Inspection on 05/07/05 for Middleton Hall Ltd

This inspection was carried out on 5th July 2005.

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 11/01/06

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 Co Durham DL2 1HA Lead Inspector Rachel Dean Unannounced Inspection 5 July 2005 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 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 B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Middleton Hall Care Home Address Middleton St George Darlington Co Durham DL2 1HA 01325 332207 01325 332522 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Middleton Hall Ltd Mrs D Lamont Care Home 64 Category(ies) of OP - 64 registration, with number PD - 64 of places TI - 5 Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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 1-20, 22-23 and Care Homes rooms 15, 32, 33 and 38. Date of last inspection 02 March 2005 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 B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Middleton Hall took place on Tuesday 4th July 2005. This inspection focused on how service users are admitted to the home, the records that are kept about their care needs, how well care is actually provided, how medication is managed, what social activities take place and the quality of the food and drink. During the inspection a selection of care records were inspected and five service users and a relative were spoken to in detail about the care they received. The registered manager, manager of the nursing unit and a member of care staff were also spoken to about the care provided at Middleton Hall. The lunch time meal was observed and the menus for the meals provided over the last four weeks were inspected. What the service does well: What has improved since the last inspection? What they could do better: Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 6 The way Middleton Hall assesses the need for bedrails and the risk of individuals using them could be improved to help keep the people who use them safe. Due to changes in the way nursing homes are required to dispose of unused medication, it is required that Middleton Hall makes suitable arrangements for the disposal of medication that meets the new requirements. Guidance on this issue was provided during this inspection. It has also been recommended that advice is sought from the fire authority about propping doors open in a safe way, so that residents would be protected in the event of a fire. These things were discussed with the manager during the inspection and will be addressed as soon as possible. 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 B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 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 standard(s) 3 & 6 Admission procedures at Middleton Hall ensure that service users needs are assessed before they move in to the home. This makes sure that needs of the service users living at the home can be met. Middleton Hall do not provide intermediate care. EVIDENCE: During this inspection a selection of assessment and admission records were inspected. These records showed that pre-admission assessments had been completed and that information had been gathered from other professionals, such as hospital staff, social services and nursing staff where this was appropriate. Discussions with staff, service users and a relative confirmed that information was gathered about people’s needs before they came into the home. During the inspection someone came to look around the home and was shown around by the manager and made to feel welcome. The people spoken to also confirmed that they or their families had come to look around the home before they moved in and that some had come for short ‘trial’ stays before deciding to move in permanently. Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 & 11 Each service users health and personal care needs are set out in an individual plan of care, to ensure that staff are aware of each persons care needs. Robust procedures are in place to ensure that the health and medication needs of service users are met in a safe way. Service users and their relatives felt that their privacy and dignity were respected by staff at Middleton Hall. Specialist training for staff helps to ensure that care given to people at the end of their lives is given with sensitivity and respect. EVIDENCE: During this inspection the care plan and records kept about five service users were inspected. All five people had a care plan in place that provided information about the persons care needs, although there was some duplication of information in two cases, which the manager agreed to look into. Care plans included risk assessment documentation, records of changes in health and personal care needs and were agreed and signed by the service user or their relative where this was more appropriate. However, some of the documentation regarding the use of bedrails would benefit from being more Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 10 detailed and more specific. It is recommended that the registered persons consider developing a specific tool for assessing the need for bedrails, risk assessing their use and the action needed to minimise any identified risk (for example, using specialist mattresses with bedrails, confusion and likely movement of the individual while in bed) and recording regular maintenance checks. The Medical Devices Agency and Health and Safety Executive guidance on the safe use of bedrails should be used for this and were provided during the inspection. The service users and relative spoken to during the inspection indicated that they had regular involvement in reviewing the care plans and making changes to it where this was necessary. Where needs had changed these were recorded in the care plan, however, reviews were not recorded where there had been no change. During this inspection a selection of records regarding medication were inspected. Suitable recording and storage systems were in place, with records available to show that staff have been well trained and that regular checks are made by management to ensure that medication continues to be stored and administered appropriately. Several examples of good practice were identified during the inspection, including the three monthly analysis of the medication administration records to identify any patterns, such as regular refusal. This analysis was also linked with the homes regular falls analysis, helping to identify any circumstances where medication may be contributing to falls. Any issues are then brought to the GP’s attention so that they can be sorted out. In addition to this the home arranges annual ‘birthday checks’ around each service users birthday, where the GP carries out a health check and medication review. However, due to recent changes in the requirement regarding how care homes with nursing have to dispose of medication, it is required that Middleton Hall makes suitable arrangements for the disposal of medication that meets the new requirements. Guidance on this issue was provided during this inspection. Discussion with service users and a relative during the inspection indicated that the staff at Middleton Hall are polite, friendly and treat the people living in the home with respect. One relative told the inspector how the staff always drew the curtains and shut the door when helping his wife with personal care, while another service user said ‘No one comes in without knocking and they call out as they open the door, they’re friendly and very helpful. I now need help getting in and out of the bath and they help very nicely’. Middleton Hall is registered to provide care to people who have a terminal illness. Three of the nursing staff and six care staff have now completed a formal training course on ‘the care of the dying’ and the home is looking at ways of developing links with a local hospice. Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12, 13, 14 & 15 Middleton Hall provides a range of activities that are currently being developed further. This means that service users can choose to take part in a range of regular social and leisure activities if they wish. Visitors are welcomed at Middleton Hall, so that service users can maintain contact with family and friends and have visitors at times that are convenient to them. A varied menu is provided at Middleton Hall, including choices and alternatives. This helps to ensure that people living in the home have varied and nutritious diet. EVIDENCE: The provision of social activities at Middleton Hall has been reviewed since the last inspection. A programme of activities is in place, but this is used flexibly so that activities can be tailored to the wishes of the service users at that time. A record of the activities actually undertaken is kept and the involvement of individual service users is recorded in their care notes. Activities include regular visits from an alternative therapist, exercise classes, newspapers, jigsaws, quizzes, outings and games. Discussions with the manager indicated that they are trying to develop social activities into everyday life by involving Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 12 care staff and doing more one to one activities where this is appropriate. Service users indicated that there were things going on and that they could join in with activities if they wished. For example, one service user commented ‘there are things going on, but I like to stay up here on my own, sometimes I go and watch or join in dominoes, jigsaws, quizzes, there are plenty of activities’. The service users and relatives spoken to spoken to during this inspection said that visitors were able to visit the home as often as they wished and were made to feel welcome. A relative spoke about how approachable the staff were, answering any queries and keeping the relative informed in an appropriate way. The unique structure of Middleton Hall, with the separate residential care apartments, studios, residential care home and nursing unit provide a wide range of care options for people, depending on their individual needs and preferences. Choices are available in many aspects of daily life, such as meals, activities and whether to spend time in communal areas or private rooms. Where people are able they are encouraged to manage their own finances and medication. These things were recorded in individual plans of care. The menus for the last four weeks at Middleton Hall were provided to the inspector and showed that the home provides a varied and appealing diet for service users. Staff training has included ‘focus on food’ to ensure that the nutritional needs of the residents are understood and met. The service users spoken to during the inspection confirmed that a choice of meals was offered and that the quality of the meals was good, with good portion sizes provided. The relative of a service user who needed a soft diet commented on how nicely these meals were presented, with each piece of food pureed separately and arranged nicely on the plate. One service user made an interesting comment, saying that the food was good, but there were a few things that could be improved, for example ‘by now I would expect nice new potatoes, but we are still having mash’. Discussions with the manager indicated that a new chef has recently been appointed to develop the provision of food at the home further. Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 13 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 standard(s) These areas were not assessed during this inspection. EVIDENCE: Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 14 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 standard(s) These areas were not assessed during this inspection. However, advice needs to be sought from the fire authority to ensure that where doors are propped open this is done safely. EVIDENCE: It is recommended that advice is sought from the Fire Authority regarding the home’s current practice of propping some doors open with wooden chocks. 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. Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These areas were not assessed during this inspection. EVIDENCE: Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These areas were not assessed during this inspection. EVIDENCE: Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 4 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 18 No Are there any outstanding requirements from the last inspection? 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 9 Regulation 13(2) Requirement Due to recent changes in the law regarding how care homes with nursing have to dispose of medication, it is required that Middleton Hall makes suitable arrangements for the disposal of medication that meets the new requirements. Guidance on this issue was provided during this inspection. Timescale for action 30th September 2005 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 7 Good Practice Recommendations It is recommended that the registered persons consider developing a specific tool for assessing the need for bedrails, risk assessing their use and the action needed to minimise any identified risk (for example, using specialist mattresses, confusion and movement while in bed) and recording regular maintenance checks. The Medical Devices Agency and Health and Safety Executive guidance on the safe use of bedrails should be used for this. It is recommended that advice is sought from the Fire Authority regarding the home’s current practice of propping some doors open with wooden chocks. Where B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 19 2. 19 & 38 Middleton Hall Care Home 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. Middleton Hall Care Home B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection 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 B54 S0730 Middleton Hall V228408 050705 Stage 4.doc Version 1.30 Page 21 - 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. 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