Latest Inspection
This is the latest available inspection report for this service, carried out on 16th March 2010. CQC found this care home to be providing an Adequate service.
The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.
For extracts, read the latest CQC inspection for Malmesbury House.
What the care home does well The environment was clean, warm, comfortable and an ongoing programme of redecoration and refurbishment ensures standards are maintained. Staff were warm and welcoming and attentive to the needs of people using services, addressing them in a polite, age-appropriate manner. The home`s atmosphere was appropriately stimulating. The home-cooked meal served at lunch time was nicely presented and substantial, affording a choice of food. Care staff had worked hard to maintain care notes and care plans up to date, though further direction and guidance necessary. What the care home could do better: The home does not have a suitably qualified registered manager. Serious concerns were identified in the management of seizures.Immediate requirements were made for improvement in risk assessment, care planning and staff training to ensure the safety of people with a medical history of seizures. As at the time of the last inspection, shortfalls were again identified in risk assessment and nutritional assessment practice for people admitted for respite care. Improvement is necessary to record keeping, specifically preadmission assessments must be signed and dated. Summaries of care management assessment sand copies of care plans for care management purposes should be obtained before admission for individuals referred through care management arrangements. Photographs must be obtained for respite users. We were unable to evidence compliance with the requirement for improvement to staff recruitment practice owing to missing personnel records, which the registered provider is trying to recover. Random inspection report
Care homes for older people
Name: Address: Malmesbury House Malmesbury House 18 Beauchamp Road East Molesey Surrey KT8 0PA one star adequate service 25/08/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Patricia Collins Date: 1 6 0 3 2 0 1 0 Information about the care home
Name of care home: Address: Malmesbury House Malmesbury House 18 Beauchamp Road East Molesey Surrey KT8 0PA 02087830444 Telephone number: Fax number: Email address: Provider web address: mail@gajraj1.freeserve.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Mary Gajraj,Dr H Gajraj,Dr N Gajraj Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 19 Number of places (if applicable): Under 65 Over 65 0 19 dementia old age, not falling within any other category Conditions of registration: 19 0 The maximum number of service users ot be accommodated is 19 The registered person may provide the following categories of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission ot the service are within the following category Dementia (DE) Old age, notr faling within any other category (OP) Date of last inspection 2 5 0 8 2 0 0 9 Care Homes for Older People Page 2 of 10 Brief description of the care home Malmsbury House is a care home providing personal care and accommodation for up to 19 older people, the majority of whom have dementia as their primary condition. The building is a large detached property situated in a quiet residential area. The community amenities and shops of West Molesey are conveniently nearby. The accommodation is arranged on three floors, accessible by a passenger lift. Most bedrooms are of a good size and for single occupancy and have en suite facilities. Some bedrooms have doors opening onto the enclosed garden or balconies. The home is set in spacious, well-maintained grounds and provision includes a furnished courtyard. There is a spacious, well furnished conservatory and assisted bathing and toilet facilities. A car park is provided at the front of the premises. Fees rates are 591 pounds per week for respite care and 550 to 650 pounds for permanent placements, other than those funded by Local Authorities, for which contractual fees apply. Care Homes for Older People Page 3 of 10 What we found:
This unannounced inspection was undertaken by one inspector over a period of three hours between 11:30 a.m.and 2.30 p.m.The reason for the inspection was to check compliance with requirements made at the time of the last key inspection. The report will say what we found as it is written on behalf of the Care Quality Commission. We looked in particular at outcome areas specific to pre-admission assessment practice, health and personal care, the environment focusing on bathing facilities and kitchen equipment, staffing, catering and management. We carried out direct practice observations in communal areas including the lunchtime experience of people using the service. Discussions took place with one of the providers present during the visit, the designated person fulfilling the role of home manager, some people using services, staff and a visitor. The registered home manager left in October 2009. A new home manager was appointed and took up post on 29th October but resigned and left in January. Efforts to recruit another home manager through agencies have to date been unsuccessful. At the time of this inspection interim management arrangements were in place for the former deputy manager to manage the home full time with input to practice from the registered person. The home was stated to be registered with a number of agencies in an effort to recruit a suitable home manager as quickly as possible. Management shortfalls identified at the time of this inspection were fully discussed with the registered provider. Also the need to ensure a competent manager left in charge in their absence if they proceed with plans under discussion to go away for a few days. On arrival most people using the service were in communal areas. The homes atmosphere was welcoming and stimulating, individuals taking an interest in the activities of the hairdresser in the lounge. Observations confirmed independence is promoted and staff respect the dignity of people using services by ensuring good attention to their personal appearance.A programme of social activities was displayed also photographs of an outing to the coast enjoyed by some people using services and staff, since the last inspection. It was good to see developments appropriate to the needs of the the homes population to support people with problems concerning memory loss, disorientation and confusion. These included a notice board in the dining room with information about the date and weather, though ideally this would be more visible if bigger; also clearly legible name badges worn by staff and their photographs on the wall in the reception area. Discussions with a person who had lived at the home several months confirmed overall general satisfaction with service provision. Her visitor who comes in most days spoke highly of the person-centred approach of staff to meeting the needs of people using the service. We arrived as lunch was being prepared and spoke with the cook in the kitchen. We examined menus and observed the presentation and serving of the meal in the dining room. We sampled nutritional assessment and weight monitoring records. The need to ensure the same standard of nutritional assessment for respite users was again discussed. Weights were recorded monthly on the three files examined however a baseline weight not obtained on admission for one person currently receiving respite care. Discussions with the cook, some people using services and the provider and
