Inspection on 12/06/07 for Middleton Hall Ltd

This inspection was carried out on 12th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 11/01/06

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 09:30 12 & 13th June 2007 th 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.V342332.R03.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 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.V342332.R03.S.doc Version 5.2 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) of places Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 - Residential Care Apartments 1-20, 22-23 and Care Home rooms 15, 32, 33 and 38. 11th January 2006 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 provides residential and nursing care and offers a range of accommodation options. Service users have the choice of residential care apartments, studios and more traditional bedrooms, depending on their level of need. At the time of this inspection the home was developing a block of retirement apartments and building a new nursing facility that will provide modern en-suite accommodation. At the time of this inspection it cost between £290 and £685 per week for care at Middleton Hall. Up to date information about fees should always be sought from the home’s manager. Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 12th and 13th June and was completed by one inspector. During the site visit the inspector spent time observing the care that people were being given, talking to people about their experiences of living at the home, talking to staff, the manager and director, and looking at a selection of the home’s records. A number of surveys were given to people so that they could let the inspector know their views if they wished to. What the service does well: Comments made about the care at Middleton Hall include ‘the staff are very happy and welcoming and nothing is too much trouble. Mum is very content there and I know she is receiving the best possible care’, ‘all carers help and are good’, ‘the staff are very good, they’ll do anything you ask them, no complaints at all’ and ‘I have been very impressed by the standards of care at Middleton Hall’. People receive the health and personal care that they need and medication is managed safely at the home. People were complimentary about the meals provided at Middleton Hall, confirming that they got plenty of choice. Special diets and individual preferences are catered for. Visitors felt that they were welcomed into the home and encouraged to join in with social events, such as having meals with their relative or friend. The home offers a variety of different types of accommodation, with large, comfortable rooms and a high standard of furnishings. Building and refurbishment work is currently being carried out. This will provide high quality, modern facilities and accommodation, including a new unit providing nursing care and more en-suite rooms. Staff training is given a high priority at Middleton Hall, with staff feeling that they are given lots of training opportunities and support. Over 80 of the staff have a National Vocational Qualification in care and other training is provided regularly. New staff are only taken on after a thorough recruitment process, including interviews, obtaining references and Criminal Records Bureau disclosures. The home has a very strong management team, with a very experienced and capable registered manager. Standards in the home are monitored by regular checks and systems, including feedback from people living in the home. Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 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.V342332.R03.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessment procedures are in place, making sure that the home can meet the needs of people before they move in. People are provided with information about the home and can visit before deciding if they want to live there permanently. EVIDENCE: The home has a lot of written information that it provides to people about the care and service they can expect from Middleton Hall. The manager and director are aware of recent changes to the requirements around providing people with information about terms, conditions and fees. A review of the home’s information is being undertaken, to make sure that they are providing people with the information they need. It is recommended that this process is completed as soon as possible. Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 9 A selection of the home’s records were inspected, including records of assessments and admissions. Pre-admission assessments had been completed and information had been gathered from other professionals where this was appropriate. Since the last inspection the home has reviewed it’s assessment documentation to make it more user friendly. People confirmed they had been able to visit the home before moving in and some had stayed at the home for short periods before deciding to move in permanently. Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive the health and personal care that they need and are treated with respect by care staff. Care records provide staff with information about people’s needs, but these could be more detailed and person centred. Medication is stored and administered safely. EVIDENCE: During this inspection a selection of care records were looked at. The records that were looked at were generally satisfactory, although some of the information was very general. The information about people would benefit from being more detailed, individually specific and person centred in style. The home would also benefit from reviewing the paperwork system it currently uses for people visiting the home for short-term care, to make it less repetitive and more user friendly for those people who visit the home more than once. The home’s manager was aware of some of these shortcomings and there are Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 11 plans to introduce a new care planning system, which is more resident focused and will provide the opportunity to include more individual detail in care records. The home continues to carry out internal audits and checks, which help to make sure people are getting the care they need. For example, regular analysis of falls identifies any resident who has had more than three falls and triggers an investigation to identify a cause, such as reviewing their medication and footwear. People were complimentary about the care they received at Middleton Hall. Comments made about the care at Middleton Hall include ‘the staff are very happy and welcoming and nothing is too much trouble. Mum is very content there and I know she is receiving the best possible care’, ‘all carers help and are good’, ‘the staff are very good, they’ll do anything you ask them, no complaints at all’ and ‘I have been very impressed by the standards of care at Middleton Hall’. Observations showed that people looked clean, tidy and were treated with respect by staff. Since the last inspection all staff who are responsible for handling medication have received training on this from a local college. They have also received training from the home on Middleton Hall’s expectations, policies and procedures. Regular checks are carried out to make sure staff are handling medication safely and recording things properly. Observation of a medication round showed medication being given safely, with staff explaining what they were doing to people in a pleasant and friendly way. The home is reviewing it’s current medication system and hope to implement a new system in the near future, with the help of their local pharmacist. Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Activities and social stimulation are seen as part of daily life at Middleton Hall. Visitors are welcomed into the home and encouraged to take an active part in social events. A varied menu, with lots of choice, is provided and people are involved in decisions about menu changes. EVIDENCE: The home has a social care coordinator, who helps organise activities and events at Middleton Hall. Staff also take an active part in people’s social care, with activities and social interaction being built into staff’s daily routine. During the inspection people were seen reading the daily papers and magazines, staff engaged people in quizzes and games, spent time with people while painting their nails or doing their hair. Staff recognised the importance of one-to-one time with residents, particularly those who didn’t want to or couldn’t join in with group activities. A driver has been employed to help with transport and a full activities calander, including events for relatives to join in and opportunities for people to practice their religion, were in place. People confirmed that they enjoyed joining in with the events and activities and that there was enough going on at the home. Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 13 Relatives confirmed that they are always made to feel welcome and that there were no restrictions on visiting. Comments included ‘everyone is extremely approachable’ and ‘I’m always welcomed when I arrive’. Routines at the home were thought to be reasonably flexible, with people choosing where they wanted to spend their time and when they wanted to get up and go to bed. People living in the home were complimentary about the meals at Middleton Hall. People confirmed that there was lots of choice, including a vegetarian option available now that a couple of vegetarians lived at the home. People were happy with the amount of food available and confirmed that portions were generous. Menu’s and records showed that people received a balanced diet and that individual needs and preferences were catered for. A group of residents confirmed that they had recently had a meeting with the kitchen staff to talk about the meals and what changes they would like. One relative confirmed how their relative, who had been underweight on admission, had successfully put on a lot of weight and really enjoyed the food. Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. 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, investigated properly and used as a way of improving the service. People spoken to during the inspection felt that they could speak to the manager or 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 in ‘the protection of vulnerable adults’ takes place every year and that abuse policies and procedures are covered in the induction of new members of staff. Allegations and suspicions of abuse have been handled correctly by the home in the past. Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Middleton Hall provides people with a comfortable and well maintained place to live. The refurbishment and extensions that are currently in progress will provide good quality, modern facilities for the people living at the home. EVIDENCE: Middleton Hall is undergoing a period of investment, refurbishment and extension. A new nursing wing is being built and will provide modern and spacious en-suite accommodation. The residential accommodation will also soon benefit from refurbishment, to provide more en-suite rooms and modern facilities. The inspection showed that disruption to residents during this work is being carefully managed. Areas of building work are being partitioned off and residents who are close to the work have been offered alternative rooms where this is possible. People living in the home confirmed that they have Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 16 been kept well informed of the plans and the progress of the building works. Other parts of the home were nicely decorated, comfortable and maintained to a high standard. People living in the home confirmed that it is kept clean and tidy. A suitable team of domestic staff is employed and a new domestic supervisor is being recruited. This post will be responsible for managing the home’s domestic and house keeping staff once the home’s expansion is completed. Staff receive training in infection control. Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Middleton Hall employs a well trained and competent staff team. Staff are recruited safely and staffing levels are under review to make sure that sufficient staff are always on duty. EVIDENCE: Staffing levels at Middleton Hall are under review, with plans to increase day and night time staffing levels through out the home. This is because of the increased number of people who will be living at the home when the extension and refurbishment work is completed. At the time of this inspection staffing levels seemed to be sufficient and the home has recently recruited staff to fill vacancies. A couple of people did comment that they sometimes had to wait for assistance or found it difficult to attract staff attention. One person commented ‘they have too much to do, that’s the problem’. However, other people commented that staff came promptly if they ‘buzzed’ for assistance and were always helpful. Discussions with the manager indicated that although the home had recently had vacancies, staff had covered shifts so that staffing levels in the home had never been reduced. Discussions with other staff confirmed this and staff generally felt that staffing levels were satisfactory. Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 18 Training is seen as very important at Middleton Hall. Staff confirmed that they are provided with lots of training opportunities and 82 of care staff have achieved an National Vocational Qualification (NVQ) level 2 in care. Recent training at Middleton Hall has included first aid, manual handling, fire, protection of vulnerable adults, nutrition, medication, food hygiene and infection control. A random selection of staff recruitment records were inspected. These were well organised and showed that people were recruited thoroughly and safely. The recruitment process included interviews and obtaining two written references and a criminal records bureau (CRB) disclosure before staff started work. There was evidence of people being refused work where they did not meet the standards that Middleton Hall expected. Middleton Hall has also recruited a number of male carers, helping to increase the choice that people have about who provides their care (for example, male residents now have more access to male care staff). Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. 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. Maintenance, servicing and health and safety systems are in place and help to keep staff and service users safe. EVIDENCE: 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. The management team at Middleton Hall continue Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 20 to actively develop and improve the service and are always looking for ways in which they can do things better. 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 within the home. 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. 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. A random check of maintenance information confirmed this. 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 the hot water tests could be improved. Middleton Hall Care Home DS0000000730.V342332.R03.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 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Middleton Hall Care Home DS0000000730.V342332.R03.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. 1. Refer to Standard OP2 Good Practice Recommendations It is recommended that the home reviews the information it provides to people about Middleton Hall, including it’s contracts and terms and conditions, to make sure that they are compliant with the new regulations and the Office of Fair Trading’s recommendations. It is recommended that the information in people’s care plans is developed to be more detailed, individual and person centred. It is recommended that the assessment and care planning paperwork for respite admissions is reviewed and made more user friendly, especially for people visiting the home for multiple stays. It is recommended that the regularity and frequency of hot water temperature tests are reviewed, to make sure all outlets are tested regularly. 2. OP7 3. OP38 Middleton Hall Care Home DS0000000730.V342332.R03.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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. 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