Inspection on 26/04/06 for Middletown Grange

This inspection was carried out on 26th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Middletown Grange 11/08/08

Middletown Grange 14/08/07

Middletown Grange 08/11/05

Middletown Grange 08/06/05

Middletown Grange 26/01/05

Middletown Grange 06/09/04

Middletown Grange 09/12/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Middletown Grange Middletown Hailey Witney OX29 9UB Lead Inspector Kate Harrison Unannounced Inspection 26th April 2006 09:20 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 Middletown Grange DS0000040174.V291408.R02.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. Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Middletown Grange Address Middletown Hailey Witney OX29 9UB 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) 01993 700396 01993 775704 middletowngrange@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited Care Home 40 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (1) Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Condition 1 Of the 40 places in the home, up to 30 places may be used for service users with nursing needs being met by the nursing staff in the home. Condition 2 The individuals with nursing needs must fall within the OP category, as the nursing facilities are not providing a specialist service for any other category of care. Condition 3 The 10 non-nursing residents in the home may fall within the following categories: OP; DE(E) and PD(E). Condition 4 The home must be staffed to a least the minimum levels within the agreed staffing statement for the home. Condition 5 A maximum of 5 beds may be used for intermediate care (N) within a designated area of the home as agreed with CSCI. Service users to be accommodated in intermediate care beds must be aged over 65 years. 8th November 2005 3. 4. 5. Date of last inspection Brief Description of the Service: Middletown Grange is registered to provide care for up to 40 residents aged 65 and over, and is owned by Barchester Healthcare Limited. Thirty beds are registered for nursing care, including five beds used by the NHS Primary Care Trust for the intermediate care of individuals discharged from hospital awaiting return to their home. There are two spacious lounges, a conservatory and a separate dining room on the ground floor, with bedrooms on the ground and first floors. Recreational and social activities are provided and there is a large enclosed front garden. The home’s scale of charges range from £650 to £750 per week, and the home is situated in a village location approximately 4 miles from the market town of Witney. Phase 1 of the building programme is nearing completion, and when all the building work is completed the home will provide separate accommodation for individuals discharged from hospital and expecting to return home, as well as improved accommodation for the other residents of the care home. Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 09.20 hours and was in the service for 9.5 hours. This inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the home since the last inspection. The inspector saw all areas of the home and looked at records and documents relating to the care of the residents. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. Nine comment cards were received from relatives, four from residents and two from health care professionals. 28 residents were at the home on the day of inspection, and a group of staff were away from the home attending training on dementia care. Building work was in progress and a new fire alarm system was being fitted. The new manager is undertaking training on equality and diversity, and the staff group represents nine nationalities. From other evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. The inspector looked at how well the service was meeting the standards set by the government and has, in this report, made judgements about the standard of the service. What the service does well: Residents feel well cared for by the staff, and all comments about the staff were very complimentary. Comments included: ‘Wonderful’, ‘Marvellous and kind’ and ‘They go out of their way to be helpful’. Residents enjoy the range of activities provided, and appreciate the qualities of the activities organiser. Maintenance issues are quickly addressed. Good food is provided, and the chef keeps in touch with the residents’ preferences. Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 Page 6 The home benefits from the quality overview by the Barchester organisation, such as the visit by the hospitality manager on the day of inspection. What has improved since the last inspection? What they could do better: All the assessments to identify risks to residents’ health and welfare should be carried out as soon as possible after admission, and information from the assessments needs to be used to plan residents’ care. The manager should check that the changing needs of all the residents are recognised, so that action is taken in a timely way to meet all their health and welfare needs. Action needs to be taken to minimise the risk of fire in the laundry, and the management of the laundry needs to be improved to minimise the risk of infection. The manager needs to look again at the staffing needs of the residents using the conservatory. Regular reviews, through questionnaires to residents and relatives on the quality of the services provided, should be undertaken, so that the views of the residents and relatives are taken into account. Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 Page 7 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. Middletown Grange DS0000040174.V291408.R02.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 Middletown Grange DS0000040174.V291408.R02.