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Inspection on 26/10/07 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 26th October 2007.

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

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

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

What the care home does well

Michaelstowe Hall provides a relaxed and friendly environment where relatives and representatives of residents are welcomed into the home. There are regular residents meetings held and residents have a full social activities programme offered to them with choices accommodated. There are weekly outings arranged in the home`s minibus to local attractions and supported by the `Friends of Michaelstowe Hall`. Staff are friendly and caring towards residents and aim to meet their personal and health care needs in a way that upholds their privacy and dignity. The premises are homely and furnished in keeping with the client group.

What has improved since the last inspection?

Social activities have been developed further to meet residents` needs. The standard of care plan writing has improved and contact with multi-disciplinary teams has improved. Medication issues highlighted at the previous key inspection have been addressed. The home employed several staff over the last 12 months and no longer requires agency staff.

What the care home could do better:

Assessments and staff training need to include meeting mental health and cognition and religious and cultural needs. Staff would also benefit from training in communicating with the deaf. Closer monitoring of health care needs and medication recording need to be addressed to ensure referrals are made promptly and needs met. The gardens need to be kept tidy and maintained. Cleaning of carpets needs to be improved to ensure there are no malodorous smells in the home. Staffing levels need to be closely monitored and increased to ensure residents needs and choices are met. Recruitment practices need to be more robust. Reporting to the CSCI of all events under the regulation must be improved to include all events that adversely affect residents.

