CARE HOMES FOR OLDER PEOPLE
The Mallards Care Home 5 Dynevor Road Bedford Bedfordshire MK40 2DB Lead Inspector
Dragan Cvejic Unannounced Inspection 10th February 2006 10:30 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 The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Mallards Care Home Address 5 Dynevor Road Bedford Bedfordshire MK40 2DB 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) 01234 356988 Lansglade Homes Limited Ms Louise Roper Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (22), of places Physical disability over 65 years of age (22) The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: The Mallards is a residential home for older people. It can house up to 22 service users. The building is situated in a quiet street, but still not too far from the town centre with the facilities necessary for community living. The 3-storey building has been utilised to provide a homely environment and adaptations were appropriate to enhance service users independence. Although a dining room on the ground floor was not big enough to accommodate all service users, additional dining space provided on other floors ensured a comfortable and homely eating space for all. The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It was carried out during 2.5 hours. The old and new formats for care plans were inspected. Partial case tracking was the main methodology, so a service user was spoken to in details and four other users gave brief comments. A member of staff was spoken to in addition to the manager. Two visiting physiotherapists also commented on the operation of the home. A quick tour through the home provided the opportunity for the environment related standards to be checked. The ownership of the home had been changed two weeks prior to the inspection. The proposed changes related to this transfer to new owners were discussed in detail with the manager. What the service does well: What has improved since the last inspection?
The new format for care plans was introduced and both service users and staff found it much better, more concise and used it as a real working document. The training programme was reviewed and started according to the new plan and covered all mandatory and discretionary training about the conditions the service users suffered the most, such as dementia. A new induction programme was also introduced and proved to be more effective. Support to the home was now coming from two “sister” homes, belonging to the same owners, and the owners themselves who visited the home several times a week. The service users were delighted with the opportunity to talk to them in private and described them as very caring and approachable. Management was relieved of some extra tasks and was focused on the planned day-to-day operation of the home. The manager had introduced the maintenance book on the day of the inspection.
The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 Page 6 The owners had informed the regulation authority of their plans to redecorate the identified areas within the home and new dining chairs had already been ordered. 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 Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 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 The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 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): 1,2,3,4 The manager was reviewing documents to demonstrate recent changes of ownership and to produce accurate and updated information about the home. Once finalised, potential users would have a clear information about the home. EVIDENCE: The manager was updating the statement of purpose and the service user’s guide to update these documents in relation to the change of management. New contract form was designed and offered to all new service users. However, there was a need to produce some evidence in longer staying users’ files to demonstrate that contracts were transferred when the new ownership took over the home and the business. Assessments done prior to admission were appropriate and contained details obtained from both previous professionals working with users and their family members. Addressed needs covered all major aspects of their lives. A service user spoken to confirmed that the home met not only all his needs, but also the needs of his wife before she was transferred in a setting that met her changed, increased needs. The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 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 the following standard(s): 7,8,10,11 The home devised and had started using a new format of care plans that provided a better working document: more clear for staff and for service users. EVIDENCE: The home had the old and new format of care plans. In the old format, the detailed picture of needs and the actions how to meet the goals was presented in descriptive form. The old type of plans contained some details that were obvious and did not need to be part of the plan. These “extras” made care plans too long and practically unusable for everyday work. The new format summarised the information from the initial assessment, previous care plans, from the users’ history and information from the relatives. This format was much better, staff confirmed that they were using the plans now and a service user stated that he preferred this type of record. Not all care plans were signed, but the manager explained that she tried to ensure that families signed care plans when they visited their relatives who were not able to sign the plans themselves. Health care needs were addressed in plans and evidently recorded in service users’ files in section for professional visits.