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): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission assessment process for prospective residents is good, as is the assessment of individuals coming to the home for intermediate care. EVIDENCE: A registered nurse from the care home assesses all individuals before they come to stay at Middletown Grange. Pre-admission information usually includes information from family or friends, health professionals or social workers. For those coming from hospital to the care home for intermediate care before returning home, a member of the Primary Care Team carries out the assessment, and to make sure that all the needs can be met, discusses the arrangements with the home’s manager before the individual is admitted. All the care plans are developed from the assessment. The plans to provide separate intermediate care accommodation are in hand, but at present the dining area is shared with other residents at the home. Middletown Grange DS0000040174.V291408.R02.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, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector assessed the detail of two care plans. The home uses a commercially available care record system, and produces the risk assessments and care plans from the system. In general the care planning for physical and emotional health care is good, but one care plan did not contain information from the risk assessments conducted and, in another instance, no risk assessment was conducted for moving and handling the resident, although the care instructions for staff to prevent the resident falling again were good. The inspector understood that this omission may have arisen when the recording system was rearranged to make it more user-friendly, as the appropriate risk assessments were conducted for other residents. Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 Page 11 The inspector spoke to the physiotherapist and the occupational therapist involved with the intermediate care residents, and both were happy with the care of the individuals at the home. Two health care professionals responded to the CSCI comment cards and said that they were satisfied with the overall care provided to residents at Middletown Grange. All necessary assessments to identify risks to residents’ health and welfare should be carried out as soon as possible after admission. Information from the risk assessments should be used to plan the individual’s care. One resident told the inspector that poor sight limited his/her enjoyment of books and that ill-fitting hearing aids were preventing him/her from listening to audio tapes, so that life was becoming less interesting. Another resident said that it was complicated to arrange an appointment for a consultation for advice with the GP. The manager should check that the changing needs of all the residents are recognised, so that action is taken in a timely way to meet all their health and welfare needs. Medication, including controlled drugs, is appropriately recorded at the home, and a contract is in place regarding the safe disposal of drugs. The medication procedures have recently been reviewed, and the community pharmacist has approved the temporary storage arrangements needed due to the building programme. Residents said that staff treat them with respect, and that their privacy is respected. One resident praised ‘the devotion of staff’ to their work. The inspector observed good relationships between staff and residents, and saw instances where residents’ views were respectfully listened to and quickly acted on. Middletown Grange DS0000040174.V291408.R02.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): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s arrangements regarding residents’ daily life are good. EVIDENCE: Residents are able to decide how to spend their day, and one resident said that the activities provided made a big difference to life in the home. The activities organiser was said by one resident to be ‘worth his weight in gold’, and an activities programme is available at the home. The manager is planning to improve the staff understanding of residents’ needs by introducing work on life histories, so that as far as possible residents can continue their social lives while living at the home. Group and individual activities are provided, and visitors are able to come at reasonable times. One resident said that he/she ‘was very happy here’. Relatives or representatives manage financial arrangements when the resident is no longer able to do so, and an advocate can be contacted when the resident has no relatives to help. Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 Page 13 All the residents who responded via the CSCI comment cards said that they liked the food, and several residents told the inspector that the food was good. One resident commented that the chef was ‘Wonderful’. Middletown Grange DS0000040174.V291408.R02.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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s arrangements regarding complaints and protection are good. EVIDENCE: The complaints procedure is freely available to all residents, and residents who responded to the Commission’s comment cards said that they knew who to speak to if they were unhappy with their care. Two residents told the inspector that they knew who to complain to within the home, and were confident that their concerns would be taken seriously. Since the last inspection the Commission has received information from an anonymous source about staffing levels at the home, and the home responded appropriately to the Commission regarding this information. The home has policies regarding the protection of vulnerable adults and the manager was aware of the local procedures to address any concerns. Staff have initial training on the protection of vulnerable adults at induction and more training is available at other times. Middletown Grange DS0000040174.V291408.R02.