Inspection on 08/11/05 for Middletown Grange

This inspection was carried out on 8th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 26/04/06

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 Oxfordshire OX29 9UB Lead Inspector Annette Miller Unannounced Inspection 8th November 2005 10.45 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.V264915.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. Middletown Grange DS0000040174.V264915.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Middletown Grange Address Middletown Hailey Witney Oxfordshire OX29 9UB 01993 700396 01993 775704 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) 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.V264915.R01.S.doc Version 5.0 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 June 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. Thirty beds are registered for nursing care. 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 is situated in a village location approximately 4 miles from the market town of Witney. Building work is currently in progress to increase the accommodation. Middletown Grange DS0000040174.V264915.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by two inspectors from 10.45am to 5.15pm. The inspectors spoke to residents and staff to obtain their views of the home, as well as undertaking a tour of the building and examination of records. Mrs Janet Richardson (relief manager) has been managing the home since the beginning of November 2005 and was present throughout the inspection. The registered manager’s post has been vacant since October 2004 and, since that time, there has been a succession of relief managers and, for a short period in 2005, a permanent manager was in post. These constant changes have resulted in a lack of consistent leadership and this has had a detrimental effect on staff morale. The inspection held on 8th June 2005 was unannounced and eight requirements and two recommendations were made. On 15th September a manager and an inspector from the Commission for Social Care Inspection (CSCI) carried out an unannounced monitoring visit and four requirements were made. A senior member of staff from the company submitted a robust action plan on 31st October 2005 showing what action had already been taken and what was planned. What the service does well: What has improved since the last inspection? Pre-admission assessments are now being carried out on prospective residents. Staff turnover has reduced and there was evidence that staff morale is improving. Mrs Richardson intends to stay at the home until a permanent manager is appointed and the company has confirmed this. She is an experienced manager and the company accepts that it is crucial that the home has a period of management stability in order to provide the leadership that is required. Middletown Grange DS0000040174.V264915.R01.S.doc Version 5.0 Page 6 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. Middletown Grange DS0000040174.V264915.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 Middletown Grange DS0000040174.V264915.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): 1, 3 and 6 Prospective residents have an assessment of their care needs so that the home, the prospective resident and their family are clear that these can be met. EVIDENCE: The home has a Statement of Purpose and Service User Guide that set out the services provided. The company is currently reviewing these documents. NHS nurses assess residents to determine how much nursing care is needed and the level of NHS funding to be paid. This money is paid to the company and it is then repaid to residents by deducting it from the home’s fees. The company must provide residents with written information about the procedure for refunding this money. Pre-admission assessments were looked at for two residents and a good range of information was obtained. This information forms the basis of a resident’s care plan. Middletown Grange DS0000040174.V264915.R01.S.doc Version 5.0 Page 9 The home is registered to provide intermediate care for up to five residents. Accommodation is provided in a designated area of the home where there are facilities for an occupational therapist to help residents regain the skills needed for them to return home. The designated dining room space that was originally allocated for intermediate care residents was not being used and the reason for this should be reviewed. Middletown Grange DS0000040174.V264915.R01.S.doc Version 5.0 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, 9 and 10 Whilst there is some evidence that care planning has improved since the last inspection, further improvements are needed before residents can be assured that their care needs will be met. Some medication procedures are poor and these potentially place residents at risk. EVIDENCE: A sample of four care plans was inspected, and whilst it was apparent that improvements had occurred, the following shortfalls were found: • The information about changes in condition for one resident had not been written as a care plan, even though staff action was needed. The only reference to the change was in the daily record and this is poor practice as this could lead to aspects of care being overlooked. A resident was assessed as needing weekly weights but this action was not being carried out as frequently as stated. Nutritional risk assessments had been completed in the care plans examined, but one resident assessed as ‘high risk’ had not been referred to a dietician, even though this was indicated as necessary by the guidance provided with the risk assessment. DS0000040174.V264915.R01.S.doc