Inspection on 22/05/06 for Middlefield House Nursing Home

This inspection was carried out on 22nd May 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.

Other inspections for this house

Middlefield House Nursing Home 02/05/07

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

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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 Elisabeth Pinder Key Unannounced Inspection 22nd May 2006 09:00 Middlefield House Nursing Home DS0000002573.V296404.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.V296404.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.V296404.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) Prime Life Limited Care Home 17 Category(ies) of Learning disability (17) registration, with number of places Middlefield House Nursing Home DS0000002573.V296404.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 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 dining 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. 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.V296404.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit was made to the home to form part of a key inspection. It started at 08:45 and lasted 5 ¾ hours. Information was taken from the preinspection questionnaire, notifications to the Commission and correspondence with the company and used to plan the visit and produce this report. No surveys were received. However, a support worker from the Community Support services otherwise known as SEC (Social Educational Centre) was contacted to obtain her views of this service and her comments can be found in the report. This site visit focused on key inspection standards and checking whether recommendations from the previous inspection had been addressed. A partial tour of the home was undertaken and a sample of records was inspected. The main method used for this was “case tracking” a sample of three residents with a range of needs via their records, observation, and discussion with one resident’s key-worker. No relatives or representatives were seen during this visit. The deputy manager facilitated this inspection. What the service does well: What has improved since the last inspection? The location of the dining room has moved enabling residents to have their meals without constant interruption as the room previously used is also used as a thoroughfare. A new handrail has been fitted to the side of the steps leading to the front door and a privacy screen has been fitted to the glass window in one of the bedrooms overlooking the road. Middlefield House Nursing Home DS0000002573.V296404.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. Middlefield House Nursing Home DS0000002573.V296404.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.V296404.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 at least once during a 12 month period. 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 the service. Information about the service must be more available to residents. Procedures are in place to ensure residents are only admitted into this home after a full needs assessment has been carried out. EVIDENCE: The statement of purpose and service user guide is held in the ‘managers bible’ in the office. The service user guide has been written in plain English and uses pictures to help residents with communication difficulties to understand it. A discussion was held around this document being made more available for residents and the deputy manager agreed to do this. Two of the three files inspected showed that a thorough full needs assessment had been carried out prior to admission. One resident had been admitted before it was a requirement to undertake a pre-admission assessment. Contractual information is held with the company’s central office and this was confirmed during the visit. Middlefield House Nursing Home DS0000002573.V296404.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 at least once during a 12 month period. 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 the service. Care planning in this home is good, providing detailed information on how the health and social care needs of the people are met. EVIDENCE: 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. However, there is still information on some files, which was written some time ago and is no longer relevant. A discussion was held with regards to archiving this information and the deputy manager agreed to do this. All residents have a learning disability and most are unable to agree or contribute to their plan of care and decisions are made by their relatives, one to ones or key-workers. Good risk assessment systems are in place and the key-worker of one resident traced demonstrated a good knowledge of the care and support the resident currently needs. Middlefield House Nursing Home DS0000002573.V296404.R01.S.doc Version 5.2 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): 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 the service. Activities must be recorded to show these are based on the preferences of residents. Residents’ rights are respected and mealtimes are flexible and well managed. EVIDENCE: During the visit two residents went to a day centre in the town where they are able to meet with other people who have a disability, some of whom have become friends. Other residents were either in one of the lounges with staff, or sitting in the quiet lounge. One resident proudly showed the inspector his book with pictures of tractors and smiled as he pointed to them. As part of the process to gather information a telephone call was made to Community Support services to discuss the care of one of the residents traced. The support officer spoken to said that there are no current issues of concern with the home, she has been made aware that there was a new manager, Middlefield House Nursing Home DS0000002573.V296404.R01.S.doc Version 5.2 Page 11 although had not been officially informed. She had a clear understanding of the resident’s needs and spoke about the activities offered at the centre. Information received in the pre-inspection questionnaire identified the activities available, however, records did not demonstrate that these are being offered. The deputy manager explained that the manager and herself are developing a new recording system to show activities undertaken more clearly. Due to the severe disabilities of residents a discussion was held regarding this information being produced in a pictorial format to help residents choose their preferred activity and this was agreed to. Photographs are on display of holidays and outings. Mealtimes were observed to be flexible and at breakfast residents were offered a choice of porridge, cereal and toast. Although residents are unable to verbally tell staff what food they like or dislike they were observed to use signs and gestures. New menus are currently being written and again it is suggested that these are produced in a pictorial format to help residents make their choice of food. Middlefield House Nursing Home DS0000002573.V296404.R01.S.doc Version 5.2 Page 12 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 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The health and care needs of people the service supports and their preferred lifestyles are being met. This is supported by the care planning system and staff’s knowledge of individual needs. EVIDENCE: A period of observation was undertaken whilst residents were having breakfast and getting ready for the day centre. During this time staff were observed to be offering a high level of encouragement and support to residents who required help to eat their meals and get ready to go out. Records show that residents regularly see their GP, practise nurse and, when necessary, their consultant. Visits to see the dentist, optician and chiropodist are also recorded. Procedures are in place for the safe handling of medicines and medication is given by trained nurses. The deputy manager, giving medication during breakfast, did so sensitively and in line with procedures. One resident who did not want to take his medication during breakfast was left and then asked Middlefield House Nursing Home DS0000002573.V296404.R01.S.doc Version 5.2 Page 13 again, although he still did not want his medication he came to the medicine trolley and took it when he was ready. Middlefield House Nursing Home DS0000002573.V296404.