Inspection on 02/05/07 for Middlefield House Nursing Home

This inspection was carried out on 2nd May 2007.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Middlefield House Nursing Home 22/05/06

Middlefield House Nursing Home 16/01/06

Middlefield House Nursing Home 14/11/05

Middlefield House Nursing Home 03/03/05

Middlefield House Nursing Home 08/09/04

Middlefield House Nursing Home 07/07/04

Middlefield House Nursing Home 03/03/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Middlefield House Nursing Home Middlefield Lane Gainsborough Lincs DN21 1TY Lead Inspector Julie Western Key Unannounced Inspection 2nd May 2007 11:12 Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 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.V338502.R01.S.doc Version 5.2 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.V338502.R01.S.doc Version 5.2 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) middlefield@prime-life.co.uk info@prime-life.co.ukwww.prime-life.co.uk Prime Life Limited Mr Joseph Veall Care Home 17 Category(ies) of Learning disability (17) registration, with number of places Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service is registered to care for younger adults between the ages of 18 and 65 years whose primary need is that of a learning disability. The maximum number of service users to be cared for in the home is seventeen. 22nd May 2006 Date of last inspection 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 one dining room. There are 17 single bedrooms, 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. The current weekly fee range is £432.00 - £926.60. Additional costs are made for hairdressing, chiropody, toiletries, transport and some activities. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, was carried out over 3 hours and took into account any previous information held by CSCI including the home’s previous inspection reports, its service history, pre-inspection questionnaires completed by the Manager and residents’ questionnaires sent to the home by the Commission prior to the inspection. The site inspection consisted of case tracking a sample of residents’ care and assessing the care given. Some policies and procedures were examined and some records concerning the safety of the home were also seen. Three residents, three care staff and three visitors were spoken with. The Manager was present throughout the inspection. What the service does well: What has improved since the last inspection? The manager has been in post for a year and has developed new systems and ways of working that have improved staff performance and helped staff to meet the residents’ needs. The ongoing maintenance at the home has included repairs to a leak in the ceiling and the redecoration of the staircase. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 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.V338502.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents continue to benefit from clear admission and assessment procedures; they have a range of information available to help them make a choice of where to live. EVIDENCE: The statement of purpose and the service user guide are held in the manager’s office. The service user guide has been written in plain English and uses pictures to help residents with communication difficulties to understand it. The manager said that usually he, or in the case of the last resident to be admitted, a regional manager undertook the initial assessment. Information was gathered from various professionals including the social worker. One care plan examined was not signed; the manager said this was because the resident was unable to sign and the relatives could not be contacted. It was suggested that where a signature could not be obtained, a reason was given. The home had comprehensive policies and procedures for admitting residents. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning in this home is well managed and provides detailed information on how the needs of the residents are met. EVIDENCE: The care plans looked at in depth contained clear information for staff members on each resident’s care needs and how to meet them. The action plan and the community care plan were annually reviewed by the home in conjunction with the Social Work team. Risk assessments were well identified and the key-workers spoken with demonstrated a good knowledge of the care and support needed by the residents they cared for. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 Page 10 Residents spoken with were able to indicate that they were happy in the home. Three visitors said that the home was ‘lovely – they look after our relative well’. All residents have a learning disability and most are unable to contribute to their plan of care; decisions are usually made with the assistance of relatives, advocates, key-workers and other professionals. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good range of activities and events for residents to take part in if they wish. Residents’ rights are respected and they have a choice of food at mealtimes. EVIDENCE: On the day of the inspection six residents went to two separate day centres in the town, being transported there by mini-bus. The remaining residents stayed in the home and were doing various activities such as jigsaw puzzles and watching television. The nurse in charge said that recent trips out had included a visit to Tropical world in Leeds and two animal farms; the activities book confirmed this. Other Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 Page 12 activities included twice-monthly outings for lunch and shopping, music and visits from a reflexologist. The home also has a specially adapted therapy room, which is used to stimulate the senses. Two residents had one-to-one supervision and one resident was sitting in the quiet lounge with his co-worker. Photographs of recent outings were on display in the entrance area. Residents were seen eating the mid-day meal and all except one indicated that they liked it, using signs and gestures; the resident who said ‘I don’t like this’ was immediately given an alternative. New menus are being developed and photographs of the meals are currently being devised to help residents make their choice of food. