Care Home: Malvern House

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What the care home does well People we spoke to were generally very happy with the service they received. Residents told us the staff were, "Very nice" and treated them with respect and dignity. Residents also told us they liked the food at the home and enjoyed the activities that were organised. Staff we spoke with told us that the new manager provides good training opportunities for them to increase their knowledge and skills. Seven requirements were issued at the last inspection. All of these have been complied with and as a result of this: Care plans now provide more detail in regards to the cultural and spiritual needs of residents and requirements in relation to residents` end of life wishes. The environment is safer for people with dementia and most parts of the home are clean with no offensive odours detected. Residents` money which is held on their behalf by the service is well managed with accurate audit records being maintained. We examined the files of four people who have been admitted to the home since the new manager took over. All of these contained detailed pre assessments carried out by the placing authorities as well as the home manager`s own assessments. All of these assessments indicated that the person had a formal diagnosis of dementia which is in line with the home`s categories of care provision. Records examined indicated that people have good access to health care professionals. We spoke with a district nurse about how people with pressure care management issues are supported at the home. The district nurse told us that there were no concerns regarding this matter. People who are at risk or have developed pressure sores have the appropriate equipment and district nurse input into their care. Satisfactory records were examined in relation to the recruitment of staff. All staff filesexamined contained the appropriate information for the protection of residents including proof of identity, two written references and criminal records checks. What the care home could do better: Some of the residents at the home do have some challenging behaviour which can be disruptive to other residents. The manager told us she was very careful not to admit people who the service could not support or who would cause too much disruption to other residents. We observed staff supporting residents that were becoming distressed due to their confusion. This support was kind and caring. Although some staff have undertaken training in dementia care it is important that all staff understand how to support and reassure people who are confused and distressed. A new requirement has been issued that all staff undertake dementia training with particular emphasis on communication with people with dementia and how to manage challenging behaviour. Six care plans were examined. These were detailed but important information was not always easily accessible. The manager told us that she was in the process of updating the format of these plans so that staff could understand them better. Although plans were being updated there was little evidence to suggest that residents or their representatives were involved in these monthly reviews. It is very important that people who use the service have a say in how they would like their care to be delivered. A new requirement has been issued that residents or their representatives are consulted when care plans are being reviewed each month. Records in relation the receipt, storage and administration of medication were inspected. In general these records were satisfactory however we noted that residents` weekly medication was being sent to the home from the pharmacy each week. Staff were signing receipts for a months supply. This is not accurate as staff are signing to say they have received medication that has not yet been provided. This was discussed with the manager who told us that she will change the way medication is provided by the pharmacy to ensure accurate recording takes place. A new requirement has been issued relating to medication. We toured the home with the registered manager. Previous concerns had been raised with the Commission about the standard of hygiene in the kitchen. Although the kitchen is fitted with fly screens these were not being used and as a result there were a lot of flies in the kitchen and food was not being covered properly. The manager told us that the fly screens were not working properly. The cook immediately put the fly screens down. This situation must not continue as it puts people at risk. The manager assured us that this matter would be dealt with as a priority and the fly screens would be fixed. We received written confirmation from the manager on 07/07/2010 that the fly screens had been repaired. A new requirement has been issued that the kitchen area must be clean and properly maintained to ensure the safety of residents at the home.We also saw a number of maintenance issues during the inspection of the home. One toilet door had broken and one toilet seat needed repairing. The manager told us she would deal with these matters immediately and later confirmed to us in writing on 07/07/2010 that these repairs had been undertaken. We checked the water temperatures in a number of sinks in peoples` bedrooms. The water was not very warm. The manager told us that there may be an issue with the boiler. Following the inspection of this home a relative phoned the Commission with concerns about radiators in some residents` rooms being left on and very hot in the current warm weather. We immediately phoned the manager of the home to find out what was happening with the heating. The manager told us that she had told staff to make sure radiators were turned off in the warm weather. It appears that there is some problem with the boiler or one of the boilers which means hot water and central heating can not be separated. We told the manager that this was unacceptable and that urgent action must be taken to have the boiler fixed so that hot water and central heating could be separated. We have issued a new requirement relating to this and told the manager that she must contact the Commission when the issue has been satisfactorily addressed. Sinks in toilets used by residents, staff and visitors all had anti bacterial soap and paper towels available to limit the risk of cross infection. There were some garden chairs and tables in the garden however no parasols had been put up to provide shade for residents wanting to sit out. The manager told us that she would ensure the parasols were used and also would put up a gazebo in the garden to provide more shaded areas. The manager told us that there had been no recent complaints about the service. The manager told us that any complaints were put in individual`s files. However there were no records available so it was difficult to evidence this. It is very important that a record of complaints is maintained so that the service can deal with complaints affectively. A new requirement has been issued relating to Random inspection report