Inspection on 29/11/06 for Minsden

This inspection was carried out on 29th November 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 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 31/01/06

Minsden 11/08/05

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 Mrs Alison Butler Unannounced Inspection 10:00 29th November 2006 & 14 December 2006 th 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 Minsden DS0000019470.V321343.R01.S.doc Version 5.2 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. Minsden DS0000019470.V321343.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Minsden Address Wratten Road West Hitchin Hertfordshire SG5 2AU 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) 01462 450703 01462 427651 www.quantumcare.co.uk Quantum Care Limited Ms Elizabeth Grace Street Care Home 48 Category(ies) of Dementia - over 65 years of age (48), Old age, registration, with number not falling within any other category (48), of places Physical disability (1), Physical disability over 65 years of age (48) Minsden DS0000019470.V321343.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2006 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 fees for the service range from £455.00- £535 per week (these were correct as of 29th November 2006). 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 DS0000019470.V321343.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written following an announced visit to the service, attending the homes forum and from information that has been gained from previous inspections or has been know to the Commission For Social Care Inspection. Questionnaires for residents were left at the home following the inspection with a return date of 14th December 2006. Only 2 were returned to the Commission For Social Care Inspection. The majority of the time was spent observing and talking with residents, relatives and staff. Care records were also examined. A tour of the building took place. What the service does well: What has improved since the last inspection? The medication storage has been improved since the purchase of 2 trolleys and a further 2 are waiting delivery. Care plans have been reviewed and a new and improved format has been introduced. The manager is working hard on the environment and creating a choice of rooms in which residents can spend their time either in quiet room, TV lounge or the dining area. The temperature of the medication storage is being taken and recorded appropriately. Two residents whilst in hospital have had their bedrooms decorated. Minsden DS0000019470.V321343.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Minsden DS0000019470.V321343.R01.S.doc Version 5.2 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 Minsden DS0000019470.V321343.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 Standard 6 is not applicable to Minsden Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available to residents and their representatives to enable them to make an informed choice. Assessments are carried out on all residents prior to a place being offered or taken up EVIDENCE: A comprehensive Statement of Purpose and Service User Guide is available to all prospective residents and their representatives. An updated copy of the Statement of Purpose was provided to the inspector during the inspection. Pre- admission assessments are carried out prior to admission and this forms the basis of the care plan. Each resident is provided with the terms and conditions of admission etc. Minsden DS0000019470.V321343.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Quality of information recorded is good. Residents receive a good quality of care and are supported by knowledgeable and experienced staff. Medication procedures need to be adhered to, to prevent errors. EVIDENCE: Care plans examined showed that good information is recorded with the action required by staff to meet them. It is recommended that each page contain the individual name and date of birth to eliminate any mistakes, if pages are removed for additional information to be added and then being returned to the correct file. Risk assessments must ensure that information is not contradictory to other information held within the file, as there were two manual handling assessments completed 1 said they required manual assistance the other states it is carried out mechanically. Where risk assessments are reviewed the reviewer must ensure they sign. Although monthly reviews take place they seem to only concentrate on one aspect of the individual such as they have moved to a new room, they should look at how the individual care of needs are being managed and if there should be any Minsden DS0000019470.V321343.R01.S.doc Version 5.2 Page 10 changes made to the care plan. Where a resident administers their own medication but it is held by the home, details of this should be included with their care plan. Two medication trolleys have been purchased for the home and a further two are on order and the home are waiting for their delivery. A medication audit was carried out on 14th July 2006 and it was recommended that an updated British National Formula was purchased this has been done. All medication entering the home must be signed in on receipt to ensure a full audit trial is in place. Where an error is made on the administration sheet staff must remember that a single line is placed through the error and not scribbled out, this makes it difficult to read the sheet as it appeared there was an additional signature added as the medication had been given. This had been picked up and the member of staff spoken to. A number of missed signatures where noted although these again had been picked up by the care team manager and a note made, following the company’s auditing processes. Where medication is given to relatives who then take responsibility for this a risk assessment should be completed and the relative should sign the back of the administration sheet to accept responsibility. A bring forward system should be in place to allow for reconciliation to happen at any point in time. All dates on opening had been added to bottles and packets to ensure that medication remains effective. The temperature of the storage areas is being checked and recorded appropriately. Residents spoken to indicate a general satisfaction in the care they received and felt that staff respected their dignity and privacy. Staff were observed knocking and waiting before entering residents bedrooms. Minsden DS0000019470.V321343.