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to a range of local health care services; their health care needs are responded to in an individual manner by a knowledgeable staff team. EVIDENCE: There is evidence in records that residents have their medication reviewed regularly. Where indicated, weight and dietary intake is also monitored regularly. Staff members were observed to provide sensitive support and reassurance to residents and to maintained their privacy and dignity, particularly when attending to their personal health care needs. Medication records were completed in full and audited regularly. Staff members used good infection control procedures during administration of medications. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the procedures in place for handling complaints and allegations of abuse. EVIDENCE: The complaints procedure has been produced in a pictorial format showing clear and simple pictures of feelings and shows residents what to do if they are unhappy, angry, frustrated or sad. The record of complaints showed that there had been three complaints since the previous inspection; all relating to the work of a staff member who has since left the home. Two were unsubstantiated and one was substantiated; all have been referred to the personnel department. There have been no complaints concerning adult protection issues. The visitors spoken with all said they had no complaints but would know where to go to if they needed to make a complaint; one said that her relative was ‘very safe in here’. Staff members spoken with had received training in safeguarding adults and were knowledgeable about procedures regarding complaints. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a generally pleasant and homely environment; although the building is safe, some parts need attention to ensure that they continue to do so. EVIDENCE: The manager said that recent improvements to the home had included the repair of the leaking roof and redecoration of several areas of the building, including the staircase and several rooms. The major areas now needing attention included the ceiling of one of the bedrooms, which was damaged and a bathroom, which did not have a homely atmosphere. The kitchen units were in a poor condition. Residents’ rooms were spacious and well personalised. Overhead tracks and mobile hoists were available in two of the rooms. Some bedroom doors had notices telling people to knock before entering. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 Page 16 One resident was in her room and indicated that she liked it, especially the colour the room was painted. There was a maintenance book where all issues needing attention were reported and the manager said that these were dealt with a quickly as possible. COSSH materials were locked away. On the day of the inspection the building was clean and tidy and smelled fresh. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers are in sufficient quantity for them to be able to care for the residents. Staff members are suitably trained, qualified and competent; they undergo an induction programme before commencing their duties. EVIDENCE: Staffing rotas showed that there were enough staff members on duty to meet the needs of the residents; staff spoken with confirmed this. Two residents had one-to-one care and extra carers were employed to give this. The most recent staff member to be employed confirmed that she had given references, undergone CRB and Protection of Vulnerable Adults [POVA] checks, completed an application form and been interviewed. She had undergone induction training before commencing her duties. Her records confirmed this. Training records showed that recent staff training had included moving and handling, fire and food hygiene. Several staff members were also undertaking the LDAF training course on learning disabilities. Five staff members had Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 Page 18 completed the National Vocational Qualification at Level 2 with a further three working towards it. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed competently and safely and the staff members are supported in carrying out their respective roles. The views of residents and their supporters are listened to and they are involved in decisions affecting them. EVIDENCE: The manager has been in post for twelve months; he has 21 years’ experience in learning disability care settings, two of these as a manager. He is a registered RNMH nurse and is working towards the registered manager’s award. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 Page 20 Visitors said that they and their relative were asked for their views of the home on a regular basis. Their relative was recently asked to make a choice of colours and designs for his bedroom. Staff spoken with said the manager was approachable and accessible. The company has a quality audit system in place, based on star ratings; the results of this audit are displayed on the walls near the entrance. The quality assurance review gives clear actions and timescales to make improvements to the running of the home and includes comments from staff and residents. A number of policies and procedures relating to fire safety, infection control, equality and diversity and environmental health were examined and were clear and up to date. Policies and procedures were kept in a manual in the manager’s office and were available for all staff to read. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 Page 21 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 3 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 4 X X 3 X Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 Page 22 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. 1 Standard OP19 Regulation 23[2][b] Requirement The following areas need attention: The kitchen unit doors and fittings. The ceiling of one of the bedrooms. The bathroom, which is not decorated. Timescale for action 29/06/07 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 OP7 Good Practice Recommendations Where care plans are not signed the reason for residents or their supporters not signing should be given. Middlefield House Nursing Home DS0000002573.V338502.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lincolnshire Area Office The Point Weaver Road Off Whisby Road Lincoln LN6 3QN. National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V338502.R01.S.doc Version 5.2 Page 24 - 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!