Inspection on 19/07/05 for Middlecross

This inspection was carried out on 19th July 2005.

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

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

Other inspections for this house

Middlecross 12/10/06

Middlecross 28/02/06

Middlecross 20/12/04

Middlecross 12/05/04

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

CARE HOMES FOR OLDER PEOPLE Middlecross Simpson Grove Armley LS12 1QG Lead Inspector Paul Newman Unannounced 19 July 2005 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 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. Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Middlecross Address Simpson Grove Armley LS12 1QG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0113 2310357 0113 2319071 Leeds City Council Department of Social Services Mr Martin Hudson Care home 32 Category(ies) of Dementia - over 65 (28) registration, with number Dementia (4) of places Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 20/12/04 Brief Description of the Service: Middlecross is purpose built and all accommodation is at ground floor level. The bulding and grounds are enclosed by a security fence and there is CCTV security protection covering the entrance gates and outside of the buuilding. There is a central courtyard area with raised flower beds for service users to access during the day and gardens generally are well laid out, interesting and well maintained. The home is located in the Armley area of Leeds. There is easy access of all the local facilities including shops and public houses and convenient for the local bus service, which gives access to Leeds City centre and surrounding areas. The home provides care for 31 service users who are suffering from Dementia. Nursing care is not provided but the home is supported by local healthcare services and more specialist services in relation to dementia. Accommodation is provided in 31 single bedrooms and all bedrooms have ensuite WCs. The home is divided into 4 wings and each 2 adjoining wings has a dining area and separate lounge. Attached to the dining areas are small kitchenettes which are available to the service users for snacks and drinks. There is also a small Snoozelem room for service users. There are bathing and toilet facilities on each of the 4 wings and separate toilets are available for both staff and visitors. There is a large kitchen, which provides all the meals for the home and a day centre, which adjoins the care home. Laundry facilities are available for all the service users personal laundry. Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, regulated care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was announced and took place in December 2004. There have been no further inspections until this unannounced visit. The people who live in the home prefer the term resident or simply people, and these are the terms that will be used throughout this report. This was this inspector’s first visit to the home and the purpose of this inspection was to gain an overview of the care, services and facilities provided and also to assess progress in the way the home is dealing with issues that were raised in the last inspection report. During the inspection records were looked at, some parts of the home were seen, such as bedrooms, lounges and bathrooms; care staff were seen carrying out their work; conversations were held with the manager, five members of staff, three relatives and four residents. Survey cards were left at the home for residents, relatives or visitors to complete and return to the Commission for Social Care Inspection (CSCI). These cards provide an opportunity for people to share their views of the service with the CSCI. Comments received in this way will be shared with the provider without revealing the identity of those who replied. The inspection started at 9.00 and lasted for five and a half hours. In addition, time was spent preparing for the inspection. What the service does well: What has improved since the last inspection? The last inspection report referred to issues around staffing – use of agency staff and frequent changes to permanent staff duty rotas. There is now much more stability and consistency and very little use of agency staff. Issues relating to the building, – such as the kitchen roof and a grate cover – are now also resolved. Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 6 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. Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 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 standard(s) 3, 4 and 5. Standard 6 does not apply to this home. Residents’ needs are properly assessed and well informed and knowledgeable staff meet these needs. The admission process is good and always includes introductory visits. EVIDENCE: Three care plans were checked. These each had detailed pre admission documentation and the manager said that he insists that prospective residents ‘always’ make an introductory visit that also forms part of the pre admission assessment. Relatives spoken with also confirmed that introductory visits had been made and that they felt fully involved in this process. They felt that staff communicated well and they were kept up to date with changes in the health and well-being of their relatives and were very confident in the staffs’ abilities to meet care needs. Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 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 standard(s) 7, 8, 9 and 10. Care plans provide staff with clear, and up to date information and guidance to follow. Health care needs are identified and monitored with good support from local health care services. Medication procedures and practices are safe. Staff are aware of residents’ needs and treat residents with dignity and respect. EVIDENCE: Three care plans (lifestyle plans) were checked. The detail in the plans was good, for example noting the special talcum powder that one person liked to use. The plans provided staff with clear information about the care needs of individual residents and guidance about the way to deliver the care. An example of the detail was guidance about another person that identified the therapeutic value of bathing, and the resident choosing to ‘have a good soak’ rather than this being seen as a task that might be more hurried. Any liaison with healthcare professionals was well recorded, showing that there is regular contact with specialist services in relation to mental health and dementia. Contact with relatives was recorded clearly showing that staff communicate significant events including the outcome of Doctors’ visits. The plans are evaluated each month and changes are recorded. Risk assessments are also Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 10 included and these are also subject to review and are up to date. Liaison with doctors, nurses, dentists, the optician and dentists was recorded. Medication policies and procedures were discussed and practice observed. This was safe and the recording of the administration of medicine was error free. Care practices that were observed showed staff giving sensitive care that made sure that the residents are treated with respect and dignity. Residents said that staff are friendly and helpful and respect their privacy like knocking on doors before entering. Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 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 standard(s) 12, 13, 14 and 15. Residents are encouraged to make their own decisions about their lifestyle. Family, friends and visitors are welcomed at the home. Social and leisure activities are offered that people are happy with. Good wholesome food is provided and residents’ personal likes and dislikes are known and honoured. EVIDENCE: During a tour of the building early on in the inspection, staff were observed serving breakfast. The residents looked well cared for and their care was sensitive, warm and personable. The breakfast menu had several choices including a ‘cooked’ breakfast. The visiting policy makes it clear that relatives and friends can choose to eat as well. The five week rolling programme of menus looked to provide choice with good wholesome food. Choices are made at the time of the meal and do not have to ‘booked’ in advance. Later in the inspection the chef was observed checking that the dining room was set properly and provided a nice setting for people to eat in and the lunch looked good and was enjoyed by those spoken with. The home publishes a monthly newsletter. This is informative covering areas like planned entertainment, other activities that the home is involved in, information about the sort of staff training that has been going on and changes in the staff team. The newsletter encourages contributions or ideas for publication and encourages visitors to attend forthcoming events. Apart from Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 12 these regular events like ‘a night at the races’ that the relatives spoken with were also looking forward to, the home has a daily activity programme. It is clear from speaking with both staff and relatives that relative involvement is seen as an integral part of the care package, so visits are encouraged as well as involvement in the events that are arranged. One relative spoken with said that her mother had lived at the home for about seven weeks. She felt that staff were wonderful, she felt very welcome at the home and was delighted at the way staff seemed to take account of relatives feelings - concerns, guilt, and fears – and said that staff spent time listening, and helped and reassured them. Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 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 standard(s) 16 and 18. Residents and/or relatives understand that they can raise concerns and feel confident in doing this. They feel that staff want to listen and respond quickly to put things right. EVIDENCE: The home’s complaints procedure is made available in the written information about the home that is given to all prospective residents and/or their relatives. There are also copies displayed and available in the home. There is a clear adult abuse policy and procedure and staff have been provided with training about what abuse is and about the procedures. Without exception, the relatives all felt that staff made it clear from the outset, that if there were concerns or worries, however small, they must talk about these straight away. Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 25 and 26 The home is safe and well maintained and offers a variety of comfortable communal lounge areas. Bedrooms suit personal needs, are en-suite and can be personalised with your own possessions and made private. The home has aids that make things like bathing and toileting easier. The gardens are safe, interesting and well maintained. EVIDENCE: Middlecross is a purpose built care home providing a selection of small and larger seating areas within each colour coded section for sitting, eating, and interacting with other residents, staff and visitors. Although most residents have a preferred area it was observed that they were free to move around if they wished. Communal spaces include small lounges and a dining area in each section and a large room near the bar area. Each bedroom has an ensuite toilet