Version 5.0 Page 11 • • Middletown Grange • Psychological health was not well assessed and lifestyle histories were not routinely provided. Care plans were raised as an issue of concern at the July 2005 inspection and also during the visit on 15th September 2005. The company informed CSCI on 31st October 2005 that changes were being made to the current care planning system and that a clinical manager from the company was reviewing and auditing care plans on a regular basis. There were several gaps on the medication record sheets where staff had not signed to say a drug was given, and no explanation was given about why it was omitted. A resident admitted for intermediate care was self-medicating but a risk assessment had not been completed to determine whether it was safe for her to be responsible for this aspect of her care. Medication was left out in the resident’s room and this was unsafe. Lockable storage facilities must be provided for residents who self-medicate. The residents spoken to said that they were always treated kindly and with respect. An inspector observed staff approach residents in a sensitive and kindly manner. A relative said, “The care here is great, we couldn’t ask for better for our mum”. Middletown Grange DS0000040174.V264915.R01.S.doc Version 5.0 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 and 14 Social activities are well managed and provide daily variation and interest for people living in the home. EVIDENCE: The activity organiser is an enthusiastic and committed member of staff who organises a wide range of events and activities. A firework and barbeque party with wine and beer was being held later in the day for residents and their guests. A pianist was booked to provide musical entertainment. Many of the residents are mentally and physically frail and it is therefore particularly noteworthy that the activity organiser is aware of these residents’ recreational needs, and tries whenever possible to include them in the events held. Residents are helped to exercise choice and control over their lives in a variety of ways, such as what they have to eat and what activities they take part in. They are encouraged to go to the dining room for their meals as this provides a pleasant social environment, but if residents prefer to have meals in their rooms this is arranged. Middletown Grange DS0000040174.V264915.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 and 18 The home has a satisfactory complaints procedure with some evidence that residents and relatives feel their views are listened to and acted upon. EVIDENCE: The home has a complaint’s policy that was updated in September 2005. A copy is provided to new residents with the admission pack. The copy on the noticeboard did not show the name and address of the CSCI and the manager should ensure that this information is provided. The home’s complaint file was examined and the last complaint dealt with was in September 2005. Information provided by the manager showed that the home has dealt with three complaints since the last inspection and that two were substantiated and one partly substantiated. These complaints were investigated within 28 days. No concerns have been received by CSCI since the last inspection. The home’s policy on adult protection and prevention of abuse was updated in September 2005. A discussion was held with the manager about the Oxfordshire multi-agency procedures for dealing with abuse and it was clear that she understood the need for training, although evidence of recent training was not available. Middletown Grange DS0000040174.V264915.R01.S.doc Version 5.0 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 the following standard(s): 19 and 26 Overall, the standard of bedroom and living accommodation within this home is good. The standard of cleanliness could be improved in the dining room after meals by removing food debris from the floor more promptly. EVIDENCE: The home is comfortably furnished and décor is good. Building work is currently in progress to increase the size of the home and this work is separated from residents’ accommodation satisfactorily. The home’s cleanliness was good, except that food debris was still on the dining room floor at 2.45pm and soiled tablecloths were piled on a dining room table. Clean linen was being stored on the linen cupboard floor, which is unhygienic. Seven bags of dirty laundry had accumulated in the laundry and the manager should ensure that there are sufficient laundry assistants on duty to deal with the amount of laundry that is generated. Middletown Grange DS0000040174.V264915.R01.S.doc Version 5.0 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 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 The amount of supervision needed by new workers resulted in residents’ personal care being delayed. New carers must have a satisfactory knowledge of the English language to enable them to communicate effectively with residents and visitors. The procedures for the recruitment of staff are not robust and do not offer protection to people living in the home. EVIDENCE: During the morning there was one registered nurse and six carers for 29 residents. Two carers were new and needed to be supervised by senior carers, which caused a delay in providing personal care to some residents. The relief manager is a registered nurse and was on duty to deal with day-to-day management duties and to provide advice and support to the staff team, which she was seen doing. One carer had difficulty understanding questions about a resident’s care needs. The manager must ensure that staff who are directly involved with residents have a satisfactory knowledge of the English language. 