CARE HOMES FOR OLDER PEOPLE
Michaelstowe Hall Residential and Nursing Home Ramsey Road Ramsey Harwich Essex CO12 5EP Lead Inspector
Diana Green Unannounced Inspection 5th April 2006 10:50 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.V289803.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.V289803.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) none 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.V289803.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) The total number of service users accommodated in the home must not exceed 96 persons 13th January 2006 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. CSCI inspection reports are made available to prospective service users at their request to the manager. The fees range from £367.15-£615.00. Additional costs apply for hairdressing, newspapers and chiropody. This information was provided to the CSCI on 26/05/06. Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.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 05/04/06 lasting 4.5hours. The inspection focussed mainly on Greenlands Unit and the 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 health and social care staff; a tour of the premises including a sample of residents’ rooms, bathrooms, toilets, communal areas and sluices; and inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). Fourteen standards were inspected, six requirements were made including one repeat requirement and two were brought forward as they were not inspected. One recommendation was also made. Feedback from the majority of residents indicated they liked living at Michaelstowe, felt safe, well cared for by staff who treated them well and liked the food. Some conflicting feedback was received with some residents stating their privacy was not always respected and suitable activities were not provided. What the service does well: What has improved since the last inspection?
Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.R01.S.doc Version 5.1 Page 6 Good progress had been made in the developments of care planning and in ensuring staff were aware of residents’ needs. There was good communication between staff through handover records/meetings. Arrangements were in place to ensure staff were supported during the absence of the manager. This included the appointment of a consultant nurse and a senior nurse from another home. The proprietor was also in attendance and taking an active part in supervision and monitoring of care standards. Improvements had been made in monitoring of access to health care through staff supervision and auditing records. Staff attendance at training sessions had improved and further sessions were planned. The profile of the activities had been raised through a notice board displayed for residents’ and relatives’ information and the programme developed to include physical exercise. Residents spoken with said they enjoyed these activities that included a snakes and ladders floor game. The activities coordinator had enrolled on a five month NVQ course on social activities for older people. 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.V289803.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.V289803.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.V289803.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, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to the service.
All residents have a care plan that is regularly reviewed. Care plans are developed by care staff but do not include residents’ contribution or active involvement. Residents’ healthcare needs are generally well met but some delays in referrals to GP’s compromise the health and wellbeing of some residents. Most staff have a caring approach towards residents and aim to uphold their privacy and dignity. EVIDENCE: New care documentation had been introduced in recent months. During previous weeks, a consultant had undertaken an audit and recorded an action plan to address shortfalls found in the records. Four care plans were inspected. Each had an assessment of need with care plans that included all elements as detailed under this standard. Evidence of residents/representative agreement to the care plan was present on those sampled but the date of agreement was not recorded in all four files. Risk assessment for falls, skin integrity, moving and handling and nutritional assessments were undertaken and regularly
Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.R01.S.doc Version 5.1 Page 10 reviewed. The daily statement of one resident’s file recorded that a small wound was present, but there was no wound care plan, and no record of how the wound had been managed. Some risk assessments did not include the date or the signature of the assessor. Daily statements were recorded in detail and there was evidence that care needs were being monitored and appropriate action taken as required. A pain chart had been introduced for monitoring of pain in residents with wounds. Analgesia given was recorded on the medication administration sheet but there was no evaluation of this on the wound care plan. One relative said they had viewed the care plan and found the health care information incomplete and was therefore not confident their needs were being fully met. Residents were observed to be well cared for. Those spoken with said that their personal care needs were met and that most staff treated them with respect. Feedback received from residents indicated that most liked living at Michaelstowe, felt safe, felt they were well cared for and that staff treated them well. However some conflicting information was received from relatives that indicated personal care needs were not fully met and privacy and dignity were not always upheld. The records confirmed that residents were enabled access to GP’s, health care professionals including specialist nurses, chiropody, dieticians, audiology, and dentists and through outpatient appointments. However some problems had been reported that prompt referrals had not been made to the GP and advice on wound care and provision of equipment given by the specialist nurse for tissue viability had not been followed. From discussion with the Proprietor and an examination of records it was evident that appropriate action had been taken and advice had subsequently been followed and regular contact made to request further advice. Further concerns were made regarding medication not being given as prescribed. This appeared to relate to the lack of competency of agency staff and communication issues. These had been addressed directly with the agency employer and through the development of protocols for recruitment of agency staff. The majority of feedback received from residents and their relatives indicated that staff treated residents well and respected their privacy. However from discussion with some relatives it was evident that this was not always the case and was dependant on which staff were involved. One instance was quoted where care staff clearly compromised a resident’s privacy and dignity in the presence of a relative. The standard for death and dying was not fully inspected. However from feedback from health professionals and an inspection of records, it was evident that a resident’s wish to remain at the home had not been respected and they had died several hours following admission to hospital. Requirements for staff training in care of the dying have been made in this report. Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.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, 13 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. The social activities are good but could be further developed with involvement of all care staff. Visiting arrangements are open and relaxed; staff encourage contact with the local community. EVIDENCE: The home’s activities coordinator had enrolled on a five-month social activities NVQ course for older people that will enable her to develop skills in social care therapy. A programme of activities had been developed that included outings and entertainment and was graphically displayed on a notice board for residents’ and their representatives’ information. Four residents were taking part in a snakes and ladders floor game that provided them with some physical exercise and stimulated social interaction between them. Those spoken with said they had enjoyed the recent activities organised on their behalf. Advice was given to develop further individual activities such as manicures and hand massage for those residents who because of their dependency were unable to take part in group’ activities.
Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.R01.S.doc Version 5.1 Page 12 The service users’ guide and record of activities confirmed that links were made with the local community. Residents spoken with said their visitors could come at anytime and staff were friendly and helpful towards them. Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.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): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. Appropriate policies, procedures and practices were in place to promote the protection of residents from abuse. Any complaints/allegations of abuse were fully investigated and appropriate action taken. EVIDENCE: The home had a complaints procedure that included timescales within which complainants can expect a response and their right to complain directly to the CSCI at any stage. No complaints had been received by the CSCI about the home since the last inspection. The procedure was included in the statement of purpose for resident and representatives’ information. Feedback from residents was generally very positive about the care and staff at the home. Michaelstowe had a whistle blowing procedure place for staff guidance. The Essex Guidelines on the Protection of Vulnerable Adults (POVA) was available. The proprietor 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. Three recent allegations regarding care, medication, delays in referral to GP and not adhering to residents wishes had been upheld. Appropriate action had been taken following investigation to address shortfalls in standards of care. This included auditing of records, staff training, disciplinary action, the development of protocols for recruitment of agency and the provision of specialist pressure relief equipment as advised by the tissue viability nurse. Further requirements have been made in this report with
Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.R01.S.doc Version 5.1 Page 14 regard to respecting the wishes of residents and the provision of staff training in care of the dying. Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.R01.S.doc Version 5.1 Page 15 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to the service. Michaelstowe Hall was safe and 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 good standards of infection control practices evident. Further attention to detail will assure residents and relatives that these standards are not compromised. EVIDENCE: A partial inspection of the premises was made that included communal areas, bathrooms, sluices, toilets, and a number of residents’ rooms. The refurbishment of the home was complete and now provided a comfortable place for residents to live. There was a programme of regular maintenance in place and action was ongoing to address the requirements made by the local fire service. Communal rooms were clean and well decorated and furnished to provide a homely environment for residents. Residents spoken with said their
Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.R01.S.doc Version 5.1 Page 16 rooms were always kept clean. The gardens were attractive and provided a pleasant outlook over open countryside with good access for residents. The home was clean and hygienic throughout with no odorous smells. The infection control practices in place in the home were observed to be safe. However feedback from one relative indicated that sometimes drinking glasses and washing bowls were not adequately cleaned. The home had two sluice disinfectors, one on each floor of the premises that were well maintained. The laundry was large and equipped as required. Laundry and sluice facilities were located away from areas where food was prepared or eaten. Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.R01.S.doc Version 5.1 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to the service. Staffing levels were sufficient to meet residents’ needs. EVIDENCE: There were nineteen residents at the home. Staffing levels were confirmed at one registered nurse and five care assistants and were appropriate to meet the dependency needs of residents at the home. There had been no increase in registered nurse levels during the night, however the number and dependency of residents’ needs was less than at the previous inspection. A registered nurse/mental health nurse was also in attendance that had been seconded from another home to also provide support in the absence of the proposed registered manager who was on sick leave. Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.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, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to the service. Arrangement were in place to ensure the management of Michaelstowe Hall was effective during the absence of the proposed manager. Records were accurate, up to date and stored securely. The health and safety of residents and staff is promoted and protected by the policies and practices in place. EVIDENCE: The proposed registered manager was on sick leave and a consultant had been employed in recent weeks to provide support to the home. The consultant was not present due to a previous overseas commitment but planned to return to the home following the two-week period. A senior nurse from another home was providing management support during this period. The proprietor was also in attendance at the home and took an active part in the inspection.
Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.R01.S.doc Version 5.1 Page 19 Records required by regulation for the protection of service users were maintained, up to date and accurate. The inspector examined individual service users care plans, fire safety records, accident records, menus, nutrition records, staff records, staff rotas, the Statement of Purpose and the Service Users Guide, and the visitor’s book. There was evidence that residents and their representatives were made aware they could access their records. All records were stored securely in locked filing cabinets and lockable offices. The home had a health and safety policy. Policies and procedures included monitoring of practices to ensure the health and safety of residents and staff as far as possible. The records confirmed that maintenance of the premises and equipment were undertaken as required. Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.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 3 8 3 9 X 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 x 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X 3 3 Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.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 OP9 Regulation 13(2) Requirement 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. This requirement has been brought forward as it was not inspected. 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. This requirement has been brought forward as it was not inspected. The registered person must ensure that staff uphold the privacy and dignity of residents when providing personal care. The registered person must ensure that resident’s wishes not to be admitted to hospital when they are dying are adhered to. All care staff to receive training on care of the dying. The registered person must
DS0000015326.V289803.R01.S.doc Timescale for action 30/06/06 2 OP9 13(2) 30/06/06 3 OP10 12(4)(a) 30/06/06 4 OP30 12(3) 30/09/06 5 OP26 13(3) 30/06/06
Page 22 Michaelstowe Hall Residential and Nursing Home Version 5.1 6 OP36 18(2) ensure that infection control practices are adhered to. This refers to the provision of clean drinking glasses and cleaning of washbowls following use. The registered person must ensure that a system of formal supervision is provided for all staff. This is a repeat requirement 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The registered person should ensure that individual activities are provided for residents who are unable to take part in group activities. All care staff to be encouraged to develop skills in this area. Michaelstowe Hall Residential and Nursing Home DS0000015326.V289803.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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