Care homes for older people Name: Address: Malvern House 271-275 Hale End Road Woodford Green Essex IG8 9NB two star good service 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: David Hastings Date: 0 1 0 7 2 0 1 0 Information about the care home Name of care home: Address: Malvern House 271-275 Hale End Road Woodford Green Essex IG8 9NB 02085315081 02085315084 info@malvernresthome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Vijaylakshmi Devi Sisteedhur Type of registration: Number of places registered: Conditions of registration: Category(ies) : Malvern House Retirement Homes Ltd care home 34 Number of places (if applicable): Under 65 Over 65 0 34 dementia old age, not falling within any other category Conditions of registration: 34 0 The maximum number of service users who can be accommodated is: 34 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Care Homes for Older People Page 2 of 12 Brief description of the care home Malvern House is a privately owned care home offering residential accommodation and support to 34 elderly people, including those with dementia. There are 2 double bedrooms and 30 singles. All have wash hand basins and several have ensuite toilets. There are two lifts and access is suitable for those with limited mobility. There are three bathrooms, with assisted baths. There is a conservatory, patio and attractive garden planted to lawn and flowers. The home is situated on a main road in a residential area of Chingford (in the London Borough of Waltham Forest) with access to local shops and transport links. The current fees range from £460- £612 per week. Information about the service is available at the front reception area of the home, including inspection reports, to people living in the home and to other stakeholders. Care Homes for Older People Page 3 of 12 What we found: The Care Quality Commission carried out this unannounced inspection of Malvern House on Thursday 1st July 2010. The reason for this inspection was to check compliance with the requirements we made at the last key inspection of this service. The Commission also received some anonymous concerns about the service in relation to care practice, hygiene issues and staffing. The Commission wanted to make sure that people who use the service were safe and being cared for properly. We met the registered manager who was open and helpful throughout the inspection. We spoke with nine residents, three staff, two relatives and one visitor to the home. We also looked at various care records, policies and procedures. We inspected the premises and spoke with a district nurse. What the care home does well: People we spoke to were generally very happy with the service they received. Residents told us the staff were, Very nice and treated them with respect and dignity. Residents also told us they liked the food at the home and enjoyed the activities that were organised. Staff we spoke with told us that the new manager provides good training opportunities for them to increase their knowledge and skills. Seven requirements were issued at the last inspection. All of these have been complied with and as a result of this: Care plans now provide more detail in regards to the cultural and spiritual needs of residents and requirements in relation to residents end of life wishes. The environment is safer for people with dementia and most parts of the home are clean with no offensive odours detected. Residents money which is held on their behalf by the service is well managed with accurate audit records being maintained. We examined the files of four people who have been admitted to the home since the new manager took over. All of these contained detailed pre assessments carried out by the placing authorities as well as the home managers own assessments. All of these assessments indicated that the person had a formal diagnosis of dementia which is in line with the homes categories of care provision. Records examined indicated that people have good access to health care professionals. We spoke with a district nurse about how people with pressure care management issues are supported at the home. The district nurse told us that there were no concerns regarding this matter. People who are at risk or have developed pressure sores have the appropriate equipment and district nurse input into their care. Satisfactory records were examined in relation to the recruitment of staff. All staff files Care Homes for Older People Page 4 of 12 examined contained the appropriate information for the protection of residents including proof of identity, two written references and criminal records checks. What they could do better: Some of the residents at the home do have some challenging behaviour which can be disruptive to other residents. The manager told us she was very careful not to admit people who the service could not support or who would cause too much disruption to other residents. We observed staff supporting residents that were becoming distressed due to their confusion. This support was kind and caring. Although some staff have undertaken training in dementia care it is important that all staff understand how to support and reassure people who are confused and distressed. A new requirement has been issued that all staff undertake dementia training with particular emphasis on communication with people with dementia and how to manage challenging behaviour. Six care plans were examined. These were detailed but important information was not always easily accessible. The manager told us that she was in the process of updating the format of these plans so that staff could understand them better. Although plans were being updated there was little evidence to suggest that residents or their representatives were involved in these monthly reviews. It is very important that people who use the service have a say in how they would like their care to be delivered. A new requirement has been issued that residents or their representatives are consulted when care plans are being reviewed each month. Records in relation the receipt, storage and administration of medication were inspected. In general these records were satisfactory however we noted that residents weekly medication was being sent to the home from the pharmacy each week. Staff were signing receipts for a months supply. This is not accurate as staff are signing to say they have received medication that has not yet been provided. This was discussed with the manager who told us that she will change the way medication is provided by the pharmacy to ensure accurate recording takes place. A new requirement has been issued relating to medication. We toured the home with the registered manager. Previous concerns had been raised with the Commission about the standard of hygiene in the kitchen. Although the kitchen is fitted with fly screens these were not being used and as a result there were a lot of flies in the kitchen and food was not being covered properly. The manager told us that the fly screens were not working properly. The cook immediately put the fly screens down. This situation must