Inspection on 28/02/06 for Middlecross

This inspection was carried out on 28th February 2006.

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

The inspector 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 19/07/05

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 Leeds LS12 1QG Lead Inspector Paul Newman Unannounced Inspection 09:30 28 February 2006 th 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 Middlecross DS0000033202.V283546.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. Middlecross DS0000033202.V283546.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Middlecross Address Simpson Grove Armley Leeds LS12 1QG 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) 0113 2310357 0113 2319071 Leeds City Council Department of Social Services Mr Paul Martin Hudson Care Home 32 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (28) of places Middlecross DS0000033202.V283546.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th July 2005 Brief Description of the Service: Middlecross is purpose built and all accommodation is at ground floor level. A security fence encloses the building and grounds and there is CCTV security protection covering the entrance gates and outside of the building. There is a central courtyard area with raised flowerbeds 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 that 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 DS0000033202.V283546.R01.S.doc Version 5.1 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 unannounced and took place on the 19 July 2005. There have been no further inspections until this unannounced visit. The people who live in the home prefer the term resident, and this is the term that will be used throughout this report. 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, four other members of staff, five residents and two relatives. 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. It is appreciated that the manager sent out comment cards to all relatives and twenty-one replied to the CSCI. The results were extremely positive and just two negative comments about personal possessions going missing were shared with the manager who undertook to follow this through at the next relatives meeting and in the home’s newsletter. The inspection started at 09.30 and lasted for four hours, in addition time was spent preparing for the inspection. Not all National Minimum Standards were inspected during this visit, but over the two inspections all core standards have been inspected at least once. To gain a full picture of how the home meets standards, this report should be read in conjunction with previous reports. What the service does well: There is nothing to add to the comments made in the last inspection report and the same comments apply. The home is well managed and the interests of the residents are the main concern of the manager and staff. The staff are well organised. They are experienced, well trained, know what they are doing and have a good knowledge of the residents they care for. They have good relationships with residents and relatives. Relatives feel welcome at the home and are confident in the manager and staff in the home. There is a warm and supportive atmosphere in the home. Record keeping is clear and up to date. Middlecross DS0000033202.V283546.R01.S.doc Version 5.1 Page 6 Views expressed by relatives were consistent. 100 said that they were satisfied with the overall care provided at the home. Some additional comments made were: ‘I have two Aunts at the home and whenever I visit they are always clean, have been to the hairdresser, have had their nails done. It is one of the best homes I have been in and I am so pleased I have both my Aunts there. The staff couldn’t look after them any better and the staff always make our family welcome’. ‘I believe Middlecross is a well run establishment providing high quality professional care for its residents. I am always kept well informed; the staff appear to be well trained, helpful and supportive. Excellent manager’. ‘On my visits the staff are always smiling and friendly and it is obvious from watching the residents that they are made to feel loved and cared for’. All in all I have no adverse comments on any aspect of the work and helpfulness of the staff and the ambience of Middlecross. Any questions are honestly answered and we can contact them at any time with queries – very satisfied’. ‘When my mother’s condition made it impossible for the family to give her the care she required, we reluctantly agreed to her going into residential care. We have monitored my mother since going to Middlecross and have been very pleased with the results. When we visit she always seems happy and content. She is always clean and smart. The family have every confidence in the staff and trust their judgement in all matters relating to my mother’. What has improved since the last inspection? What they could do better: The manager needs to complete the Registered Manager’s Award. recommendation is made in relation to providing shower facilities. A Middlecross DS0000033202.V283546.R01.S.doc Version 5.1 Page 7 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 DS0000033202.V283546.R01.S.doc Version 5.1 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 Middlecross DS0000033202.V283546.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1. The current written information about the home is clear and accurate. There are plans to introduce intermediate care to the home later in 2006 and the information will need to be amended as this takes effect. EVIDENCE: Earlier this year, the manager had approached the Commission to check out what needed to be done if the home introduced intermediate care and further discussions took place during the inspection. The manager provided a copy of the proposal report. This is for five beds in one wing of Middlecross to be established as a dedicated facility providing intermediate care and outreach support for prescribed health and social care crises as an alternative to both general and psychiatric hospital or non specialist care home admission and to facilitate general and psychiatric hospital discharge. The report covers the aims of the project, eligibility criteria, the service specifications including the staffing model, approach to care management, assessment of additional equipment and medical support. Middlecross DS0000033202.V283546.R01.S.doc Version 5.1 Page 10 The manager undertook to keep the Commission informed of developments and it was recommended that work begin in revising the homes statement of purpose and service user guide. Middlecross DS0000033202.V283546.