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 at least once during a 12 month period. 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 the service. Residents are protected by the procedures in place for handling complaints and allegations of abuse. EVIDENCE: The complaints procedure has been produced in pictorial format showing clear and simple pictures of feelings and shows residents what to do if they feel unhappy, angry, frustrated or sad. There are policies and procedures for staff to follow in relation to complaints and adult protection. The home uses the company’s procedure and the Local Authority Adult Protection procedure dated February 2005. Care staff have undertaken adult protection training through Ldaf (Learning Disability Awards Framework) and although the deputy manager was unable to complete the training, due to working nights and other commitments she said she plans to re-commence this as soon as possible. A record is kept of all complaints made. The commission has not received any complaints since the last inspection. The homes record indicated that there had been one complaint within the last twelve months and this had been dealt with internally. There have been no adult protection issues in the last twelve months. Middlefield House Nursing Home DS0000002573.V296404.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Priority must be given to a number of maintenance items needing attention to ensure residents continue to live in a homely, comfortable environment. EVIDENCE: During a partial tour of the building the home was seen to be clean and tidy and smelt nice. The bedrooms of the three residents traced were seen and these were spacious and well personalised. One room had recently been redecorated and the colour was chosen by the resident’s key-worker. Overhead track hoists and mobile hoists were available in two of them. Bedroom doors have name plaques and some have notices telling people to knock before entering. Since the last inspection a privacy screen has been fitted to the glass window in one room overlooking the road and where staff had reported that the resident was frequently pulling the curtain 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 are Middlefield House Nursing Home DS0000002573.V296404.R01.S.doc Version 5.2 Page 16 numerous items needing attention including a leak to the roof and one bath is currently out of use. The deputy manager said that the maintenance person is due to spend some time in the home to address these issues. The home has a separate laundry room. Middlefield House Nursing Home DS0000002573.V296404.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 at least once during a 12 month period. 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 the service. 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 08.00 – 20.00hrs and one qualified nurse and from 22.00hrs – 08.00 there are two care staff and one qualified nurse. Two residents have one to one carers working an additional 70 hrs. There is also a cleaner, laundry assistant and a cook covering a total of 75 hrs per week. Information taken from the pre-inspection questionnaire evidenced that there is an ongoing programme of training which staff attend and training recently undertaken includes updates in fire awareness, moving & handling and COSHH (control of substances hazardous to health). As previously highlighted staff also undertake Ldaf training. Two new staff members have been employed since the last inspection and their records show that they have been recruited using robust procedures Middlefield House Nursing Home DS0000002573.V296404.R01.S.doc Version 5.2 Page 18 based on equal opportunities. CRB records are held within the company’s central office but there was evidence that disclosures have been received prior to employment. Staff have copies of the General Social Care Council code of conduct and a company handbook. Middlefield House Nursing Home DS0000002573.V296404.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 at least once during a 12 month period. 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 the service. This home is well managed and the health, safety and welfare of residents are promoted. EVIDENCE: Since the previous inspection the manager has moved to one of the company’s other services and the deputy manager has left his employment. The manager taking over this role has worked as deputy in another Prime Life home in the north of the county. He has now been at Middlefield House for approximately four weeks and is completing his application for registration. The deputy manager has worked in the home as a registered nurse on nights for the past three years. The manager was not on duty during this site visit and the deputy manager was in charge. She demonstrated a clear knowledge of the residents needs Middlefield House Nursing Home DS0000002573.V296404.R01.S.doc Version 5.2 Page 20 and had an overview of the daily issues around management and was observed to provide support to staff when needed. The company has a quality audit system in place and the date for review has been given as October 19th 2006. However, the report of information collated from the last review is dated 2004 and the deputy manager is asked to make available the 2005 document. During the telephone conversation with a community support officer she confirmed that the centre had not been involved in any quality assurance methods but felt that this would be of value. The pre-inspection questionnaire identified a number of policies and procedures available relating to fire, health & safety and environmental risk assessments. This information detailed dates policies and procedures were reviewed and gave dates of maintenance tests. Training dates were also given and certificates held on staff files verified them. The supervision records of one member of staff could not be located, however, this member of staff confirmed that she has regular supervision. This was brought to the attention of the deputy manager who will look into this. Staff meetings are held and the agenda was on display for a meeting this week. The manager deals with all but one resident’s personal allowance. Receipts are kept of any money paid out. Each resident has their own bank account and regular audits are undertaken by the company. Middlefield House Nursing Home DS0000002573.V296404.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 3 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 3 X X 3 X Middlefield House Nursing Home DS0000002573.V296404.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. 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. Refer to Standard Good Practice Recommendations Middlefield House Nursing Home DS0000002573.V296404.R01.S.doc Version 5.2 Page 23 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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