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): 19 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the general environment in the home is well managed, the laundry management is poor. EVIDENCE: The home is undergoing an extensive building programme, and Phase 1 is nearing completion. On the day of inspection a new fire alarm system was being fitted. One member of staff is responsible for the safety and maintenance of the home, and has systems in place for staff to report maintenance issues for residents, so that he can quickly take action to address the issue. Access to the home is by electronic keypad and the grounds are safe for all the residents. Some residents said that the building work was ‘a nuisance’ but understood the need to improve the home. Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 Page 16 The home’s laundry is temporarily housed in a wooden shed in the grounds, and cardboard boxes were stored there on the day of inspection. This temporary arrangement was not subject to a fire risk assessment, and a risk assessment needs to be carried out and action taken to minimise the risk of fire in the laundry. Items were blocking the access to the hand washing area for staff, and clothes in bins awaiting washing were overflowing against the wooden walls and on to the floor. Action should be taken to minimise the risk of infection in the home by improving the management of the laundry. The home has acted quickly to address the above issues and both the recommendations have now been met. Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 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, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing arrangements are adequate, and the arrangements for staff recruitment, induction and training are good. EVIDENCE: The home’s staffing notice dated 2003 from the previous regulatory body was superseded in December 2004 through agreement with the Commission and Barchester Healthcare, when the numbers of nursing places at the home were increased to 30. The staff rota for the week ending 9th April showed that a registered nurse was available at all times, and that the staff numbers met the agreed arrangement for the 23 residents with nursing needs and for the other 18 residents. Comments from relatives showed that, at times, there may not be enough staff available for residents using the conservatory during the day, and the manager should consider how best to deploy staff so that the needs of residents are met. Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 Page 18 Eight staff members who are employed as care staff are registered nurses in their own countries, and some are undergoing the conversion course to register as nurses in the UK. This means that at least nine members of staff have NVQ Level 2 status and, as the full compliment of care staff is 15, the home now meets the standard of 50 care staff having NVQ Level 2 status. The inspector saw the recruitment files of three staff members. A photograph of one staff member was missing, but this was quickly located, and the inspector was satisfied that the home’s recruitment procedures work well. All new staff attend corporate induction which is completed within six weeks of starting work. All staff have personal development plans, and staff training is well organised by the new manager. Several staff were attending training on dementia on the day of inspection. Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is good. EVIDENCE: The new manager has been at the home for a short time, and is due to apply to the Commission to be the registered manager. The company’s quality assurance system includes regular visits by the hospitality manager to oversee quality issues about food, the laundry service and the environment. The hospitality manager was in the home on the day of inspection, and was available to listen to the views of residents. Monthly reports are submitted by the organisation to the Commission about quality management and staff meetings are held regularly. Residents and relatives meetings are scheduled from May 2006. Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 Page 20 To improve quality assurance, the inspector recommends that regular reviews through questionnaires to residents and relatives on the quality of the services provided are undertaken. Relatives or representatives manage relatives’ personal money, and residents are invoiced for expenditure such as chiropody or hairdressing. The home has a safe working practice policy and provides training for staff on safety topics. A named staff member is responsible for health and safety and a health and safety committee meets regularly. All the appropriate checks were carried out regarding fire precautions, and contracts for the maintenance of equipment are in place and are carried out regularly. Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 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 X 3 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X 3 X 3 X X 3 Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 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 OP7 Good Practice Recommendations All necessary assessments to determine and minimise risks regarding the resident’s health and welfare should be carried out as soon as possible after admission. Information from the risk assessments should be used to plan the individual’s care. The manager should check that the changing needs of all the residents are recognised, so that action is taken in a timely way to meet all their health and welfare needs. Action should be taken to minimise the risk of infection in the home by improving the management of the laundry. This recommendation has been met. A fire risk assessment should be carried out and action taken to minimise the risk of fire in the laundry. This recommendation has been met. DS0000040174.V291408.R02.S.doc Version 5.1 Page 23 2 OP8 3 OP26 4 OP26 Middletown Grange 5 6 OP27 OP33 The manager should consider how best to deploy staff so that the needs of residents are met at all times. Regular reviews through questionnaires to residents and relatives on the quality of the services provided should be conducted. Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Middletown Grange DS0000040174.V291408.R02.S.doc Version 5.1 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!