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Inspection on 16/01/06 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 16th January 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 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

This home provides a comfortable, clean and homely environment, where residents are supported and cared for by a committed group of staff. A good rapport was noted between residents and staff and comments from one resident indicated that they felt able to raise concerns with them should they arise. Staff had a good knowledge of the needs of residents. There is an ongoing training programme for staff and some have achieved National Vocational Qualification awards.

What has improved since the last inspection?

There were no requirements made at the time of the last inspection. Staff continue to have regular training and support from management.

What the care home could do better:

There were no requirements made at this inspection and the home demonstrated a good standard of care and support for residents. Four recommendations were made in the interests of good practice and consideration should be given to address these.

CARE HOME ADULTS 18-65 Middlefield House Nursing Home Middlefield Lane Gainsborough Lincs DN21 1TY Lead Inspector Elisabeth Pinder Unannounced Inspection 16th January 2006 09:30 Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 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.V276159.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 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.V276159.R01.S.doc Version 5.1 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.V276159.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 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.V276159.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 4 hours and was carried out by two inspectors as the 2nd of two statutory inspections for 2005/6. The main method of inspection used was “case tracking”. This involved selecting two residents and tracking the care they receive through the checking of their records, discussion with one of them, the care staff and observation of care practices. Two bedrooms were viewed and a selection of care records inspected. Before the visit, information was gathered from the pre-inspection questionnaire. Seven comment cards were received from relatives/representatives, one from a general practitioner and one from the home’s pharmacist. Comments made were very positive with specific comments of “Very hospitable and informative members of staff” and “well cared for, receiving the best attention possible”. However, two of the comment cards identified that they were not aware of the home’s complaints procedure. What the service does well: What has improved since the last inspection? What they could do better: There were no requirements made at this inspection and the home demonstrated a good standard of care and support for residents. Four recommendations were made in the interests of good practice and consideration should be given to address these. Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 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.V276159.R01.S.doc Version 5.1 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.V276159.R01.S.doc Version 5.1 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): Standards 2 and 3 were assessed during the previous inspection EVIDENCE: Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 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 Care planning in this home is good, providing detailed information on how the health and social care needs of the people are met. EVIDENCE: Since the previous inspection a new care-planning format is being used and all care plans are in the process of being re-written. Care plans examined contained clear information for staff relating to the care needs of residents. There is evidence of regular reviews including annual multi agency reviews and these showed that consultation had taken place with one resident who can communicate. However, there are sections of the care plans that are not used and it is recommended that staff record ‘not applicable’ or ‘not known’ instead of leaving these sections blank. Individual risk assessments are written and staff spoken to had a clear understanding of these. However, a discussion was held regarding the general risk assessment sheet making reference to individual risk management plans and this was agreed to. All residents have a learning disability and most are unable to agree or contribute to their plan of care and decisions are made by resident’s relatives, one to ones or advocates. Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 Page 10 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): Standards 12, 13, 15, 16 and 17 were assessed during the previous inspection. EVIDENCE: Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 Page 11 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): Standards 18, 19 and 20 were assessed during the previous inspection. EVIDENCE: Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 Page 12 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): 22 & 23 Residents are protected by the procedures in place for handling complaints and allegations of abuse. EVIDENCE: There are policies and procedures in relation to complaint’s and adult protection. The home uses the company’s procedure and the Local Authority Adult Protection procedure dated February 2005. Staff spoken to knew both procedures and who to report to and training records showed that staff have undertaken specific adult protection training courses. A record is kept of all complaints made. The commission have not received any complaints since the last inspection. The home’s own record indicated that there had been one complaint since the last inspection and this had been dealt with internally. There have been no adult protection issues in the last twelve months. One resident spoken to said that they would feel comfortable to raise concerns with the manager. Staff were observed throughout the visit to be listening to residents views about everyday issues and responding to any requests for assistance or support. The company also has other policies that are designed to protect residents, such as physical intervention/restraint and the management of residents monies and financial affairs. Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 Page 13 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): 24 and 30 Residents live in a homely environment, which is well maintained. They benefit from a good standard of hygiene and from staff who have a clear understanding of infection control issues. EVIDENCE: During a tour of the building the home was seen to be clean and tidy and smelt nice. Bedrooms are spacious and well personalised. Overhead track hoists and mobile hoists are used when required and bedroom doors have name plaques and notices to knock before entering. However, it is recommended that a privacy screen is fitted to the glass window in one room which overlooks the road and where staff report that the resident frequently pulls the curtains down. There is a record kept of all maintenance issues that are reported and staff said that these are dealt with as soon as possible. However, there is an ongoing problem with the heating system in the old part of the building and management said that this is being addressed. Throughout the day, staff were seen demonstrating their understanding of infection control as they performed their work e.g washing their hands appropriately, using aprons and gloves. Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 Page 14 Training records showed that staff have received training in infection control and they were able to demonstrate their knowledge of this subject. The home has a separate laundry room. Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 Page 15 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): 32 & 35 The staff group are an established team and staffing levels are sufficient to meet the current needs of residents. Staff are provided with training to ensure they have the skills needed to carry out their roles and are committed to the work they do. EVIDENCE: Records showed that there are normally three care staff on duty from 8am until 8pm plus one qualified nurse. Three residents have one to one carers funded by their local authority and they work in addition to the rostered staff. There is also a cleaner and a laundry assistant. Comments from staff indicated that there is an ongoing programme of training, which they attend that includes updates in relation to some matters such as fire training, health and safety and more specific training to meet needs of residents. Information provided prior to the inspection indicated that 10 staff held a first aid certificate and that five had attained a National Vocational Qualification (NVQ) award at level II or above. Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 Page 16 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): 37, 39 & 42 This home is well managed and the health, safety and welfare of residents are promoted. EVIDENCE: The acting manager and deputy manager have both completed the Registered Manager award. Staff said that they get good support from management and both are approachable and available for advice when required. The deputy manager demonstrated a clear overview of the daily issues and provided direct support to staff when needed. There was evidence of delegation of work and good levels of communication between the staff team. The organisation has a quality audit system in place. This includes quality assurance questionnaires being sent out to all relatives and other professionals and visits to the home by a representative of the organisation. Staff meetings and resident meetings are held and records are kept of both. However, it is recommended that action taken to address items raised by residents should be discussed and recorded at the next meeting. Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 Page 17 Information received prior to the inspection detailed maintenance dates and records are available in the home to support these. However, the home does not have a landlords gas safety certificate, although records showed that boilers have been serviced. A fixed electrical wiring certificate was also not available but records state that provision has been made for this to be addressed. Risk assessments are documented in relation to health and safety issues that may arise from the environment of the home and there are a range of policies and procedures available relating to fire safety and fire risk assessments. Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X 3 X 3 X X 3 X Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No 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. 1 2 3 4 Refer to Standard YA6 YA6 YA25 YA39 Good Practice Recommendations It is recommended that the home complete all information sections in residents files, for example using statements such as not applicable or not known where necessary’. The document referred to as ‘the general risk assessment sheet’ should cross reference to individual risk management plans. A privacy screen should be fitted to the glass window in one of the bedrooms overlooking the road where a resident frequently pulls the curtains down. Action taken to address issued raised by, or on behalf of, residents during meetings should be recorded and discussed at the next meeting to demonstrate what action has been taken. Certificates should be obtained in relation to fixed electrical wiring and landlords gas safety. 5 YA42 Middlefield House Nursing Home DS0000002573.V276159.R01.S.doc Version 5.1 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. 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