CARE HOMES FOR OLDER PEOPLE
Middleton Manor Care Centre Middleton Hall 48 Wantz Road Maldon Essex CM9 7DJ Lead Inspector
Sharon Thomas Unannounced Inspection 2nd February 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 Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 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 Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Middleton Manor Care Centre Address Middleton Hall 48 Wantz Road Maldon Essex CM9 7DJ 01621 856464 01621 851535 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) Ashbourne (Eton) Limited Manager post vacant Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home may accommodate 41 persons of either sex who only fall within the category of Old Age 27th October 2005 Date of last inspection Brief Description of the Service: Middleton Manor is a large three-storey property adjoining other properties in a residential area close to the centre of Maldon. The home is owned by Asbourne Healthcare. Residents’ bedrooms are located on all three floors of the home and comprise of 31 single rooms and 5-shared rooms. On the ground floor of the home there are two communal lounge/dining rooms and two communal lounges. On the first floor there are two small conservatory type lounges also available for residents. Two passenger shaft lifts provide access between all floors. The home provides 24-hour personal care and support to residents with varying dependency levels. The home is well decorated and furnished throughout. Visitor car parking is provided to the side of the property. At the rear there is large patio style garden that is fully enclosed and has been subject to extensive improvements. Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 2 February 2006, and took 5.5 hours to complete. Nine of the thirty-eight National Minimum Standards were inspected: five were met, and four were nearly met. For the purpose of this report the individuals living in the home spoken with on the day stated that they would prefer to be called residents. The inspection process included: discussions with the manager, two members of staff, two residents and one relative. The tour of the premises included observation of four bedrooms, bathrooms and toilets, communal areas, the kitchen and the laundry. There was an opportunity to spend a considerable period of time observing the care being provided by the staff. The inspection included the examination of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). The home was warm clean and tidy. The residents spoke highly of the care that they receive in Middleton Manor and spoke highly of the efforts of the staff. The home has a permanent manager in post and she is currently applying to the Commission for Social Care Inspection (CSCI) for registration. The home has a number of residents who appear to have dementia, this issue was identified at the previous inspection and since then the home has reassessed the residents and have made an application to vary the registration to residential care with specific beds for dementia. What the service does well:
The home provides residents with a comfortable warm and friendly environment. Middleton Manor is homely in nature and provides residents with appropriate aids and adaptations to ensure a safe environment. The residents receive care from a well-trained staff team. The staff in the home are sensitive, kind and caring and have a sound knowledge of the residents that they work with. Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 6 The systems used in the home safeguard the residents from abuse. The staff are aware of the complaints procedure and the Adult abuse process and procedure. The staff have received sustained training with regard to this issue. The home has identified the need to change its registration to include dementia beds; the home has made the necessary changes to ensure that they can meet the needs of these residents. The residents and the relative spoken with commented that the staff working in the home are respectful and kind. Many comments were made regarding the professionalism of the manager and the staff, and all felt that their needs were being met in Middleton Manor. What has improved since the last inspection? What they could do better:
The home’s care plans do not contain adequate information that directs staff on how to deliver the care that the resident needs. The risk assessments used in the home do not contain sufficient information and do not identify all the risks experienced by the residents. The daily records used in Middleton Manor
Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 7 are not satisfactory; they do not give a clear indication of the care that is actually being provided. The assessments used in the home did not contain enough information to ensure that the residents’ needs were being met. The care plans were not reviewed on a regular basis. The home does not provide a full range of options at breakfast time. The home does not provide a full range of fresh fruit to residents. The kitchen in the home was not cleaned to an acceptable standard. The home did not have a robust recruitment system in place that safeguarded the residents. The home did not gather all of the required information prior to recruitment of staff. Middleton Manor had not implemented a comprehensive quality assurance system that enabled the home to analyse and monitor the care provided in the home. 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 Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 8 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 Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 9 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): None of the above standards were inspected – please see previous report. EVIDENCE: Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 Care plans examined indicated that the home’s care planning systems are insufficient. The residents care needs were not fully identified, planned for, or monitored in an appropriate manner. The shortfalls identified have the potential of placing resident at risk. EVIDENCE: Three care files were examined on the day. None of the three contained sufficient information regarding the resident’s need, the action to address this need, and the long-term outcome of the care given. The care plans did not cover all aspects of a resident’s physical, mental and social needs. Risk assessments and manual handling assessments were not completed with enough detail to enable staff to deliver care that is safe and appropriate. One care plan was that of the newest admission into the home. This care plan did not contain adequate information regarding the needs of the resident, or the action needed to ensure that the resident was well cared for. This care plan contained both risk or manual handling assessments but contained limited information. The concerns regarding the lack of information contained in care plans was discussed with the manager and care manager and it was agreed that urgent action to address this situation would to be taken by the staff. All of the care plans examined indicated that these were not reviewed on a
Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 11 monthly basis. There was no evidence to suggest that residents signed care plans or were involved in the planning process. The daily records contained in the care plans contained limited information, and at times only one of the three shifts was recording the care being provided. Residents spoken with confirmed that the staff in the home provided them with a good level of support and assistance. The relative spoken with reported that the home would contact them if there was a change in need, but they had not seen the changes made in the care plan. Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 15. The home provides the residents with flexibility and choice with regard to their daily lives. Residents are enabled to maintain contact with relatives and friends and the local community as they wish. Residents are provided with a varied, nutritional and wholesome diet that addresses specific individual needs. The assistance that residents require at mealtimes is not not fully provided. EVIDENCE: Staff, residents, and the relative spoken with confirmed that residents see relatives and professionals in private. Visitors to the home are welcomed at any time and there are no restrictions on visiting time. External entertainment is provided in the home and this was displayed in the foyer. The staff are provided with training regarding resident choice and providing a flexible service. The staff confirmed that residents choose who they wish to see and when. Overall all residents spoken with were positive about the meals provided, and confirmed that a choice of food was available. They commented that the breakfast served was “always the same” and “was boring”. The residents
Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 13 confirmed that they would “like to be offered a cooked breakfast”, “at least once a week”. The main meal served on the day was well presented and appealing. The cook showed a good knowledge of residents personal preferences and any individual needs, and was flexible and adaptable with respect to the meals provided. Nutrition records showed a good range of meals being provided. At lunchtime staff assisted some of the residents in an appropriate and discreet manner, and the dining environment was pleasant. The food stocks in the home were high in quality and quantity and staff stated that they had access to food when the chef finished his shift. The home offered limited fresh fruit (bananas only) and this issue was discussed with the manager on the day. The standard of hygiene in the kitchen was poor and the equipment and surfaces were in need of a deep clean. Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home provided residents and relatives with a thorough and comprehensive complaint policy and procedure that enables them to make a complaint. The home operates appropriate practices and procedures to protect vulnerable adults. The manager and staff actively promote awareness of adult protection issues. EVIDENCE: The home has Complaint Procedure that was both clear and concise. The document directed the individual on how and to whom, to make a complaint. It contained timescales for action, and the details of the CSCI. It was written in plain language and was user friendly. One resident confirmed that they were aware of the existence of the Complaint procedure, and they were able to confirm that they knew who to complain to, and felt confident that their concerns would be dealt with immediately. The home’s complaint log contained one new complaint and this was well recorded and dealt with in a timely and appropriate manner. The complaint log was well maintained, and up to date. This standard was not fully inspected. On the previous inspection it was identified that the home had not responded appropriately to an allegation from a resident. However, since the previous inspection the home has responded to the allegation using the home’s Protection of Vulnerable Adults policies and procedures. During this event the manager contacted the CSCI for advice and support and the issue was dealt with by the home in a satisfactory manner. Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were inspected – please see previous report. EVIDENCE: Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 16 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): 28, 29 There is a stable and loyal staff team, which ensures consisitency in the delivery of care. Overall the recruitment procedure in the home was not robust and therefore did not ensure the safety and protection of the residents. EVIDENCE: Records confirmed that of the 27 staff currently employed at Middleton Manor nine members of staff in the home had achieved the NVQ Level 2 qualification while five members of staff were undertaking the NVQ Level 2. The manager provided evidence that the home is securing places with the provider on the NVQ Level 2 for the remaining thirteen staff. The staff personnel files of the two newest recruits to the home were examined on the day. These both contained some of the information needed to ensure the safety of residents through the recruitment process. They both contained a POVA first/Criminal Reference Bureau check. One file contained the required two references, while the other contain only one reference. Both files contained a photograph of the member of staff and only one contained the required personal ID. Both members of staff had received a contract of employment and a copy of the General Social Care Council Code of Conduct for staff. Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 17 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): 33 & 38. The home does not have systems in place to ensure that the quality of care is measured and acted upon. Middleton Manor has comprehensive health and safety systems in operation, to ensure the ongoing welfare of both residents and staff. EVIDENCE: The home provided staff with appropriate Health and Safety training. Risk assessments of the premises are undertaken and regular Health and Safety checks of the facilities and equipment are also undertaken. The manager was able to discuss relevant Health and Safety legislation and is committed to the welfare of both the residents and staff group. Hot water, fire alarm and equipment checks are accurate and up to date. The staff spoken with are committed to the safety of the residents in their care. Staff are aware of Health and Safety issues around the home and wore personal protection clothing when required.
Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 18 Although the standard regarding quality assurance was not fully inspected, records confirmed that the home has completed resident and relative questionnaires. However, the manager was not aware of the quality assurance process and confirmed that she would get support through the management to enhance her knowledge. The results of the survey have not been analysed and the manager agreed to send the results to the CSCI when completed. Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 19 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 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 3 Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 13 (4) 15 (1) Timescale for action The registered person must 02/02/06 ensure that service users are involved in the care planning process. The care plans must contain fully complete and detailed risk assessments. The care plans must contain information regarding all aspects of care. The daily records must reflect the care that is provided by the home. The monthly reviews must be detailed and comprehensive. This is a repeat requirement and some of the above elements were initially identified in January 2005. The registered person must 31/03/06 ensure that the home provides a varied and nutritional meal to the residents. The home must consult with, and act upon residents’ choices with regard to the menu. The home must provide a choice of fresh fruit to the residents. The kitchens must be cleaned to a high standard to safeguard the residents under Health & Safety regulations.
DS0000017886.V283171.R01.S.doc Version 5.1 Page 21 Requirement 2. OP15 12 (1) 13 (2) Middleton Manor Care Centre 4. OP29 24 (4) (5) 4. OP33 18 (1) (a)19 The registered person must 02/02/06 ensure that the home secures all of the required recruitment documentation prior to the appointment of staff. Staff should not start work in the home until all checks are undertaken and are satisfactory. The registered person must 31/03/06 ensure that the quality assurance system used in the home is fully implemented and that the manager is supported to undertake this task. 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 Middleton Manor Care Centre DS0000017886.V283171.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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