Inspection on 11/08/05 for Minsden

This inspection was carried out on 11th August 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

Minsden 24/07/07

Minsden 29/11/06

Minsden 31/01/06

Minsden 02/03/05

Minsden 08/07/04

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 Minsden Wratten Road West Hitchin Hertfordshire SG5 2AU Lead Inspector Tom Cooper Unannounced 11 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Minsden Address Wratten Road West, Hitchin, Hertfordshire, SG5 2AU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01462 450703 01462 427651 Quantum Care Limited CRH Care Home 48 Category(ies) of DE(E)-48, OP-48, PD-1, PD(E)-48 registration, with number of places Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The home may accommodate a maximum of 48 service users over 65 years of age with dementia. The home may accommodate a maximum of 48 service users over 65 years of age. The home may accommodate 1 service user under the age of 65 with physical disability. The home may accommodate 48 service users over the age of 65 with physical disability. Date of last inspection 2 March 2005 Brief Description of the Service: Originally built in 1960, Minsden was first registered with Hertfordshire County Council on 1st July 1992. It was refurbished in the mid- 1990s. The home is situated in a quiet residential area within walking distance of Hitchin town centre. The accommodation is on two floors served by a lift. On the ground floor there are 19 single bedrooms, quiet room, smoking lounge, lounge/dining room, Asian elders day centre, kitchen, laundry room, several offices, 3 bathrooms, 2 shower rooms and toilets. On the first floor are 22 single bedrooms, lounge, kitchen diner, quiet lounge, 3 bathrooms, 2 shower rooms and toilets. To the front of the building there is ample car parking and a medium size garden and patio to the rear. The Asian elders day centre is a particular feature of the home, providing a valuable resource for the local community, open Mondays to Fridays each week. The homes statement of purpose states that the emphasis is at all times on making service users feel that Minsden is their home. Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday afternoon between midday and 16.30 hours. During this time service users were observed having lunch and spending time in the communal areas of the home or their bedrooms. The inspection comprised a tour of the building; discussions with service users, visitors, members of staff and the manager and deputy manager; examination of care plans, medication storage and records; observation of staff and service users interacting. There was a calm atmosphere in the home with positive relationships evident amongst staff and residents. There were 45 service users in residence on the day of the inspection. The new manager has made a good start and has already overseen positive changes in a number of areas that have and will improve standards in the home. What the service does well: Service users are well cared for and made universally positive comments about life in the home, the attitudes and abilities of staff and the levels of personal choice available to them. The building provides a comfortable, safe and calm environment that allows the elderly service users to follow their own pursuits at their own pace. Staff relate well to service users and respect their dignity and privacy. They also understand their individual needs, including cultural issues, as evidenced by the impressive detail found in the care plans examined. Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 Page 6 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. Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not inspected on this occasion. Previous inspections have demonstrated that the home has a good preadmission procedure and a Statement of Purpose and Service User’s Guide that meet the standards. EVIDENCE: Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8. 9. 10 Care plans for each service user provide an excellent overview of their individual needs, frequently reviewed and updated. Staff constantly monitor individual healthcare needs and seek appropriate help from outside health professionals as necessary. A well managed and safe medication system is in place, although continuous monitoring is required by the management to ensure staff always accurately record administration on the medication administration record (MAR) sheets. Most service users feel they are treated with respect, that their views count and that staff promote their dignity and privacy. However extra efforts should be made to meet the expectations of all service users with regard to personal care and cleanliness and their relatives as some dissatisfaction was expressed by one person. EVIDENCE: Seven care plans were examined. Each contained considerable detail of each service user physical, medical, psychological, social and cultural needs. There were clear instructions to staff on how to proceed in order to meet the needs identified. Also included was useful background information regarding social Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 Page 10 history, particular personal preferences, useful ideas for handling particular care issues, recorded in a manner that conveyed a good sense of each person as an individual with special characteristics. For example, dietary requirements and specific cultural expectations were clearly indicated. Good records of daily progress had been made by staff, including notes of visits by GPs. In addition risk assessments were documented covering the principal risk areas associated with living in the home, for example moving and handling falls, pressure sores and so on. Each care plan had been regularly reviewed and updated. The care plans seen were excellent working tools for staff that demonstrated an effective