53 of present carers have a qualification equivalent to NVQ Level 3. Three carers are currently undertaking NVQ Level 2. Middletown Grange DS0000040174.V264915.R01.S.doc Version 5.0 Page 16 Three staff files were examined and shortfalls in the recruitment procedures were found for each person. None of the files inspected was well ordered. • • • File A: There was no criminal record bureau disclosure, no application form and only one reference. File B: There was no evidence that a check against the protection of vulnerable adult list at the Department of Health had been done. File C: Two references had been obtained, but one was not from a named referee. It is good practice to record an explanation as to why references were not obtained from a named referee. The manager said that several training events had been arranged since the last inspection. Training records were available for some members of staff but a complete record of training for all staff was not available. The company provides induction for all new workers. The records relating to this training were not inspected. Middletown Grange DS0000040174.V264915.R01.S.doc Version 5.0 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): 31, 33, 36 and 38 The relief manager is providing good leadership and is gaining the support of her staff team. This is having a beneficial effect on the standard and consistency of care offered within the home. EVIDENCE: The post of registered manager became vacant in October 2004 and the company has experienced difficulty in recruiting a permanent manager. There has been a succession of relief managers, and for a short period in 2005 a permanent manager was appointed. Frequent management changes have resulted in poor morale within the workforce. The current relief manager showed a clear understanding of her acting management responsibilities. Quality assurance and quality monitoring systems involving residents and relatives have not been done in the past year, but the manager said this is planned. All members of staff have recently been invited by the company to provide feedback on a range of matters. Middletown Grange DS0000040174.V264915.R01.S.doc Version 5.0 Page 18 A system of staff supervision had commenced and the inspector noted a new members of staff being supervised at the time of inspection. An inspector observed care assistants to be competent in moving and handling techniques. The manager should arrange for a health and safety representative to be appointed and for the person’s name to be shown on the health and safety notice displayed at the home. There was a new maintenance person in post and he was receiving training and guidance from a company employee experienced in this type of work. At the time of inspection the maintenance person was being instructed in the use of the home’s fire alarm system and how to carry out the required fire checks. Middletown Grange DS0000040174.V264915.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 2 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 X 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 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 3 X 2 Middletown Grange DS0000040174.V264915.R01.S.doc Version 5.0 Page 20 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. 1. Standard OP1 Regulation 5a Requirement Written information must be produced that explains to residents how they receive NHS money for their nursing care. Lockable storage facilities for medication kept in residents’ rooms must be provided. The reason why a medication has not been administered must be recorded. The skill mix of staff must be monitored to ensure that new carers are provided with the support they need and that this does not reduce the time available to residents. Staff appointed to provide care must have a satisfactory knowledge of the English language. The required recruitment documents and checks must be completed prior to the appointment of new workers. Timescale for action 31/12/05 2. 3 4 OP9 OP9 OP27 13 13 18 08/11/05 08/11/05 08/11/05 5 OP27 18 08/11/05 6 OP29 19 08/11/05 Middletown Grange DS0000040174.V264915.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. 1 2 Refer to Standard OP6 OP7 Good Practice Recommendations There should be designated dining space for intermediate care residents and the manager should review why the room previously allocated is not used for this purpose. When staff action is needed to deal with a change in a resident’s condition, this should be recorded on an individual care plan. The frequency of weighing residents should be followed as per the care plan instructions, or the reason for not doing so recorded. Residents should be referred to a dietician when risk assessments indicate that this is necessary. Psychological health should be assessed and lifestyle histories kept. 3 4 5 6 7 8 OP9 OP26 OP26 OP29 OP30 OP38 Residents who wish to self-medicate must be assessed to ensure that it is safe for them to do so. Clean linen should be stored above floor level. Bags of dirty laundry should not be permitted to accumulate. Personnel files in which recruitment documents are kept should be better organised. A database of training attendance should be kept in order that training needs can be identified. A health and safety representative should be named on the health and safety notice. Middletown Grange DS0000040174.V264915.R01.S.doc Version 5.0 Page 22 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.V264915.R01.S.doc Version 5.0 Page 23 - 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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