Inspection on 27/10/05 for Middleton Manor Care Centre

This inspection was carried out on 27th October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Middleton Manor Care Centre 11/09/07

Middleton Manor Care Centre 20/09/06

Middleton Manor Care Centre 02/02/06

Middleton Manor Care Centre 14/01/05

Middleton Manor Care Centre 21/06/04

Middleton Manor Care Centre 22/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Middleton Manor Care Centre Middleton Hall 48 Wantz Road Maldon Essex CM9 7DJ Lead Inspector Sharon Thomas Unannounced Inspection 27th October 2005 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.V262352.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 Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 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.V262352.R01.S.doc Version 5.0 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 Date of last inspection Brief Description of the Service: 14/01/05 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. The home is situated a few minutes walk from Maldon High Street with a wide range of shopping facilities and access to public transport links. Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 27th October 2005, and took 5.5 hours. Fourteen of the thirty-eight National Minimum Standards were inspected; nine were met, and five 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, and three residents. The tour of the premises included observation of six bedrooms, the bathrooms and toilets, the 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, it was agreed that a re-assessment of these residents would be completed with a view to the home applying to vary the registration to residential care with specific beds for dementia. A meeting between Ashbourne Healthcare and the CSCI has taken place to discuss this issue. What the service does well: Overall, the information held in the home about residents is generally well maintained and well recorded. The home has close links with the health care team in the area and works with both professionals and residents to promote and maintain the residents health. The home promotes the rights of the residents and staff provide care that ensures privacy and dignity. The residents interacted comfortably with the staff. The home provides a warm and homely atmosphere for residents. The home has created a family type atmosphere that all of the residents spoken with mentioned. Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 Page 6 The residents living in Middleton Manor benefit from an established and knowledgeable staff group who give sensitive and professional care. The staff have a well-formed knowledge regarding the needs of the individual residents. This was seen in the positive relationships that have formed between the residents and staff. 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. Middleton Manor Care Centre DS0000017886.V262352.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 Manor Care Centre DS0000017886.V262352.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): 3 The home did not receive all of the appropriate information required prior to admission. The lack of information may result in the inappropriate admission of a resident and place that person at risk. EVIDENCE: Four care plans were examined; two of the care plans looked at were those of the newest admission into the home. These did not contain a social services assessment and there was no evidence that the resident and their family were involved in the care planning process. The home had used its own preadmission assessment and the information gathered was insufficient. Middleton Manor Care Centre DS0000017886.V262352.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): 7, 8 & 10 Overall, the care plans identified the needs of the residents and were detailed and well maintained. The staff have a sensitive and caring approach towards residents and treat them with dignity and respect. The residents’ healthcare needs are well met in Middleton Manor. The residents’ care plans are detailed and directive. EVIDENCE: Four care files were examined. All contained detailed information regarding the resident’s need, the action to address this need, and the long-term outcome of the care given. The care plans covered nearly all aspects of the individual resident’s physical, mental and social needs, and were reviewed on a monthly basis. All of the care plans contained a detailed risk assessment and manual handling assessments. There was no evidence that residents signed care plans and were involved in the planning process. Residents spoken with confirmed that the staff in the home provided them with a good level of support and assistance. They commented that the staff “had taken the time to get to know what I needed,” and “I trust the staff to provide me with what I need,” and that staff “do a very good job to look after all of us.” Staff were Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 Page 10 observed treating residents with care and sensitivity, addressing residents appropriately and demonstrating a genuine level of care. The four care plans examined all contained clear and detailed instructions for the delivery of personal care for residents. Oral healthcare was detailed in the care plans. Routine health checks offered, such as optician, dentist, and podiatrist, were documented. The home provided residents with access to aids and equipment to address their healthcare needs and issues. The manager stated that the home is well supported by the local primary healthcare team. The care plans contained additional information that included moving and handling, pressure care, and continence assessments. Two service users stated that they were confident that staff would take the “right decision when they were ill,” and that “the staff always contact my family when I am poorly.” The residents spoken with spoke highly of the treatment they received from staff in Middleton Manor. The residents stated that their privacy and dignity was maintained in a variety of ways, including the way staff provided personal care, toileting issues, respect for visitors, and the provision of private areas in the home that enabled residents to see visitors in private. Observation of staff during the inspection indicated that staff were friendly, considerate and respectful toward residents. Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 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 the following standard(s): 12 & 14 Overall, the home provides an appropriate range of activities for residents. Routines in the home are flexible and residents are enabled to exercise choice. EVIDENCE: Middleton Manor has a dedicated activity co-ordinator who works 15 hours a week. The activity programme offered a variety of social activities that were appropriate to the needs of the residents. However, the manager and the inspector agreed that 15 hours a week did not provide enough activity time for the residents. The care plans looked at detailed the social and recreation needs of the residents. The residents were observed spending time in various parts of the home, communal areas and in their bedrooms. All of the residents spoken with confirmed that there was a programme of activity and that “there was always something to do,” and “sometimes we have outside entertainment.” Regular social events take place and residents confirmed that they were consulted regarding the entertainment brought in from the outside. The manager confirmed that the home does not act as appointee for any of the residents living there. The residents spoken with on the day were aware of the advocacy service and this information was displayed in the home. Arrangements for residents to bring in possessions were discussed prior to admission, and records of possessions were available. One resident Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 Page 12 commented that they felt that they were “happy with the routines in the home.” Staff reported that they always try to offer choice to the resident and that “choices are always offered to residents.” Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 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 the following standard(s): 16 & 18 The home provided residents and relatives with a thorough and comprehensive complaint policy and procedure that enables them to make a complaint. Overall, 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 a 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 not aware of the existence of the complaint procedure, however, 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 did not contain any new complaints, it was well maintained and up to date. The home had a comprehensive and clear set of Protection of Vulnerable Adult from abuse policies and procedures, produced by Ashbourne Healthcare. The home had clear guidelines for staff to follow should an allegation of abuse be made. Copies of the relevant national guidelines were available to staff. The most recent copy of the Essex County Council practitioner guidelines was not held in the home. One incident that appeared to be an adult abuse issue had not been dealt with appropriately. This was discussed on the day and it was agreed that the manager would refer the issue to social services for advice. The senior on duty was not fully aware of the adult abuse procedures and Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 Page 14 would benefit from appropriate training. One resident stated that they “trusted the staff,” and “had never heard or seen staff treating anyone badly.” Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 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): 19 & 26 Overall, the residents at Middleton Manor live in a safe, well maintained, clean and comfortable environment. EVIDENCE: Middleton Manor is a large property that has been adapted to meet the needs of older people. The building is well maintained, and decorated and furnished to a good standard. The home has a budget that is held at the head office and is accessible to the manager. On the day of the inspection it was found that two fire doors within the home were in need of repair and that this had taken an inappropriate amount of time. This issue was discussed on the day and the manager contacted the head office to resolve the issue. The resident’s comments regarding the environment included: “I always feel safe walking around the home,” “the home is always clean and tidy,” and “the staff work hard to keep the home clean.” Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 Page 16 The home’s laundry facilities are located away from communal areas and individual bedrooms, reducing the risk of cross infection. The equipment in the laundry is suitable for the needs of the residents. The washing machine in use has a sluice cycle that ensures that laundry is washed at appropriate temperatures. The home has a sluice in operation and this was clean and well maintained. Residents confirmed that their clothes were returned from the laundry “washed and ironed,” and “in good nick.” Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 Staffing levels (number and competence) met the needs of current residents. There is a stable and loyal staff team, which ensure consisitency in the delivery of care. The recruitment procedure in the home was robust and provided the safeguards to ensure that appropriate staff were employed. EVIDENCE: The staff rota examined reflected that the home was providing the agreed levels of staff. The home had an appropriate number of day care and night care staff and additional numbers were on duty during busy periods. The staff rota also indicated an appropriate number of ancillary staff to maintain the standards of hygiene in the home. Three staff personnel files examined contained all of the information necessary to ensure the safety of residents through the recruitment process. The three files contained the two required references, a CRB check, an appropriate application form, a photograph, and personal identification. Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 Page 18 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): 31 & 35 Middleton Manor has a competent, skilled and knowledgeable manager who has the confidence of both residents and staff. The home safeguards the resident’s financial affairs. EVIDENCE: The home has a skilled and knowledgeable manager. The manager is currently in the process of registering with the CSCI. The personal accounts of three residents were examined and found to be accurate, well maintained and secure. The records kept in the home, regarding monetary transactions, were accurate and tallied with the money held in individual accounts. Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X X Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 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 OP3 Regulation 14 Schedule 3(1)(a) Timescale for action The registered person must 27/10/05 ensure that home is in receipt of all of the professional assessments to ensure both appropriate, and safe admissions for prospective residents. The registered person must 31/12/05 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. This is a repeat requirement. The registered person must 27/10/05 ensure that procedures relating to the protection of vulnerable adults is followed and accurately recorded. The registered person must 27/10/05 ensure that the home is maintained to provide a safe environment. The registered person must 27/10/05 ensure that staffing levels are maintained at all times. Requirement 2 OP7 13 (4) 15 (1) 3 OP18 12 (1) 13 (2) 4 OP19 24 (4) (5) 5 OP27 18 (1) (a) 19 Middleton Manor Care Centre DS0000017886.V262352.R01.S.doc Version 5.0 Page 21 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.V262352.R01.S.doc Version 5.0 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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