Inspection on 11/01/06 for Middleton Hall Ltd

This inspection was carried out on 11th 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.

Other inspections for this house

Middleton Hall Ltd 12/06/07

Middleton Hall Ltd 05/07/05

Middleton Hall Ltd 02/03/05

Middleton Hall Ltd 05/08/04

Middleton Hall Ltd 04/06/03

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middlesbrough Intermediate Care Centre

The Gardens Care Home

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

CARE HOMES FOR OLDER PEOPLE Middleton Hall Care Home Middleton St George Darlington Durham DL2 1HA Lead Inspector Rachel Dean Unannounced Inspection 11th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Middleton Hall Care Home DS0000000730.V266165.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Middleton Hall Care Home Address Middleton St George Darlington Durham DL2 1HA 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) 01325 332207 01325 332522 debby@middleton_hall.com Middleton Hall Limited Mrs Debby Lamont Care Home 64 Category(ies) of Old age, not falling within any other category registration, with number (64), Physical disability (64), Terminally ill (5) of places Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Convalescent: Persons over the age of 55 may be accommodated commensurate with the home`s statement of purpose. Terminal Illness: Up to 5 persons with a terminal illness (Palliative care) may be accommodated commensurate with the home`s statement of purpose and where appropriately qualified and competent staff are provided Persons with a physical disability over the age of 55 may be accommodated commensurate with the home`s statement of purpose. A maximum of four of the following rooms and apartments may be used as double rooms at any one time - Residents Care Apartments 120, 22-23 and Care Homes rooms 15, 32, 33 and 38. 5th July 2005 3. 4. Date of last inspection Brief Description of the Service: Middleton Hall is a converted Georgian Manor house on the outskirts of Middleton St. George. The home is situated in extensive grounds and gardens that are accessible to the people living there. The home offers both residential and nursing care, short break care and palliative care. Middleton Hall offers a range of accommodation to meet the identified needs of the individual. This includes a number of residential care apartments where more independent people can be accommodated. The apartments are self-contained, though the residents meet together to dine and socialise.The philosophy of Middleton Hall is to promote dignity and encourage independence and choice through a range of services, these include a social care co-ordinator, alternative therapies and opportunities for involvement with the local community. Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Middleton Hall took place on Thursday 11th January 2006. Two inspectors carried out the inspection, including a nursetrained inspector who could look at the nursing care provided at the home. This inspection focused on how complaints are handled and vulnerable adults protected, the standard of accommodation provided and how this is maintained, staffing levels and training, management arrangements, how the home makes sure it is providing a good service and how the home makes sure that people are kept safe. During the inspection a selection of care records were inspected, 4 service users and a visitor were spoken to about the care they received. The registered manager, manager of the nursing unit, a member of nursing staff, manager of the residential unit and two members of care staff were also spoken to about the care provided at Middleton Hall. The inspectors also spent time looking around the home. What the service does well: What has improved since the last inspection? Middleton Hall continues to provide a good standard of accommodation and care for its residents. The home’s management team continues to be quick to address any issues that are identified during the inspection process and to identify other changes that the home would benefit from. For example, since the last inspection the home has made new arrangements for the disposal of medication and has employed a new chef to develop the meals and refreshments provided in the home. Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 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. Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during this inspection. Only outstanding issues were followed up during this inspection. EVIDENCE: Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during this inspection. Only outstanding issues were followed up during this inspection. EVIDENCE: Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during this inspection. Only outstanding issues were followed up during this inspection. EVIDENCE: Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Complaints are taken seriously and investigated appropriately at Middleton Hall. Adult protection procedures are in place to help protect service users from abuse. EVIDENCE: Middleton Hall continues to have in place a suitable complaints procedure. Records of complaints and the action taken to resolve them were available and showed that complaints were taken seriously and investigated properly. People spoken to during the inspection felt that they could speak to staff about any concerns that they had and that these would be dealt with promptly. The home has in place policies and procedures for handling suspected adult abuse and staff were aware of these. Staff confirmed that training takes place in the protection of vulnerable adults and that these policies and procedures are also covered in the induction of all new members of staff. Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Middleton Hall provides a range of accommodation, that is safe, well maintained and provides service users with a pleasant place to live. The home is kept clean and tidy, so that service users with a pleasant place to live. EVIDENCE: During this inspection the inspectors looked round the home and spoke to residents about what it was like to live there. Middleton Hall provides a range of accommodation for residents, including apartments, studios, en-suite rooms and rooms without en-suite facilities. All of the accommodation is decorated and furnished to a high standard. A lot of service users had brought personal possessions and furniture into their personal accommodation and the rooms looked homely and personalised. Staff reported that any maintenance issues were quickly seen to and residents confirmed that they found their accommodation pleasant to live in. On the day of the inspection some service Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 13 users had chosen to sit in the communal lounges where appropriate music was playing and others had chosen to spend time in their rooms. However, on the day of this inspection the heating in some parts of the home (mainly the lounge and dining room of the nursing unit) was not working properly, with supplementary heaters being used. Discussions with the manager confirmed that the heating was in the process of being repaired and that the use of the heaters would be risk assessed to make sure that the supplementary heating being used did not place service users at risk. It was also noticed that some doors (for example, the downstairs residential kitchenette area and office) were left propped open. It is recommended that advice is sought from the Fire Authority regarding the home’s current practice of propping some doors open. Where necessary appropriate door closure systems should be fitted that allow doors to be propped open and keep service users safe in the event of a fire. The home was observed to be clean and tidy on the day of this inspection. The service users and staff who were spoken to confirmed that that was always the case. One service user commented that ‘it’s (the home) immaculate, they’re very particular, forever cleaning’. The laundry was seen to be well organised, with sufficient industrial washers and driers to cope with the amount of laundry Middleton Hall produces. The laundry assistant confirmed that this was the case and that a good maintenance and repair contract made sure that any problems with the laundry machinery were fixed quickly. However, it was observed that there were some gaps in the impermeable floor covering and that small electric heaters were being used to supplement the heating in the laundry. It needs to be considered if these heaters are safe to use in an area where large amounts of washing is being handled and dried. Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Sufficient numbers of staff are on duty at the home. However, night-time staffing levels would benefit from being reviewed to make sure they are sufficient to the needs of residents and the buildings layout. Staff are well trained and well qualified, so that service users are in safe hands and have their needs met at all times. A thorough recruitment process makes sure that all staff are suitable to work in the home. EVIDENCE: During the day the home is staffed as four separate units and the service users and staff spoken to during this inspection were happy with the staffing levels provided. The staff spoken to felt that there was a good staff team at Middleton Hall and service users commented on how staff were ‘pleasant’, ‘easy to get on with’ and that ‘everyone’s very friendly’. However, there was some concern about night-time staffing levels, with only four staff being on duty during the night. Discussions with the manager showed that night staff were consulted about staffing levels, that no concerns had been raised and that systems were in place to raise staffing levels if the dependency levels of residents made it necessary. However, the manager agreed to look into the current night-time staffing arrangements and review if these were satisfactory. Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 15 Training at Middleton Hall is given high priority with staff being well trained and qualified. A high number of staff have achieved either NVQ level 2 or 3 and staff training records showed ongoing training in areas like manual handling and fire safety took place regularly. The staff members spoken to during the inspection were very enthusiastic about training and developing good practice, confirmed that lots of training was available and that any requests for training were taken seriously by management. Nursing staff are given training to keep their practice updated. For example, one nurse on duty said she had received training and updates in palliative care, infection control and the safe handling and administration of medication. The recruitment records for four staff members (two care staff and two nursing staff) were inspected. These records showed that new staff went through a thorough recruitment process. This included obtaining references and a Criminal Records Bureaux (CRB) disclosure, before the staff member started work in the home. Although staff had been given a copy of their terms and conditions to sign, a number of these had not been signed or returned so that a copy could be put on file to demonstrate that the staff member had been given and agreed to those terms and conditions. Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Middleton Hall is well run and well managed by suitably qualified and experience manager and senior staff team. The views of people living in the home are actively sought and used as part of the home’s quality assurance system. Safe systems are in place to help service users manage their personal money. However, some service users may benefit from access to money being available at weekends. Maintenance, servicing and health and safety systems are in place at Middleton Hall to help keep staff and service users safe. However, the use of supplementary heating needs to be carefully considered to make sure it is safe and the current hot water safety checks need to be improved. EVIDENCE: Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 17 The manager of Middleton Hall is well trained, very experienced at managing a care home and registered with the CSCI. Staff reported that there was a good staff team at the home and that the manager and senior staff were approachable and effective. Staff and service users felt that the small individual units were working well, with residents getting to know the small staff teams and having more continuity because of this. A comprehensive quality assurance system is in place at Middleton Hall. This helps the management make sure that they are providing a good service and identify areas that could be improved. The system includes service users, relatives and staff through regular meetings, reviews and surveys. Monthly statistical information about the home (including the occurrence of falls, dependency levels and staff sickness) is collected and analysed, with the results being used to make positive changes to peoples care or systems in the home. For example, if a particular service user has experienced a number of falls the person’s doctor will be involved to review medication, identify any probable cause and take preventative action. Systems are in place to help service users have access to small amounts of money and manage their personal expenses. This system involves a billing system for regular expenses like hairdressing, alternative therapies and chiropody. Petty cash is used for all requests for cash, with the amount then being added to the person’s bill. However, the current system does not allow service users weekend access to cash, unless this is planned in advance when the office is open. Records and receipts of all transactions were available for inspection. Appropriate maintenance and servicing contracts are in place a Middleton Hall to ensure that the building and equipment is appropriately maintained and kept in safe, working order. The home’s maintenance staff carry out regular safety tests of water temperatures, fire alarms and emergency lighting. However, the records of these tests showed that the regularity and frequency of some of these tests needed to be improved. For example, the water temperature tests were carried out very randomly and some rooms were not getting tested. It is also important that, where temperatures are identified as being above 43oC, action is taken to remedy this and that this action is recorded. A number of records showed significantly high temperatures (for example, 51oC) with no record of any action being taken or any reason why action had not been taken (for example, service users request for hotter water and accompanying risk assessment). Middleton Hall Care Home DS0000000730.V266165.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 2 Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 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. 1 Standard OP19& OP38 Regulation 13(4) & 23(2)(p) Requirement The problems with the heating system must be fixed promptly and the supplementary heating being used must be risk assessed to ensure the safety of residents. It needs to be considered if the freestanding electric heaters in the laundry are safe to use in an area where large amounts of washing is being handled and dried. The regularity and frequency of some of water temperature tests needed to be improved. It is also important that where temperatures are identified as being above 43oC, action is taken to remedy this and that this action is recorded. Timescale for action 31/01/06 2 OP19& OP38 13(4) & 23(4) 31/01/06 37 OP38 13(4) & 23(4) 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 20 No. 1 Refer to Standard OP19&OP3 8 Good Practice Recommendations It is recommended that advice is sought from the Fire Authority regarding the home’s current practice of propping some doors open. Where necessary appropriate door closure systems should be fitted that allow doors to be propped open and keep service users safe in the event of a fire. The gaps in the laundry’s impermeable floor covering should be repaired or the floor covering replaced. It is recommended that night-time staffing levels in the home are reviewed, with consideration to the dependency of residents and the layout of the building. A signed copy of terms and conditions should be kept on each staff members file. It is recommended that systems are developed to allow resident access to their personal monies at weekends. 2 3 4 5 OP26 OP27 OP29 OP35 Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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 Middleton Hall Care Home DS0000000730.V266165.R01.S.doc Version 5.0 Page 22 - 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. 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