and washing hand basin but residents have the choice of four bathrooms and access to five toilets positioned on the corridors near communal areas if they do not want to return to their own rooms. There are Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 15 aids, adaptations and specialist hoists to make things safe for staff and residents moving about the building, toileting and bathing. This was not a detailed inspection, but the tour around the building found good standards of cleanliness and no unpleasant odours. The relatives and hairdresser who has attended the home for ten years all agreed that this was the norm. Initial impressions are that the building is well maintained and comfortably furnished. There is a rolling programme for the replacement of furnishings. Residents are able and encouraged to bring their own items of small furnishings, pictures, photos, ornaments and electrical gadgets, so that their bedrooms are personalised, homely and familiar. The gardens are well maintained, interesting and provide some stimulation safe outdoor space for residents. On the day of inspection representatives from the City Council were at the home judging for the annual Council gardening competition. They kept their ‘cards close to their chest’ with no indication how the home had done. The home was left a £500 donation in the will of a former City Councillor and they have used this to purchase additional garden furniture. Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29. The staff are experienced, well trained and know what they are doing. They have good relationships with the residents and care for them well. EVIDENCE: Four members of staff were spoken with during the inspection. They are well organised and there are well established systems of shift handovers, staff meetings that mean information about the residents is up to date. A shift handover was observed and each of the residents was discussed. There is a written record of the handover that details, the residents appointments for the day, hazards noted or repairs needing attention, tasks that need to be done and telephone calls received or that must be made. The staff knew each of the residents well and the relationships were good with a lot of warmth and humour. The residents said that staff are good, that they listen to their views, are friendly, and treat them well. They felt well cared for. This was a view shared by the relatives and hairdresser. The duty rotas showed that there are enough staff to meet the needs of the residents. There is currently one care staff vacancy. There has been a lengthy period in trying to fill a domestic vacancy but this was eventually filled and there is good cover seven days a week. The Social Service Department has a training programme that staff can access and the home has exceeded targets that were set in National Minimum Standards for NVQ qualified staff with two thirds now qualified. The staff Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 17 spoken with are committed to personal development including expertise in dementia care and several are studying the Certificate in Dementia Awareness. Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 37 and 38. The home is well managed and the interests of the residents are the main concern of the manager and staff. Record keeping, safety checks and systems of communication make sure that the home is a safe place to live. EVIDENCE: The manager is experienced and the staff, residents and relatives spoken with like the way he manages. He is member of a group of professionals in the west of Leeds who have a primary role in the care and treatment of dementia. This keeps him in touch with modern trends, idea sharing and problem solving. He was personable and professional in his dealings with staff, visitors and residents on the day of inspection. He likes to know what is going on and checks things personally. He likes to eat meals with residents to ‘stay in touch’. All of the residents, relatives and staff said that the manager was very approachable and listened to their views. There are other more formal ways of Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 19 checking the standards of care like satisfaction surveys that are being developed. The atmosphere in the home is warm and friendly and the residents and relative said that they like this. The record keeping in the home is good. The information about residents is clear and up to date including risk assessments, and regular safety checks are made on equipment and are recorded to make sure the building is safe. Staff are trained in safe working practices and regular up dates are scheduled. Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 4 x 3 3 4 3 x x x 3 3 Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 21 yes Are there any outstanding requirements from the last inspection? 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 OP31 Regulation 9 Requirement The manager must complete the Registered Managers Award or other recognised qualification. Outstanding from inspection report of 20/12/04 Timescale for action 01/01/06 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 manager is encouraged to develop the ideas in introducing Lifestory Work discussed during the inspection. Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 22 Commission for Social Care Inspection Aire House Town Street Rodley LS13 1HP National Enquiry Line: 0845 015 0120 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 Middlecross 20050719 Middlecross UN Stage 4 S33202 V238577 J52.doc Version 1.40 Page 23 - 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. 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