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 26th October 2007 09:30 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 Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.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.V354656.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 Michaelstowehall@btconnect.com none Handylodge Limited 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) 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.V354656.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 admit 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 22nd May 2007 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. Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 5 The fees range from £374.50-£635.81. Additional costs apply for hairdressing, newspapers and chiropody. This information was provided to CSCI on 26/10/07. Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that was undertaken by two inspectors on the 26/10/07 and lasted 7 hours. The inspection process included: discussions with the administrator, the laundry assistant, domestic assistant, the cook, eight residents, one registered nurse, five care staff, two 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 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). Evidence was also taken from completed surveys and the Annual Quality Assurance Assessment completed by the management of the home and submitted to the CSCI. Twenty-seven standards were inspected and eight requirements and five six recommendations made. The administrator and staff were welcoming and helpful throughout the inspection. What the service does well: What has improved since the last inspection? Social activities have been developed further to meet residents’ needs. The standard of care plan writing has improved and contact with multi-disciplinary teams has improved. Medication issues highlighted at the previous key inspection have been addressed. The home employed several staff over the last 12 months and no longer requires agency staff. Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 7 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.V354656.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 Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.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): Quality in this outcome area is adequate based upon sampled inspected standards 1, 3. Assessments did not include sufficient detail to ensure residents’ needs could be met 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. A resident spoken with confirmed this had been made available prior to admission. Copies were displayed in the entrance of the home for visitors’ information. Two residents care files were inspected. These were both of residents who had been admitted to the home since the previous inspection. The pre-admission form was available for one resident only and covered all key issues apart from mental health/cognition. The admission assessment details were completed with brief comments on all key needs, though nothing in religious/cultural Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 10 needs. Both had full updated assessments in place undertaken following admission. The service does not offer intermediate care. Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 11 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. The personal care needs of residents are in the main well met through care planning that is regularly reviewed but closer monitoring and prompt referrals for advice will ensure health care needs are appropriately met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Samples of eight residents’ files were viewed. Care plans were available for individual needs (personal care, pressure area care, continence, mobility, medication etc.). In some cases the range of care plans (i.e. range of needs covered) was quite limited, and there were other needs that could/should have been addressed in the care plans to emphasise what the person could do for themselves and what they needed help with (especially re mental health and social needs). Additional risks assessments were completed for manual handling, skin integrity, nutritional assessment/weight monitoring, general risks and all had been reviewed monthly. Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 12 Care plans included evidence that appropriate action had been taken, i.e. referral to dietician, specialist diets, and supplements provided. It was noted that one person in the home was deaf and it is recommended that the staff team may benefit from some training in communicating with people who are deaf or deafened (re improving their communication skills with people who lip read, and learning some basic signing skills (British Sign Language)). The records confirmed that residents had good access to health care through visits by district nurses, continence nurses, GPs, chiropody and opticians, and that some attended outpatient clinic appointments as needed. Feedback from some health professionals indicated that referrals were not always made promptly. One resident had a wound that had broken down, but staff had reintroduced treatment as previously advised by the Tissue Viability Nurse, rather than seek further guidance. The home had two separate systems for medication, one on Oaklands (residential) Unit and one on Greenlands (nursing) Unit. Both systems were inspected. Medication was provided by the local pharmacy in pre-dispensed packs and individual containers. Two pages of guidance had been provided for staff by the providing pharmacist and ordering and disposal procedures were observed to be adhered to. Published guidance from the Commission was also available. However there was no medication policy or procedures specific to the home, although these had been available at previous inspections. In Greenlands Unit, medication was stored in a a drug trolley that was held in a locked cupboard. In Oaklands medication was stored in a designated room with the drug trolley secured to the wall as required. Monitoring of room temperatures was undertaken and recorded to show that temperatures were within recommended levels (25°Centigrade). Both units had a drug fridge available and monitoring of temperatures were also checked and recorded to demonstrate that appropriate action would be taken as necessary. Medication was administered by registered nurses in Greenlands and by designated staff who had received relevant training in Oaklands. A list of authorised staff names with signatures and initials was available in Greenlands but not in Oaklands. Eight residents’ records were inspected. There was evidence of regular medication reviews being undertaken. All records had a photograph of the resident for identification. Residents’ supplies were checked and confirmed that the prescribed medication was available. Medication administration records (MAR) were generally well recorded. One medication had been changed by fax and signed by the GP. However this had not been entered on the MAR sheet to ensure it would be given as prescribed. The home had a Controlled Drug (CD) Register as required that was well recorded. Recording of of creams was recorded in the daily record by care staff following application. However there was no care plan for staff guidance that detailed the name of the cream and the reason for application. Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 13 Staff spoken with were clear on peoples’ preferred names and the records also confirmed this was discussed with residents on admission. Reference to upholding privacy and dignity was seen in the care plans viewed and residents said they were generally happy with the way staff treated them. Residents were not routinely provided with keys to their room but arrangements had been made for those who wished to have keys. Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 14 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 on standards 12, 13, 14 & 15. The social activities offered at the home met residents’ cultural needs and expectations and enhanced their daily lives. Visitors were warmly welcomed into the home. The home provided residents with a well-balanced and nutritious diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a full time activities co-ordinator, who had completed appropriate training (e.g. a two day dementia course, and an ‘Activities for Older People’ NVQ), which is commended. She showed good knowledge of her work and a commitment to developing new ideas for activities. The home has no budget allocated for activities (resources, entertainment, etc.), and is dependent on funds raised by the Friends to pay for outside entertainment and additional resources. An activities programme was displayed in the hallway, and showed a good range of group activities taking place in the home (one each day), including a trip out each Friday. Activities included bingo and quizzes, games, music, church services, film afternoon, etc. Trips included to garden centres, shops and other community facilities. The co-ordinator is commended on the frequency and range of trips, as this takes some effort to Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 15 plan and maintain. The home has a minibus and needs four staff to take out up to 7 residents (4 wheelchairs, 3 walking). However, the home does not provide any care staff to support these trips, which are dependent on volunteers (a driver from the ‘Friends’, plus the home’s two care helpers who help out on trips on a voluntary basis); the volunteers should be commended for giving up this time on a regular basis. The absence of any attending care staff meant that this limited the residents who could go out on trips to those who did not require personal care or any moving and handling support whilst out. Care plans contained very little information relating to the support people needed to occupy their time, receive stimulation, or engage in activities. The file of a new person viewed did contain a ‘social care assessment’, showing interests and hobbies (other files did not have this form). The forms viewed contained a range of entries (e.g. playing cards/dominoes, trips out, sitting outside in garden, quiz, bingo, ‘songs of praise’, old time music hall, etc.); however, all entries related to activities organised by the activities coordinator, none by care staff. A number of residents on the residential side also suffered with some degree of cognitive loss, making it more difficult for them to engage in group activities without some support. Care staff do not generally organise any activities or assist in the group activities arranged by the activities co-ordinator, making it more difficult for service users who need extra support to manage in a group setting. This also means that activities would not take place when the activities co-ordinator is off sick or on leave. Residents said that their friends and relatives could visit at any time, and they could meet with them in private in their rooms. The home arranged a monthly communion service and representatives of other faiths attended the home as relevant. From previous knowledge of the home and discussion with the activities coordinator it was confirmed that some local community groups had visited the home at Christmas (local school children carol singing etc). All residents had a relative or representative to act on their behalf. Some residents’ rooms had personal items of furniture and pictures that they had been enabled to bring into the home. Most residents ate in one of the two dining rooms and some were observed to have their meals in their own rooms, as they chose. One resident spoken with said they went to bed in the afternoon and that was their choice. However the few numbers of staff on duty after 7:30pm raises concern that some residents may have no choice given of time in going to bed or getting up. The home has a four weekly menu, which provided an appropriate range of meals, with a choice of main meal and pudding each day, and sandwiches plus a hot or cold alternative each tea-time. Predominantly frozen vegetables are used during the week with fresh vegetables served on Sundays and at some meals. The kitchen was clean and well organised. The cook confirmed that there were always sufficient stocks to produce the planned meals. Frozen vegetables are used during the week, with fresh vegetables served on Sundays and at some meals. There were no specific dietary needs in the home, other Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 16 than soft diet and diabetics. The cook showed good knowledge of the dietary needs of people suffering with diabetes, and appropriate ingredients were available. Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 17 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 were in place to promote the protection of residents from abuse but regular updated training and monitoring through supervision is needed to ensure practices are robust. 