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Contact with family and friends are maintained. Autonomy and choice is promoted within the home. Residents are able to pursue the lifestyle that suit them and take part in activities of their choice. EVIDENCE: Residents were complimentary about the choice of activities on offer and were able to choose whether to join in or not. Although some residents felt they would like more activities to be on offer. On the previous day they had decorated the Christmas Tree. Other activities included quizzes, games and social events. Most residents were complimentary about the food provided and they were able to ask for alternatives if it was not to their liking. There are 3 cooks in the home one who provides Indian meals for the Asian residents who attend the day centre. One residents felt that they would prefer basic English dishes, where as another said they enjoyed the curries. This shows how difficult it is to provide meals that suit a large number of people. The manager and her team are constantly looking at the meals and discussing this with the residents. Minsden DS0000019470.V321343.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust procedures are in place to ensure the protection of the residents. EVIDENCE: A copy of the complaints procedure is available. Residents spoken to state that they were clear about whom they could speak to if they were unhappy about any aspect of their care and felt confident that it would be dealt with. No complaints had been received since the last inspection although a number of compliments had been received thanking staff for the care they have provided to their loved ones. Minsden DS0000019470.V321343.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and well maintained. Regular checks are carried out on services and equipment. EVIDENCE: A tour of the building showed that it was well maintained, clean and free from any odours. The decorators were in to paint the corridors as they had started to look a bit tired through general wear and tear. The workmen were trying to ensure they did not cause too much disruption to the residents by working on small areas, thus allowing residents to travel along the corridors. The quiet lounge has been revamped from being the smoking lounge and access to the garden has got the go ahead The large dining/lounge is to become a dining area with the other becoming a TV lounge this provides and will provide the residents with more choice. The laundry facilities are adequate to meet the needs of the residents and they all looked well kempt on the day of the inspection. Most residents spoken to Minsden DS0000019470.V321343.R01.S.doc Version 5.2 Page 14 were very pleased with the laundry facilities and felt they were quite efficient in returning their clothes to their rooms. Policies and procedures are in place to prevent the spread of infection. It was noted during the inspection that staff wore gloves whilst using the hoist with various individuals this should not be seen as common practice, but only when dealing with personal care for example toileting etc Minsden DS0000019470.V321343.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust procedures are in place to ensure that residents are protected at all times. The numbers and deployment of staff appear to meet the needs of the residents. EVIDENCE: Three staff files were examined and contained all the required documentation and that all relevant checks had been carried out prior to commencing employment. On the day of the inspection, staff on duty included the manager, deputy manager, 3 care team managers and 8 carers. This represents an excellent staff to resident’s ratio. From examination of the rotas this is a typical picture from day to day. Observations of staff showed they were knowledgeable about the needs of the residents. Residents spoken to felt they encouraged them and offered assistance as appropriate. Quantum Care provide an on-going training programme to ensure staff have regular updates on care practice and they are competent in their role. Minsden DS0000019470.V321343.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good management structure in place. The health welfare and safety of residents, staff and visitors to the home is protected at all times. EVIDENCE: Although a check was not carried out at this inspection previous inspections have shown that residents monies held is well managed and a company audit is also carried out yearly. Policies and procedures are in place for the management of residents’ finances. The manager continues to ensure that staff receive appropriate training and also ensure she to updates her skills and competency. All statutory records were available for inspection and were well maintained with the exception of the medication records (see health and personal care section for further details). Minsden DS0000019470.V321343.R01.S.doc Version 5.2 Page 17 Good policies are in place cover health, safety and welfare of all residents, staff and visitors. Although risk assessments are in place these are generic form created by the company and these should be individualised for each resident and include information that is relevant to them and their setting. Minsden DS0000019470.V321343.R01.S.doc Version 5.2 Page 18 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 3 X 3 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 Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Minsden DS0000019470.V321343.R01.S.doc Version 5.2 Page 19 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 OP9 Regulation 13(2) Requirement The manager must ensure that all medication entering and leaving the home is recorded in line with the guidance contained within the Administration and Control of Medicines in Care Homes and Children’s Services published by the Royal Pharmaceutical Society published in June 2003.This has been brought forward from the previous inspection. Timescale for action 31/12/06 A risk assessment must be completed for medication that is handed over to relatives who take responsibility for the administration. Minsden DS0000019470.V321343.R01.S.doc Version 5.2 Page 20 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 OP38 Good Practice Recommendations Risk assessments should be written for the individual and the environment for which they live in. Minsden DS0000019470.V321343.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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