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10. The healthcare needs of residents’ are met and care plans provide clear and detailed instruction for staff to follow. Staff are aware of residents’ needs and there is good communication amongst the staff group and with healthcare professionals. Residents are treated with respect and in a dignified way. EVIDENCE: Three care plans (lifestyle plans) were checked. The plans continue to be detailed and provide staff with clear information about the care needs of individual residents and guidance about the way to deliver the care. 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 included and these are also subject to review and are up to date. As on the previous inspection that was also unannounced, observations throughout the day showed staff to be professional but personable with residents and relatives. The relationships were warm and friendly. Residents Middlecross DS0000033202.V283546.R01.S.doc Version 5.1 Page 12 looked well cared for. Staff were observed to manage the residents sensitively and survey questionnaire results indicated that staff are held in high regard. Residents said that staff gave them good support, gave assistance when they needed it and respected their privacy like knocking bedroom doors before entering. Middlecross DS0000033202.V283546.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected in detail but all met requirements at the previous inspection and no significant changes were reported this time. Survey questionnaire results indicate standards continue to be met. EVIDENCE: Middlecross DS0000033202.V283546.R01.S.doc Version 5.1 Page 14 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): These standards were not inspected in detail but the key standards both met requirements at the previous inspection and no changes were reported this time. EVIDENCE: Middlecross DS0000033202.V283546.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 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. The range of bathing facilities should be expanded to include walk in showers that would give residents a choice. There are aids, adaptations and specialist hoists to Middlecross DS0000033202.V283546.R01.S.doc Version 5.1 Page 16 make things safe for staff and residents moving about the building, toileting and bathing. The tour around the building found good standards of cleanliness and no unpleasant odours. 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 and are a safe outdoor space for residents to enjoy. The home achieved third place in the Council’s annual gardening competition and intends to expand the sensory herbal garden with the £200 prize. Middlecross DS0000033202.V283546.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, 28 and 30. 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: Once again the staff spoken with demonstrated their professionalism, good knowledge of the residents they care for and their commitment to personal development and training. The survey questionnaire results also show the confidence and satisfaction that relatives and residents have in the manager and staff. There are well established systems of communication and the shift handover sheets seen in the central office showed how detailed information was passed on and how staff were organised and deployed. Staff spoken with talked about the training they had been doing since the last inspection and this included completion of the Certificate in Dementia Awareness. One of the staff had started work at the home in May last year and was very experienced and had already achieved NVQ level 3. She said that she felt this was the best home she had worked in. She felt the staff are highly motivated caring people and the manager is down to earth and approachable. Whilst there are some current staff vacancies these are predominantly in the kitchen and are covered by agency staff. Middlecross DS0000033202.V283546.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, 32 and 35. There is an open and friendly atmosphere created by good leadership and management. There is a clear approach to resident care that is person centred and puts the best interests of individual residents central to staff practice. Residents’ financial interests are safeguarded. EVIDENCE: The manager continues to be ‘hands on’ to make sure there is personal ‘on the job supervision’ and checking, as well as the established formal supervision system of the staff team. The conversations with staff, residents and relatives and the survey questionnaire results show a high regard and appreciation for his management style. He has yet to complete the Registered Manager’s Award. The atmosphere in the home was warm with a lot of good humour. Staff were busy and their relationships with the residents were good. There was a lot Middlecross DS0000033202.V283546.R01.S.doc Version 5.1 Page 19 going on with activities, personal care, the arrival of a respite care resident and visitors. Only one key standard in respect of residents finance (Standard 35) was not inspected last time. Some residents’ personal monies are held for safekeeping. The records of two residents were checked and these showed transactions in and out that were supported by receipts. In both cases, a reconciliation was made with the cash held and found to be correct. Middlecross DS0000033202.V283546.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 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 4 X X 3 X X X Middlecross DS0000033202.V283546.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 OP31 Regulation 9 Requirement The manager must complete the Registered Managers Award or other recognised qualification. (Outstanding from inspection report of 19/07/05. New timescale set.) Timescale for action 01/09/06 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. 2 Refer to Standard OP12 OP19 Good Practice Recommendations The manager is encouraged to develop the ideas in introducing Lifestory Work discussed during the inspection. The provision of walk in shower facilities would be beneficial and give residents an alternative to bathing. Middlecross DS0000033202.V283546.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Aire House Town Street Rodley Leeds 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 DS0000033202.V283546.R01.S.doc Version 5.1 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!