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/service user guide and displayed in the reception area of the home. Five complaints had been received since the previous key inspection. The records confirmed that these had been investigated in line with the home’s procedures and appropriate action taken. Residents spoken with had no specific complaints, and most said they felt able to speak to staff if they had any concerns. One person said that they did not know who to make a specific complaint to at present, because there wasn’t a manager. However, they felt able to speak to senior carers. The home had a policy and procedures for safeguarding vulnerable adults and a whistle blowing procedure. There had been two allegations of abuse made since the previous inspection. One allegation regarding lack of appropriate care that was not upheld, and one that was under investigation. The CSCI has since received details of a further allegation that was received as a complaint letter to the home regarding end of life care (ref. Standard 11). The acting manager Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 18 reported that an investigation had been undertaken by the local authority and the outcome was not upheld. Staff spoken with had all attended POVA training this year and found this useful. A carer spoken to demonstrated that they knew what to do if they were alerted to any concerns about a service user (would report to senior/manager, and home would alert families, police, etc.). If they felt their concerns were not listened to, they knew who to contact outside of the home. Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 19 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 good 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 that included communal areas, bathrooms, a number of residents’ rooms, the sluices, clinical room and the laundry. The home had undergone a partial refurbishment and was generally well maintained. Communal rooms in Oaklands were clean and well decorated and furnished to provide a homely environment for residents. An upstairs corridor had been decorated since the last inspection, and was bright and clean. The dining room in Greenlands was large and less comfortably furnished. Residents spoken with said their rooms were cleaned daily and they were happy with the standard of cleaning. Six rooms were viewed and all were Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 20 clean and tidy. The smell of cigarette smoke was noted in the corridor outside a room where someone smoked: the home should make arrangements to ensure this does not impinge on areas used by other people (e.g. fit extractor fan in person’s room). Although the grass was well cut, other areas of the grounds looked very neglected, with lots of weeds (particularly around Greenlands and Woodlands Units). The home had a well-maintained passenger lift in Oaklands and ramps enabled access throughout the premises and to the gardens. There were grab rails, and aids in bathrooms, toilets and communal rooms to meet the needs of residents. Assisted baths and toilets were provided and the home was fully accessible to wheelchairs. Designated storage areas for equipment were provided but these included areas in communal rooms. Call systems were provided throughout all individual and communal rooms and staff need to ensure these are always within reach of residents. The home was generally clean and hygienic. Two residents’ rooms in Greenlands Unit had a malodorous smell. Domestic staff spoken with said that they were unable to use the industrial cleaner for shampooing the carpet and this was the responsibility of the domestic employed in Oaklands Unit. Hand washing facilities (liquid soap and paper towels) were provided throughout but bins were not provided in all areas for disposal of paper towels. The laundry room is large and there were two washing machines (one in working order), and two driers (one in working order) fitted. The maintenance person confirmed that quotes were being obtained for their repair. 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. The laundry assistant was able to demonstrate her understanding of infection control procedures and the appropriate use of personal protective clothing. Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 21 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. Staffing levels were not adequate at times to ensure residents’ choices could be met. Recruitment practices were not sufficiently robust to ensure the protection of residents. 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 5 care assistants (1 on induction) 1 care helper for 19 residents. Oaklands: 1 senior care assistant 2 care assistants 1 care helper for 18 residents. Woodlands was not staffed as there were no residents. The administrator, 3 domestic staff, 1 chef and 2 kitchen assistants and a maintenance person were also on duty. The acting manager was on sick leave. It was of concern that staffing levels are reduced to two staff so early in the evening (7:30pm) and may compromise residents’ choice of time in going to bed. One resident expressed concern that there was often no senior carer on duty during the evening, which meant that staff from the nursing section had to come over and administer medication; they felt that having only two staff on during the evening meant that night staff had less time to check on people. During the day when care helper staff were not on duty, care staff were Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 22 responsible for their duties (assisting with collecting and putting away laundry, cleaning commodes, distributing water jugs, serving drinks, supporting at meal times, etc.). This did not allow much time to spend monitoring and interacting with residents, and staff were not observed spending time in the lounge with residents. Residents spoken to were generally very positive about staff: “they look after me”; “they are friendly and caring”; but they also felt they were often in a rush and did not have much time to stop and chat. One person commented that occasionally some staff did not even speak to them when they delivered drinks to them in their room. This needs to be addressed. The home had 2 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 files of three new staff were inspected. All three had been started before a second reference was received (in two cases this was before the last employer reference was received); records of phone calls to referees had not been recorded, so no evidence of verbal references was taken up. Employment histories lacked sufficient detail to enable employer to check whether there were any gaps in employment history. All staff had started on a POVA first check and before a CRB Disclosure was received. Also there was no evidence of any systems for monitoring staff pending CRB, as per Department of Health (DH) guidance. The administrator said that two new staff had commenced induction to Skills for Care Standards (records not seen). The file of another member of staff was inspected and a copy of the Skills for Care induction booklet seen with evidence that this was being worked through with them. Since the previous key inspection training had been provided on Protection of Vulnerable Adults, food safety, manual handling, fire safety, health and safety, infection control and care planning (in-house) and this was also confirmed from the records inspected. Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 23 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 lack of a manager does not ensure clear leadership within the home or robust staff supervision. Health and safety procedures and practices in the main protect the safety of residents and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had been without a manager for several months since resignation of the former manager. A registered nurse had been appointed as acting manager in a part-time capacity until the position could be recruited to. An administrator supported the manager. The provider had been in attendance at the home but was currently on sick leave. Residents spoken with said they Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 24 were concerned that there was no manager in post to be available to them and to provide support to staff. Although previously reported by the Provider that the home had an annual plan, this was not in evidence. Nor was there any evidence of formal consultation with residents or their relatives. Regular residents’ meetings had been held and action taken to improve services from discussions held. 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 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. Service Users’ Monies: Clear and accurate records maintained for monies held on behalf of residents. The home also operates a Residents’ Bank Account: the administrator explained that this is only used for processing personal money sent to service users in the form of cheques (i.e. from ECC, solicitors or family). Money does not remain in the account for any period of time, but is withdrawn as soon as possible as cash for their use. A clear record book was seen showing transactions in and out of this account for each person, and also copies of the bank statements. However the home takes a £1 charge for each transaction processed on behalf of the residents. This was later discussed with representatives of Essex County Council who confirmed it was in breach of their contract with the home. The Provider agreed to review these arrangements and write to representatives to inform them of the changes. Since the former manager left employment staff supervision had not been undertaken as required. However the acting manager had produced a schedule of planned dates for formal supervision with all care staff. Three staff files seen had evidence that supervision had been undertaken and recorded. The home had a health and safety policy, and staff had attended relevant health and safety training. Evidence of a sample of records viewed showed that there were systems in place to ensure regular maintenance and servicing of utilities. 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.). Environmental risks to two residents were observed. One person was noted to smoke in their room whilst the door was kept closed and this had been agreed with staff; it is recommended that this is risk assessed and recorded. Another person in a first floor room had plants on their narrow balcony, and stepped over quite a high threshold to get out onto the balcony to care for them, and whilst the person was independently mobile, this could present a high risk if the person tripped. It is recommended this is also risk assessed and recorded. Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 25 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 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 X X 3 X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 2 2 2 3 Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement To ensure residents receive medication as prescribed: 1. The home’s medication policies and procedures must be available for staff guidance. 2. Omissions must be followed up and the reason recorded. 3. the staff signature list and initials for designated staff must be maintained. 4. Changes made by GPs must be recorded on the MAR sheet. 5. Care plans instructing staff to administer creams must provide specific detail of the prescription. To ensure the health and safety of residents and staff: 1.Foot operated pedal bins must be provided for disposal of paper towels. 2. the malodorous smell must be removed from the two rooms identified at inspection. Timescale for action 31/12/07 2. OP26 13(4) 31/01/08 Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 27 3. OP27 18(1)(a) Staffing levels must be kept under review to ensure they are sufficient to meet residents’ needs at all times. Timescale of 30/07/07 not met. 31/12/07 4. OP29 13(6) To ensure the protection of 31/12/07 residents: 1. Two satisfactory references must be undertaken prior to appointment. 2. Systems must be in place to monitor staff appointed on receipt of a clear PoVA First and prior to a full CRB Disclosure being obtained. All staff must receive induction in 31/10/07 accordance with Skills for Care National Occupational Standards for care homes. A manager must be appointed to the home to ensure staff have leadership and residents are protected. The home must establish a comprehensive quality assurance programme that includes an annual plane and ensures residents and their representatives views are used to improve services. Regulation 37 notifications must be forwarded to the CSCI for all events that adversely affect the well-being or safety of a resident. 31/03/08 5. OP30 18(1)(c) 6. OP31 8(1) 7. OP33 24 31/03/08 8. OP37 37 31/12/07 Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 28 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. 4. 5. 6. Refer to Standard OP3 OP7 OP19 OP19 OP28 OP30 Good Practice Recommendations Assessments should cover mental health and cognition and religious and cultural needs to ensure these are fully assessed. Care plans should provide more detail of residents’ social and cultural needs to ensure these are met. The gardens should be kept tidy and well maintained to provide access and an attractive view for residents. An extractor fan should be fitted in the resident’s room where it is agreed they can smoke. A minimum of 50 care staff should be trained to NVQ level 2 to ensure residents are cared for by skilled staff. Staff should receive training in communicating with the deaf to ensure they are able to communicate with residents with hearing impairment. Michaelstowe Hall Residential and Nursing Home DS0000015326.V354656.R01.S.doc Version 5.2 Page 29 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.V354656.R01.S.doc Version 5.2 Page 30 - 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. 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