CARE HOMES FOR OLDER PEOPLE
Mitchell House 2 Mitchell Road Canford Heath Poole Dorset BH17 8US Lead Inspector
Trevor Julian Unannounced Inspection 22nd June 2006 09:00 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 Mitchell House DS0000067219.V301508.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. Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Mitchell House Address 2 Mitchell Road Canford Heath Poole Dorset BH17 8US 01206 752552 01206 852248 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) Care UK Community Partnerships Ltd Mr Martin John Tully Care Home 49 Category(ies) of Dementia - over 65 years of age (49) registration, with number of places Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Two named persons (as known to CSCI) in the category OP may be accommodated to receive care. One named person (as known to CSCI) in the category MD(E) may be accommodated to receive care. The registered provider will work towards complete registration of the home in the category DE(E) as vacancies occur. New Service Date of last inspection Brief Description of the Service: Mitchell House is a care home accommodating a maximum of 49 older people. All new permanent admissions have a diagnosis of dementia. The home is operated by Care UK who lease the home from the local authority. Mr M Tully is the registered manager of the home. The premises are split into 5 bungalows with 10 bedrooms except bungalow 4 with 9 bedrooms. Each room is offered for single occupancy. Bungalow 4 is designated for up to 6 respite beds; the others are for permanent residence. The bungalows have communal lounge/dining space, bathroom and kitchen facilities. None of the rooms have en suite facilities other than washbasin. The home is located at Canford Heath and is within easy reach of Poole centre. Public transport operates close to the home. The premises housed a day centre facility. This has now been closed and is being used for communal activity and storage. At the time of the visit, the weekly fees were set at £477.69. Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 22nd June 2006 between 09:0017:00. This was the first inspection carried out since Care UK took over the lease for the service from the local authority. The purpose of the visit was to monitor performance of the home against key standards. Evidence was obtained through discussion with residents, staff and visitors, tour of the premises and examination of records and other documentation. For the purpose of this report, the terms resident and service user are interchangeable. What the service does well:
It was clear that the staff team remained focussed on the care of the residents during a period of great change for all those involved. Throughout the visit staff were seen providing support and encouragement to the residents. All people spoken to during the visit were full of praise for the care provided by the staff team. All admissions take place only once assessments have been completed in order to ensure the assessed needs may be met within the home. The home had continued to develop links with local GP practices and community nursing teams. Residents and visitors confirmed that the staff called for GP visits if required. The community nursing team were assisting with a review of medication practice in the home. The home links with friends, family and the community; visitors are welcomed into the home at any time. During the visit staff were seen providing regular drinks for the residents and encouraging them to drink. The meal was served in each of the bungalows from heated trolleys. The meal was well presented and the portions varied according to the known preferences of the individual. One person said people could have meals in their own rooms on request. The home had systems in place for investigating complaints and responding to allegations or signs of abuse. Care UK had carried out some improvements to the property and employed a maintenance man to carry out minor repairs. The home was clean and odour free. The home benefits from a secure garden at the rear of the property where residents can sit and enjoy the fragrant garden. One resident grows tomatoes and fuchsias in a greenhouse in another part of the grounds.
Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 Page 6 The home has a core of experienced staff helping to provide good continuity of care for the residents. The management team have suitable qualifications and experience to run the home effectively. Staff do not manage the finances for any resident. Residents may deposit cash with the administration staff for personal expenditure e.g. hairdressing and chiropody. A sample showed the monies held matched the transaction records and receipts. Safety and fire equipment were regularly tested and serviced by approved contractors to ensure the items were safe and functioning correctly. What has improved since the last inspection? What they could do better:
In one of the files reviewed during the visit there was no weight check recorded. It is important to ensure that people with dementia maintain good fluid and nutritional intakes; without a baseline assessment it is difficult to monitor weight fluctuations. The organisation was introducing electronic care recording and assessment the staff were concerned that they had not had sufficient time to get fully used to the system. A demonstration of the system showed a good level of recording however, it was operating very slowly which would create problems for the staff once the system went live. The home needs to develop programme of activities to provide residents with stimulation and interest. Staffing levels in one of the bungalows were insufficient to meet the needs of the residents. At the time the bungalow was visited there was one carer on duty and working very hard to manage the complex needs of the nine people. Other members of staff said the bungalow was too busy for one carer, there was another carer allocated to assist during the morning but that support did not help at breakfast or lunch. In discussion with two sets of visitors, both commented that there had been occasions when communication within the staff team needs to be improved. One of the visitors had raised a request with a senior member of staff and the task was not carried out as the duty staff appeared not to have been advised. They both added that it was not a reflection of the care provided in the home. Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 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. Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 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 Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments were carried out to ensure that placements were only offered once they were assured the assessed needs could be met. EVIDENCE: The files for 4 residents were examined. Each contained pre admission assessments and local authority care plans. Two visitors seen during the visit confirmed that the assessments had been completed before the placement had been offered. Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 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, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides good levels of care and support for the residents; however, some areas need further development. Medication was generally well managed to help keep the residents safe. Staff respected the rights of residents’ in order to promote their dignity and independence. EVIDENCE: The home had care plans that were used by the staff to meet the assessed needs. One file seen had a moving and handling assessment however; it was not signed or dated. The file contained a weight chart with regular checks showing no significant gain or loss. The notes identified an allergic reaction to medication, however this was not transferred to the medication records. The resident’s daughter had signed the care plan. Another file was checked and found in good order however there were no weight checks recorded. The files
Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 Page 11 had an inventory form for property brought into the home, however it had not been completed nor was there evidence of resident, or their representative’s, involvement. In discussion with visitors some commented that sometimes communication within the home could be improved on person cited a request to a deputy manager which had not been carried out by the staff as the message had not passed to the relevant person. However, all visitors said the staff were very dedicated to their role and kind and caring. The organisation was in the process of introducing an electronic care record system. Staff said they had received limited training in the system but needed time away from their daily workload in order to become comfortable with the recording system. During a demonstration of the system, the links were very slow and would cause frustration for the staff. Medication in the home was safely stored. Only senior staff who have completed a training programme are permitted to administer the medication. Photographs are included with the medication recording system to help aid identification. Before the inspection the home had discovered an error in medication; as a result of the action taken the resident suffered no lasting ill effects. A further review of the medication system was planned. Residents and visitors said that the staff call for GP visits as needed. Community nurses call at the home to provide any healthcare support. During the visit good interaction was observed between staff and residents. The staff were seen to be supportive as well as encouraging independence. People were being assisted to mobilise in an unhurried manner. One person required two people to assist her to her chair, the staff were observed giving plenty of reassurance and advising the resident of the each part of the manoeuvre. Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 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, 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents were not offered a suitable range and choice of activities. The home encouraged support from friends and family to help the residents feel valued. The food served was nutritious and well presented to encourage good nutritional intake. EVIDENCE: The residents and visitors said there were often times when there was very little activity in the home. Activities were organised by the care staff in the bungalows where they were working, this depended on the staffing levels at the time and the resources available. The manager advised that he had recently been able to appoint an occupational therapist whose role would include organising meaningful activities. Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 Page 13 Several people were seen out in the rear garden which provides a safe and secure area with seating and a water feature. In another part of the garden is a green house that is used by a resident to grow prize winning tomatoes and fuchsias. During the inspection several visitors were seen in the home, they said they were always made welcome and could visit at any time. The main meals are cooked centrally and distributed to the bungalows in heated trolleys. The meals seen were served to residents by the care staff portions were varied according to the preferences of the individual residents. Residents were offered a choice of two main courses food, records were maintained to show the choices of each resident. One person said they normally went to the dining area for meals but could take it in their own rooms if they asked. The chef showed the new four week menu charts; the charts had been copied to each of the bungalows and were available in the entrance lobby. The menus showed good variety and choice. During the visit there were plenty of drinks provided around the home and all appeared accessible to the residents. Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had systems in place for the investigation of complaints and the protection of residents from abuse. EVIDENCE: The organisation’s complaints procedure is included in the information provided to the residents. A copy was posted in the entrance hallway. There had been two complaints recorded in the home since April; both had been investigated in-house. Staff were aware of their obligations to respond to allegations or signs of abuse. The topic was covered during the induction programme for all new staff. Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well maintained; the bedrooms provide a comfortable area however the room sizes do present problems if peoples’ mobility declines. The home was well aired and clean helping to provide the residents with a comfortable environment. EVIDENCE: Care UK intend moving to new purpose built premises over the next two years. However, since taking over the property, a number of improvements had been carried out and a maintenance man had been employed to carry out minor repairs. One of the boilers had broken down this was waiting for a part. The chef said some equipment in the kitchen had failed and this was being replaced. Staff reported that breakdowns of equipment were attended to promptly.
Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 Page 16 A suite of rooms on the first floor had recently been vacated and plans were being developed to turn one room into a guest room for visitors who need to stay overnight, along with staff and training rooms. During the visit the home was clean and well aired. The cleaning staff worked hard to maintain good standards of cleanliness. The home had a contract for trade and clinical waste disposal. Soiled items are double bagged before transfer to the waste bin. However, the bins are located outside of a service corridor, which required the bags to be moved passed by an area storing food and the kitchen. The manager was aware of the potential problem but there was no short-term solution available except for double bagging the items. Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 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, 29. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels were not adequate to meet the needs of the residents. To help keep residents safe the home only starts new staff once all clearances have been obtained. EVIDENCE: During the visit some time was spent in one bungalow. There was just one person on duty and the workload was very high. One resident’s behaviour was causing distress to the other residents and other people were wanting to get dressed etc. The member of staff worked very hard to manage the situation but there was no help available for her. Staff said that the particular bungalow was too busy to manage with one carer because of increased occupancy and dependency levels, there was a second person allocated to the bungalow during the morning period but that was not until after breakfast and ended before lunchtime. Since taking over the home Care UK had recruited two members of staff both had the required references and clearances in place before starting work. Staff training programmes were not examined on this occasion.
Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes was well managed and the organisation had internal checks to ensure the service was run for the benefit of the residents. There was a good system in place to manage residents’ personal allowances, helping to protect the residents from the risk of financial abuse whilst in the home. The supervision programme had not restarted, therefore the staff were not receiving appropriate levels of supervision. This could result in poor practice and the potential to identify training needs. There were systems in place to improve the safety of residents and staff. Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 Page 19 EVIDENCE: The manager and senior staff had the required qualification and experience to manage the home effectively. In the three months since taking over the home Care UK had undertaken three internal inspections of the home and developed an improvement plan based on the findings of those visits. The organisation has a Quality Assurance system and this was due to take place in the home towards the end of July 2006. Staff meetings had taken place giving the staff the opportunity to give their views on the home. A resident and visitor meeting was held in April; minutes of the meeting were posted in the entrance hallway. The home did not manage the finances for any of the residents. There was a system for residents or their families to deposit personal allowances with the admin staff for personal expenditure. A small sample showed that income and expenditure was recorded along with receipts the balances held matched the transaction records. The staff supervision process was just being restarted. Fire records showed that fire precautions and fire safety training was up to date. Accident reports were numbered allowing an audit process some analysis of the reports took place in order to identify trends. During the visit several hoists were checked and shown to have been serviced at regular intervals. Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 Page 20 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 N/A 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 2 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 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 Page 21 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 OP9 Regulation 13(3) Requirement The registered person must ensure that relevant information relating to medication is recorded in the appropriate documentation. The registered person must ensure the home is adequately staffed. The registered person must ensure that staff receive appropriate supervision. Timescale for action 30/09/06 2 3 OP27 18(1) 18 (2) 31/08/06 30/09/06 OP36 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 Refer to Standard OP7 OP8 OP12 Good Practice Recommendations The care plans should confirm the involvement of the residents or their representatives. In order to support good nutritional screening, weight checks should be recorded. The home should ensure that residents have the opportunity to involve themselves with appropriate activities and cultural interests.
DS0000067219.V301508.R01.S.doc Version 5.2 Page 22 Mitchell House Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Mitchell House DS0000067219.V301508.R01.S.doc Version 5.2 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. 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!