Care Homes for Older People Page 4 of 10 observations of practice confirmed effort is made to accommodate food preferences and dietary needs of people using the service. The menu had been reviewed since the last inspection and the provider stated her intention to review this again to ensure meals are sufficiently varied. The provider stated her intention for this review to be an inclusive process involving people using services. The meal prepared by the cook was observed to deviate from the days menu displayed. The cook confirmed this is sometimes unavoidable when provisions run out and need to be substituted. He said there is always sufficient food.Discussions with management confirmed the requirement to maintain accurate records of meals. It was agreed a recording system would be implemented for menu changes. Comment was again made on the four-weekly rotating menu displayed in the dining room. The small font used when typing this menu is difficult to read and the information unlikely to be accessible to some service users for this reason. Care staff serving the three course home cooked lunch were observed to wear protective aprons and to assist people with their meals as necessary. A system affording a choice of meals operates and staff were observed to accommodate the wishes of a person who changed his mind as the meal was brought to the table, preferring fish option to the meat dish he initially ordered. Dining tables were nicely presented with cloth napkins, floral centre displays and condiments. Portion sizes appeared adequate and discussions with some people using services confirmed their overall satisfaction with meals. One person commented, The food here is lovely. We found evidence in the three files examined of a process for gathering information before admission about people considering moving into the home, to ensure their needs can be met. Two of the pre-admission assessments examined however were not signed and dated by the assessor.A summary of the care management health and social services assessment had not been obtained for one individual referred through care management arrangements; or copy of the care plan produced for care management purposes. The need to obtain these documents was discussed. We also noted information not recorded for one individual about hobbies and interests so that staff would know how to meet that persons social needs.Significant shortfalls were again identified in generic risk assessment practice for respite users. This was drawn to the attention of management at the time of the last inspection but no action taken for improvement. Additionally, on this occasion we were very concerned to establish risk assessments not carried out and care plans not in place for the safe management of seizures for two people using services. The three care staff on duty were unaware of the recent medical history of seizure for these people. Two of the three care staff consulted had no experience or training in the management of seizures. Immediate requirements were made for risk assessments to be carried out and care plans generated for the safe management of this condition; also for staff to be aware of the risks and to receive epilepsy awareness training.Examination of care records also identified failure to notify us about a related incident which is a legal requirement though we have since been informed by the provider that a notification was sent by post. The need to ensure recent photographs are obtained for all people using services, including respite users was discussed and remedial action agreed. Observations in the environment were limited to communal areas, the kitchen,office and first floor bathroom. The home was warm, clean and hygienic and comfortably furnished. There is an ongoing programme of refurbishment and decoration. A decorator was painting the first floor staircase during the visit and new curtains stated to be on order for the main lounge and dining room.The home had complied with requirement to ensure bathing facilities available on the first floor. A bathroom had been converted into a wet room. The need to ensure the call bell is accessible to the shower unit was discussed. A
Care Homes for Older People Page 5 of 10 new hot plate and commercial grill had also been purchased for the kitchen. The requirement for improving the safety of arrangements for supporting people using services to attend community health appointments had been met. We were informed a staff escort is organised, sometimes using transport provided by volunteers. We were unable to verify improvement in recruitment practice because personnel records for the one employee recruited since the last inspection were stated to be missing, despite restricted access. We were informed action is planned to try to recover these records. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person must 18/09/2009 ensure staff recruitment and vetting procedures include obtaining a full employment history and relevant references. Also a written explanation regarding any gaps in employment. This will ensure the safety of people using services. Care Homes for Older People Page 7 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action 1 8 12 For risk assessments and care plans to be in place for the management of seizures and all staff informed of the people using services with a history of seizures and of their care plans. For improvement in general to risk assessment practice for people admitted for respite care. This will ensure the safety and health of people using services. 23/03/2010 2 30 18 For all staff to receive epilepsy awareness training. To ensure they respond appropriately to seizures for the safety and welfare of people using services. 23/03/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 10 of 10 - 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!