application of modern person-centred care planning principles. This reflects much hard work by all involved and represents a commendable improvement since the last inspection. The Nomad system was being used for the administration of medication, although the deputy manager said that the home would shortly be switching to a blister pack system to be provided by a different pharmacist, which it was felt would produce better control and more flexible response to any changes in medication prescribed. Examination of the system revealed that stock was securely stored in the clean, well ventilated and organised stock room. Individual baskets were used for service users’ medicines held in stock. Controlled drugs were double locked and recorded appropriately. On the two units the Nomad boxes were similarly stored securely. MAR sheets were checked in both areas and demonstrated a high overall standard of recording of items coming into the home, running balances (found to reconcile with amounts checked in two areas), and of administration to service users. Four signature gaps were noted on the MAR sheets and one case where a gel prescribed for a service user had run out but despite staff reporting this to the office no replacement had been obtained. It was unclear from the record whether this was a short-term prescription not requiring renewal. Care should be taken always to write explanations on the MAR sheets for any noncompliance with a prescription. Bearing in mind that a requirement was made in the last inspection report that service users’ prescribed medication be available at all times, this requirement has been restated in this report. Nevertheless there was strong evidence that much hard work had gone into improving the handling and recording of medication and that senior staff were continuously monitoring the system. At the time of the inspection no service users were assessed as capable of self-managing medication although the home’s policy is to promote this area of independence subject to assessment of the risks involved. The deputy manager said that it was more common for short stay residents to self-administer. All service users spoken with indicated general satisfaction with the attitudes and performance of staff and said they felt well cared for. They also felt they were respected and that staff promoted their privacy and dignity. This is covered in the induction programme for new staff. Staff were observed Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 Page 11 knocking and waiting at residents’ bedroom doors prior to entering and using the preferred terms of address indicated in the care plans sampled. Health professionals always see service users in private. Staff appeared to enjoy relaxed and friendly relations with individual service users. They were observed dealing with them in a positive and confident way, in some cases sharing lighthearted banter. Service users said that they had confidence in the caring abilities and skills of staff. One Asian service user commented that his particular cultural needs were being catered for. However one visiting relative complained that her husband’s personal care was not always good. As a result, she often had to clean him herself because staff had failed to do so properly. She also said that despite raising the matter with senior staff standards had remained variable. The service user himself said that he did not like the food provided as he came from a non-English background. This complaint was discussed with the manager at the end of the inspection and should be investigated and resolved. Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14, 15 Service users are able to pursue the lifestyles that suit them within their individual capabilities. However more efforts should be made to ensure that all service users are aware of the various opportunities on offer. Relatives and friends can visit the home at any time as indicated in the service user’s guide. The home’s policies are followed by staff to help service users retain control over their lifestyles and make choices for themselves. EVIDENCE: Service users said that they could exercise reasonable choice in their daily lives, for example in respect of where to spend their time, where and what to eat, rising and retiring times, activities and so on. They indicated general satisfaction with the pace of life in the home, which is sedate as befits the age and expectations of most of the residents. Some information regarding individual activities was recorded on care plans. Various activities are provided including quizzes, games, and social events. Several service users questioned had little idea of the range of activities on offer. Therefore it is recommended that the manager take steps to publicise the opportunities available more widely. Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 Page 13 Service users’ bedrooms were arranged to suit the occupants and contained personal items such as pictures and ornaments. Most service users said that they felt the food provided was good and reasonably varied. The lunch supplied on the day of the inspection was well presented and appetising. One service user said that he would prefer fewer casseroles and more standard ”English” food whereas another said that he often did not like the choices available as he was used to West Indian cooking. The manager said that new menus were being devised for him that should suit him better. This highlights the difficulty of meeting the expectations of a large number of people from differing backgrounds. The home employs three cooks, one of whom prepares Indian meals for the Asian elders in the home, mainly attending the day centre. Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 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 standard(s) 16 Most service users feel that their complaints will be taken seriously and acted upon. However, one service user’s relative expressed a lack of confidence in the response from staff to her concerns about her husband’s care. Therefore the manager should ensure that this situation is investigated and resolved. EVIDENCE: The home uses the well-developed Quantum Care complaints procedure. The company has a good record of investigating and responding to complaints in a timely manner. All service users spoken with said that if they wished to make a complaint they would feel able to approach a senior member of staff. They were not formally aware of the home’s complaints procedure (although this is described in the service user’s guide available to all residents) but were confident that any problem raised would be received sympathetically and dealt with promptly. None of those spoken with had had cause to complain to date. One service user’s relative said that she was not satisfied with her husband’s care in the home due to poor standards of cleanliness in his personal care room and in his bedroom. She said that she had raised this with staff and standards had improved recently but were still not always good. This was discussed with the manager at the end of the inspection. She agreed to investigate the matter and resolve any care issues regarding this service user. Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 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 standard(s) 19, 23, 26 The home provides an accessible, comfortable and safe environment that is reasonably well maintained. More attention should be paid to controlling and eliminating unpleasant smells associated with incontinence. The garden should be tidied to provide a more attractive facility. Service users’ bedrooms are furnished and laid out to suit their individual needs and preferences. EVIDENCE: The home was clean and tidy throughout, although moderate unpleasant smells were noted in two bedrooms. Efforts had recently been made to deal with this problem but one visiting relative expressed concern with regard to her husband’s bedroom. The manager needs to monitor this issue and take further action if necessary to eliminate any lingering odours. All extractor fans in bathrooms were clear, following a requirement made in the last inspection report. It was noted that open waste bins were provided in toilets. For proper infection control these should be replaced with pedal bins with fitted lids. Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 Page 16 The manager stated that some bedrooms had been redecorated recently. Other areas remained in need of redecoration however and the handyman had been working on these. Quantum Care had sanctioned the redecoration of eight further bedrooms. The laundry was to be refurbished within the next month with all new machines and flooring. In addition, new contractors were being employed to restore the garden to a good standard, which was rather unkempt on the day of the inspection. These steps should restore the home to a good standard. It is recommended that the manager submit details of future plans to improve the premises to the CSCI. Service users spoken with made no adverse comments about the décor and all said they were happy with their rooms. Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Staffing numbers and skill levels are adequate to meet service users’ needs. EVIDENCE: At the start of the inspection there were 9 care staff plus 2 duty managers plus the deputy manager on duty as well as the manager (who is considered supernumerary) to care for the 45 service users. Ancillary staff included 3 domestics and 3 cooks. This represents an excellent staff to resident ratio. Staff confirmed that this was a typical picture from day to day. Observations of staff at work and the calibre of the care plan documentation and medication recording seen, as well as the positive comments made by service users, supported the conclusion that staff were knowledgeable and competent. Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not inspected on this occasion. The manager and deputy manager had been in post for only a short time but had already made a positive impact in improving standards in the home, especially with regard to care planning, record keeping and restoration of the premises. Staff said that teamwork in the home was excellent and enjoyed working in the home. EVIDENCE: Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x 3 x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x x Minsden I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP 9 Regulation 13(2) Timescale for action The manager must ensure that From 11th service users prescribed August medication is available at all 2005 and times.[This requirement was also henceforth made in the last inspection report] Accurate records must be kept of From 11th all medicines administered to August service users. 2005 & henceforth Requirement 2. OP 9 17(1) Schedule 3(3)(i) 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. 3. 4. 5. Minsden Refer to Standard OP 26 OP 9 OP 16 OP15 OP 19 Good Practice Recommendations Greater efforts should be made to control and eliminate unpleasant smells associated with incontinence The manager should ask the new pharmacist to provide refresher training in medication recording practice to all staff. The manager should look into the concerns raised by a visiting relative about her husband’s personal care. Further consultation with service users about food preferences should be undertaken to ensure that every person’s requirements are met. The manager should send the CSCI details of the current I52 s19470 Minsden v242319 310805 Stage 4.doc Version 1.40 Page 21 6. OP 26 plans to improve the premises. For proper infection control pedal bins with fitted lids should be provided in toilets. 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