaviour affected other residents. The manager stated that a medication review had been undertaken and the situation resolved. Staffing levels need to be kept under review to ensure that the care of other residents is not compromised where this occurs. Feedback was received from relatives that staff had more time to support residents at night rather than during the day. Feedback was received that some residents had to wait long time to receive assistance with personal care. The home had 6 care staff with NVQ level 2 training. A further six staff were undertaking NVQ level 2. This is less than the recommendation for 50 of staff to have NVQ level 2 training. The recruitment files of five staff appointed since the last key inspection were inspected. All had evidence that the required checks had been obtained (two satisfactory references, CRB/POVA checks) and copies of birth certificates, passports, and photographs obtained before the individuals commenced employment at the home with exception of one who had no current work permit. A copy of this has since been received by the CSCI. Staff had not yet received induction to Skills for Care Standards (records were not inspected). Copies of the GSCC booklet were provided to all staff on appointment. Since the previous key inspection training had been provided on care planning, catheter care, challenging behaviour, dealing with swallowing difficulties, dementia care, infection control, loss and bereavement, pressure relieving equipment, Protection of Vulnerable Adults, food hygiene, fire safety, and moving and handling and this was also confirmed from the records inspected. Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate based upon sampled standards 31, 33, 35, 36 & 38 The manager provides clear leadership throughout the home with most staff demonstrating a good understanding of their roles and responsibilities. The manager aimed to ensure good health and safety standards but delays in maintenance of some equipment posed risks to service users and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is a registered mental health nurse who is experienced and skilled in the care of older people and has experience in teaching and several years management experience in the care sector. Since his appointment considerable progress had been made in staff training and Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 22 development. The manager had submitted his resignation and an advert placed for a new manager. The temporary management arrangements for the home have since been confirmed to CSCI. Information received from the Provider stated that the home had an annual plan (not inspected). Quality assurance questionnaires had been circulated to obtain feedback and regular residents’ meetings had been held. The proprietor took an active role in the management of the service and was regularly in attendance. The home has secure facilities for the storage of any money looked after on behalf of residents. There were clear individual records of this, with receipts kept and cash held in individually. Four residents’ records were inspected, and records, receipts and cash all balanced. The administrator confirmed that valuables are not generally stored on behalf of residents, and therefore no specific systems were in place for this. The manager had implemented a system of formal supervision with all care staff. The records confirmed that these sessions were recorded and were held regularly. The manager said that it was planned for supervision to be provided two monthly. The home had a health and safety policy, and staff had attended relevant health and safety training. Some risks to health and safety (standard 26) were evident that pose a risk to staff and service users. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of utilities. However maintenance of some equipment had not been undertaken within the required timescale (hoists), but this has since been actioned. There was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment and door closures, fire alarms and emergency lighting, hot tap water temperatures, etc.). Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 2 x N/A 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 3 3 X X 3 X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 24 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(6) Requirement Timescale for action 30/09/07 2. OP26 13(3) 3. OP27 18(1)(a) 4. OP30 18(1)(c)(i ) 1.Staff must follow instructions given by health professionals to ensure risks to individuals are minimised and their care needs are met. 2.Staff must receive training in care of residents who have seizures to minimise risks to their health and safety. Toilets, bathrooms and hoists 30/07/07 must be cleaned between use to ensure residents are not placed at risk of infection. Staffing levels must be kept 30/07/07 under review to ensure they are sufficient to meet residents needs. All staff must receive induction in 31/10/07 accordance with Skills for Care National Occupational Standards for care homes. Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP9 OP12 OP28 Good Practice Recommendations The list of staff signature and initials designated to give medication should be reviewed to ensure it includes currently employed staff only. More activities and outings should be provided to meet all residents’ needs and enhance lives. A minimum of 50 care staff should be trained to NVQ level 2 to ensure residents are cared for by skilled staff. Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Extracts may not be used or reproduced without the express permission of CSCI Michaelstowe Hall Residential and Nursing Home DS0000015326.V341194.R01.S.doc Version 5.2 Page 27 - 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!