The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 Page 10 Both old and new types of care plans contained service users wishes and proposed arrangements in case of death. Risk assessments were comprehensive and included, among other identified hazards, the risk for users that were self medicating one or all of their prescribed medications. The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14,15 Service users could enjoy activities that they liked. The activities were stimulating and enabled users to socialise and build relationships in a relaxed and inclusive atmosphere. EVIDENCE: The service users were observed during the quiz that they used not only to stimulate their memory, but also to socialise and to build relationships. The users’ files contained records of activities. Recorded events demonstrated that activities were organised according to service users’ abilities and preferences. A service user proudly showed his computer with internet connection facilitated by the home. Service users met regularly at their meeting once a fortnight. They chose menus and discussed dishes suggested by the Italian cook, highly praised by service users for the quality, quantity and choice of food. Although the dining room on the ground floor could accommodate up to 14 service users, a first floor dining room was the preferential choice of some users and created a quieter and homelier place for eating. Records in users’ files demonstrated that a nutritional and balanced diet was carefully organised in a planned way. A service user confirmed: “Food is excellent”. The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The complaint procedure was updated and clearly displayed, in addition to the one included in home’s documents, providing the opportunity to all to make a complaint if they wished. The protection of service users was ensured. EVIDENCE: The home had not received any complaints since the last inspection. The complaints procedure was updated to incorporate the change of ownership. It had a set time scale for responding and clearly indicated to whom to complain. The manager stated that training on Protection of Vulnerable Adults was planned and booked for all staff. The procedures were in place to protect service users. The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, The home was suitable and adapted to meet the needs of service users. The environment was pleasant and homely. EVIDENCE: The location of the home was appropriate for service users. The manager had just created a maintenance book to record potential faults and areas that needed attention. A plan for re-decoration was drawn up by the new owners and the process had already started, making sure that maintenance work minimally distracted service users. The change of ownership also brought a maintenance man’s position into the staffing structure. Service users could now benefit from opportunities to have any addressed environmental issues responded to quickly and efficiently. The home had already placed an order to replace dining chairs, and carpets were measured during the inspection. The bathroom flooring had a crack that potentially could retain damp and water and could cause an infection control hazard and needed immediate replacing. The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 Page 14 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): 27,28,29,30 The home employed a sufficient number of skilled and committed staff that offered good care to service users. EVIDENCE: The rota demonstrated that a planned number of staff was employed according to the identified daily programme for service users. Staff were recruited by the manager who ensured that two written references and CRB disclosures were obtained prior to offering employment. The list of staff planned to start their NVQ was displayed, showing 14 names, 5 of which were from this home and the rest from the “sister” homes, belonging to the same owners. Staff spoken to were enthusiastic about training and in particular about the NVQ. A service user stated that he saw staff as trained, skilled and committed and that there were enough staff per shift to meet the users’ needs. The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 Page 15 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): 31,32,36 The home was well managed and the safety of service users was ensured. The change of ownership made the home better managed, reduced the management pressure on the manager and improved owner-service user relationships. EVIDENCE: There was no change in relation to the registered manager. The manager’s responsibility was shared between her and the owners and the pressure on her was reduced. The manager commented that co-operation and support from two “sister” homes helped in improving motivation, effectiveness and safety of the operational aspects of the home. The new owners visited home the approximately every second day and created a better relationship with service users, as stated by one of the users. Staff spoken to also confirmed that a supportive and friendly atmosphere was created in the home.
The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 Page 16 The stiff files demonstrated that the supervision process was not regular, but the new plan was displayed on the notice board, clearly indicated timing for supervisions that would be in line with standard requirements. Completely new training monitoring system was set and the manager hoped to effectively monitor, plan and organise all mandatory and discretionary training for staff. Two first training events were already materialised. Although infection control measures were not fully inspected, the flooring in the bathroom represented a serious risk and needed urgent replacing to prevent the development of an infection source. The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 Page 17 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 2 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 3 X X The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 Page 18 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 OP38 Regulation 13,23 Requirement The damaged flooring in the bathroom must be replaced. Timescale for action 30/03/06 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 2 Good Practice Recommendations The contracts for existing service users should contain information about the new owners and company to reflect the recent change, and to be similar to contracts for new service users admitted after the change of ownership. The manager should ensure that all care plans are transferred onto the new format to avoid potential confusion. At the same time signatures should be obtained for all care plans. 2 7 The Mallards Care Home DS0000065406.V283233.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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