not continue as it puts people at risk. The manager assured us that this matter would be dealt with as a priority and the fly screens would be fixed. We received written confirmation from the manager on 07/07/2010 that the fly screens had been repaired. A new requirement has been issued that the kitchen area must be clean and properly maintained to ensure the safety of residents at the home. Care Homes for Older People Page 5 of 12 We also saw a number of maintenance issues during the inspection of the home. One toilet door had broken and one toilet seat needed repairing. The manager told us she would deal with these matters immediately and later confirmed to us in writing on 07/07/2010 that these repairs had been undertaken. We checked the water temperatures in a number of sinks in peoples bedrooms. The water was not very warm. The manager told us that there may be an issue with the boiler. Following the inspection of this home a relative phoned the Commission with concerns about radiators in some residents rooms being left on and very hot in the current warm weather. We immediately phoned the manager of the home to find out what was happening with the heating. The manager told us that she had told staff to make sure radiators were turned off in the warm weather. It appears that there is some problem with the boiler or one of the boilers which means hot water and central heating can not be separated. We told the manager that this was unacceptable and that urgent action must be taken to have the boiler fixed so that hot water and central heating could be separated. We have issued a new requirement relating to this and told the manager that she must contact the Commission when the issue has been satisfactorily addressed. Sinks in toilets used by residents, staff and visitors all had anti bacterial soap and paper towels available to limit the risk of cross infection. There were some garden chairs and tables in the garden however no parasols had been put up to provide shade for residents wanting to sit out. The manager told us that she would ensure the parasols were used and also would put up a gazebo in the garden to provide more shaded areas. The manager told us that there had been no recent complaints about the service. The manager told us that any complaints were put in individuals files. However there were no records available so it was difficult to evidence this. It is very important that a record of complaints is maintained so that the service can deal with complaints affectively. A new requirement has been issued relating to complaints. There was evidence that residents meetings take place on a regular basis. Although there are currently no relatives meetings taking place the manager told us that she always talks to relatives to see how things are going. Some relatives we spoke with told us the manager did not always listen to their concerns. The requirement we made to ensure residents and their representatives are consulted about their care provision at the home should ensure records are now maintained regarding peoples views about the service. We also found that although residents and their representatives are sent yearly surveys by the service, no action plan or report is being developed as a result. A new requirement has been issued relating to quality assurance at the home. There were complaints procedures in some of the bedrooms we visited. However these procedures did not contain up to date information about how people can make a Care Homes for Older People Page 6 of 12 complaint. A new requirement has been issued that the homes complaint policy and procedure is updated. The service has a number of students working at the home, over and above the number of employed care workers on the staff rota. Some people we spoke with said they were sometimes confused about who these students were and what their role was at the home. This was discussed with the manager who agreed to provide name badges for students so that residents and their representatives could identify students at the home. A good practice recommendation has been issued relating to this matter. 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 7 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 8 of 12 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 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 1 7 15 The registered person must ensure that residents and or their representatives are consulted about their care each time the service user plan is reviewed. This is to ensure that people have a say in how their care is delivered at the home. 16/08/2010 2 9 13 The registered person must 16/08/2010 ensure that accurate records in relation to the receipt of medication are maintained at all times This is to ensure the safety of residents who require assistance with medication 3 16 22 The registered person must ensure that all complaints either verbal or written are recorded and investigated in line with the homes policies and procedures. This is to ensure that residents and or their representatives know that 16/08/2010 Care Homes for Older People Page 9 of 12 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 any complaint they make will be acted upon. 4 16 22 The registered person must ensure that the complaints policy and procedure is updated to reflect the new ownership of the service. This is to ensure that people know how to make a complaint about the service. 5 19 13 The registered person must ensure that heating and ventilation of the home is safe and appropriate for the needs of the residents living there. This is to ensure that residents have a comfortable environment at the home. 6 26 13 The registered person must 16/08/2010 ensure that the kitchen is clean and well maintained at all times. This is to ensure that unnecessary risks to residents are reduced. 7 30 18 The registered person must 01/09/2010 ensure that all care staff undertake dementia care training. This training should include effective communication with people with dementia and managing challenging behaviour. This is to ensure that staff have the skills and Care Homes for Older People Page 10 of 12 16/08/2010 01/09/2010 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 knowledge to support people with dementia at the home. 8 33 24 The registered person must 01/09/2010 ensure that there is a quality assurance system in place to find out the views of residents, their representatives and other stakeholders about the quality of service provided at the home. This must include a report, produced by the home and made available to interested parties. This is to ensure that residents, their representatives and other stakeholders have written information about how the service is improving. 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 1 26 The registered person should ensure that residents and their representatives are able to identify staff and students working at the home by use of name badges. Care Homes for Older People Page 11 of 12 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. 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