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Inspection on 14/11/05 for Middlefield House Nursing Home

Also see our care home review for Middlefield House Nursing Home for more information

This inspection was carried out on 14th November 2005.

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

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

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

What the care home does well

Staff members spoken to had a good understanding of the aims and objectives of the home and the needs of residents living here. Care plans are detailed and give a good picture of the needs of the people the service supports. There is good risk assessment systems in place and residents living here are enabled, as much as possible, to make decisions about their preferred routines and lifestyles.

What has improved since the last inspection?

Additional visits have been made to this home, the last being on 20.09.05 and no requirements were made on this visit. A new manager has now been recruited and an application to be registered with the Commission is currently being processed. New carpeting has been laid throughout a large part of the home. Funding has been secured for one resident requiring one to one staffing.

What the care home could do better:

Care records would benefit from old information being archived and it is recommended that the document relating to Prime Life`s policy and procedure booklet is produced in a pictorial format.

CARE HOME ADULTS 18-65 Middlefield House Nursing Home Middlefield Lane Gainsborough Lincs DN21 1TY Lead Inspector Elisabeth Pinder Unannounced Inspection 14th November 2005 10:00 Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 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 Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 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 Adults 18-65. 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. Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Middlefield House Nursing Home Address Middlefield Lane Gainsborough Lincs DN21 1TY 01427 615577 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) Prime Life Limited Care Home 17 Category(ies) of Learning disability (17) registration, with number of places Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd March 2005 Brief Description of the Service: The home is a detached property providing care and accommodation for up to seventeen residents with learning disabilities. The building has been extensively adapted to care for people some of whom also have a degree of physical disability. The home is situated on the outskirts of the town of Gainsborough and is set in approximately a third of an acre of garden. Car parking is available to the front of the home. Gainsborough town can be reached by using a bus service which passes the home. The home has a minibus which provides residents with transport for example to appointments, trips out and to attend day care services. Within the home there are four lounges, including a sensory lounge, and two dinning rooms, these are on the ground floor. There are 15 single bedrooms and 1 double room, one of which has an en-suite. There are 8 toilets and 4 bathrooms. Bedrooms are on the ground and first floors and the home has a passenger lift to access first floor rooms. The front garden has a lawn and flowerbeds and to the rear of the home is an enclosed patio area where residents wishing to smoke do so. The home is part of Prime Life Limited. Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced starting at 09:40 and took place over 6 hours. It was carried out by one inspector as the first of two statutory inspections for 2005/6. The main method of inspection used was “case tracking”. This involved selecting three residents and tracking the care they receive through the checking of their records, discussions with care staff and observation of care practices. The inspector met with residents, but due to their communication needs was not able to have in depth discussions with them. A sample of regulatory records and policies and procedures were seen and a tour of the building was undertaken. What the service does well: What has improved since the last inspection? What they could do better: Care records would benefit from old information being archived and it is recommended that the document relating to Prime Life’s policy and procedure booklet is produced in a pictorial format. Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 6 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. Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 There are satisfactory procedures for the assessment and introduction of residents prior to admission. EVIDENCE: The care records of one resident admitted since the last inspection were examined and although this resident was admitted as an emergency an assessment had been undertaken by one of the company’s directors. This described his care needs and gave sufficient information for staff to formulate a basic plan of care. Information subsequently received from the resident’s care manager details more complex needs and this was discussed with the manager who said that he is working with staff to ensure that they have access to information and training to enable them to meet this resident’s needs. Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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, 7 and 9 Care plans must contain sufficient information to ensure that the care needs of residents are met. Good risk assessment systems are in place and although residents are unable to sign their plan of care, decisions had been made by their advocates regarding preferred routines and lifestyles. EVIDENCE: All but one of the care plans examined contained clear information for staff relating to the care needs of residents. Individual risk assessments are written and staff spoken to had a clear understanding of these. There is detailed information relating, for example, to the communication needs of residents, their likes and dislikes and preferred routines. However, one record referred to a resident having epilepsy and referred to care plan 14, however, care plan 14 was not held in these care records and other records stated that this resident did not have epilepsy. This was discussed with the manager who said this resident did not have epilepsy and he agreed to update this plan of care. He also explained that some information on the file was written some time ago and he showed the inspector new care plans which are currently being written and will replace all old information. All residents have a learning disability and most are unable to agree or contribute to their plan of care and decisions are made by residents relatives, Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 10 one to ones or advocates. Risk assessments on file enable residents to live as independently as possible whilst ensuring that risks are minimised. One file contained a document relating to the policy and procedure booklet produced by Prime Life as being discussed with residents. Due to the severe disabilities of residents it is recommended that this information should be produced in a pictorial format. The document also made reference to it being discussed at the residents next review, however, there was no evidence in the review minutes to support that this had been done. Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 and 17 The home provides a range of activities and leisure interests both within the home and community. These are based on the preferences of service users who are encouraged to make choices about their preferred lifestyles and routines. EVIDENCE: During the visit some residents were at day services, others were either in one of the lounges with staff, in the sensory room or sitting in the quiet lounge. In the afternoon the home’s reflexologist visited to carry out therapy for residents. One member of staff spoken to said that residents who chose to went on holiday this year and photographs are on display of holidays and outings. Records are kept of outings and it was noted that one resident had not been out apart from attending day care since 27.07.04. This was discussed with the manager who said he will ensure all outings are recorded. During the lunch time period staff were observed to be offering a high level of encouragement and support to residents who required help to eat their meals. The cook works from 1pm – 6pm six days a week and the main meal of the day is served at tea-time. Care staff prepare and cook a snack at lunch time Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 12 and the member of staff spoken to confirmed that he had undertaken training in basic food hygiene. Although residents are unable to verbally tell staff what food they like or dislike staff explained how they know individual preferences through signs, pictures and gestures. Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The health and care needs of residents are met and staff have a good knowledge of individual needs. Medication storage and administration systems are satisfactory. Residents using this service are not able to self-administer EVIDENCE: Care records showed that arrangements are in place for residents to be registered with a GP from local surgeries and showed that other health care professionals are involved as needed, for example, psychiatrists. Assessment information includes details about dentists, chiropodist and opticians. Staff spoken to were aware of the particular health needs of the residents. Medication is given by trained nurses and records examined showed that it is being recorded appropriately. The manager stated that the company is currently making arrangements for a waste management contract. Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The above standards were not inspected on this occasion. EVIDENCE: Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The above standards were not inspected on this occasion. EVIDENCE: Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 There is a satisfactory recruitment process in operation. EVIDENCE: Although the above standards were not assessed, the recruitment of one member of staff recently employed was discussed as staff expressed their concerns due to this person being under the age of 18. It is acknowledged that this member of staff has been recruited following a robust procedure and is being supervised by a senior member of staff throughout her induction. The National Minimum Standards were discussed with the manager which make reference to staff providing intimate personal care for residents being at least age 18 and trainee staff make up 20 of the total care hours. The manager said that he was aware of this standard and that it is being followed. Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The above standards were not inspected on this occasion. EVIDENCE: Although the above standards were not inspected, since the last inspection a new manager has been recruited and currently an application to be registered with the Commission is being processed. Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 3 X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X 3 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Middlefield House Nursing Home Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000002573.V266014.R01.S.doc Version 5.0 Page 19 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 6 6 Refer to Standard YA6 YA6 Good Practice Recommendations It is recommended that old information contained within care records is archived. It is recommended that the document relating to Prime Life’s policy and procedure booklet is produced in a pictorial format. Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Middlefield House Nursing Home DS0000002573.V266014.R01.S.doc Version 5.0 Page 21 - 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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