Care Home: Middlecross

What the care home does well What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE Middlecross Simpson Grove Armley Leeds LS12 1QG Lead Inspector Paul Newman Key Unannounced Inspection 4th October 2007 09:20 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 Middlecross DS0000033202.V353266.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. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Middlecross Address Simpson Grove Armley Leeds LS12 1QG 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) 0113 2310357 0113 2319071 Leeds City Council Department of Social Services Mr Paul Martin Hudson Care Home 32 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (28) of places Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2006 Brief Description of the Service: Middlecross is purpose built and all accommodation is at ground floor level. A security fence encloses the building and grounds and there is CCTV security protection covering the entrance gates and outside of the building. There is a central courtyard area with raised flowerbeds for service users to access during the day and gardens generally are well laid out, interesting and well maintained. The home is located in the Armley area of Leeds. There is easy access of all the local facilities including shops and public houses and convenient for the local bus service, which gives access to Leeds City centre and surrounding areas. The home provides care for thirty-one residents who are suffering from Dementia. Twenty-six of these are permanent or respite residents and for these nursing care is not provided but the home is supported by local healthcare services and more specialist services in relation to dementia in a similar way to living in your own home in the community. There are four wings to the building but one of these is dedicated to respite care and intermediate care. Intermediate care was introduced in October 2006. The aim of intermediate care at Middlecross is to provide a rehabilitation service that gives people with dementia the best chance of finding an appropriate setting for them to live. This may be by returning home or in full time care in another setting. Depending on the care needs that are assessed, residents in intermediate care may be helped by any one of a number of healthcare professionals including, registered nurses, registered mental health nurses, physiotherapists and occupational therapists as well as the staff who normally work at the home. Accommodation is provided in thirty-one single bedrooms and all bedrooms have en-suite WCs. There are good communal areas and small kitchenettes. There is a small Snoezelen room for residents. There are bathing and toilet facilities on each of the four wings and separate toilets are available for both staff and visitors. There is a large kitchen, which provides all the meals for the home and a day centre, which adjoins the care home. Laundry facilities are available for all the residents’ personal laundry. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 5 The current weekly charges for people living permanently at £459. This charge does not include hairdressing, private newspapers and magazines. Charges for people on respite care a 7-night stay. The manager provided this information during visit on 4 October 2007. the home are chiropody or are £73.95 for the inspection Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit carried out by one inspector that started at 9:20 and finished at 15:00 on 4 October 2007. The same inspector carried out the last inspection in October 2006 and the one before that so had a good idea of how the home operates. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and that the outcomes for the people meet National Minimum Standards. Before the inspection information about the home that had been collected over the last year was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the inspection visit. The manager had completed an Annual Quality Assurance Assessment (AQAA) before the visit to provide additional information. This is a self-assessment of the service provided and had been completed well and gave a lot of information. Survey forms were sent to the home before the inspection for the manager to give out to people living at the home, visitors, healthcare professionals involved in peoples’ care and the staff working at the home. This gives people the opportunity to comment if they want to. Information provided in this way may be shared with the provider but the source will not be identified. A number of documents that the home has to keep up to date were looked at during the visit and all areas of the home used by the people who lived there were checked. A large proportion of time was spent talking with the people and visitors, watching what was going, as well as talking with the manager and most of the staff on duty. Some of the written comments that were made in the surveys that were returned are included in the report to show what people think of the way the home is run. What the service does well: The home is well managed and the staff team are well trained, experienced and good at their job. They are happy in their work and committed to providing high standards of person centred care. The needs of residents are the focus of the staff attention and residents look happy and well cared for. Staff make sure that residents are treated with dignity. Staff are also good at supporting family members who visit the home. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 7 Information about the home is readily available and up to date. People are properly assessed before they come to live at the home and because of this a good care plan can be drawn up that identified peoples needs. The home works closely with other healthcare professionals, makes referrals at an early stage and takes the advice that is given. Staff know the care needs and personal preferences of individuals and are good at identifying non-verbal behaviour that indicates when a resident is happy or unhappy. The homes record keeping is good. These are some of the comments and responses made by people living at the home: All of the responses to a question about whether staff listen and act upon what you say were positive – • ‘Well yes. Its smashing. Yes, very good are the staff, in all ways’ • ‘They are all good and my friends’ All of the responses about meals were positive. Responses showed that people felt they got the medical support they needed. People felt there were activities that they could take part in – • ‘I was at the sing-a-long yesterday singing my head off’. People knew how to complain – • ‘Yes, don’t worry, I’d make a complaint if I wanted to. about making one’. People thought the home was fresh and clean – • ‘It’s lovely every day’ • ‘Yes, but I haven’t looked in the corners yet, but I will do’. The comments made by relatives were equally positive but there were some reservations about staffing levels – • ‘I have always been made welcome in Middlecross, no matter what time I visit. I do visit every single day and see the problems which face carers and so think they need a little extra help’. • ‘Sad but true, more staff as they seem to be run off their feet. Middlecross is a good happy home and do care for my Mum. I hope it doesn’t change’. Healthcare Professionals who responded view the home in a good light. In response to a question about whether the home seeks advice and act upon it to improve peoples’ health, one survey said – • ‘I find Middlecross staff exceptional in this area. They involve service users and carers in decision making at all stages – they are very person centre focused in all the care they give’. Some other comments made by healthcare professionals were: Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 8 Never thought • • • ‘Middlecross staff go out of their way to promote dignity and privacy where needed – the staff have a very good understanding of the needs of a dementia sufferer’. ‘Staff at Middlecross are very good at identifying and encouraging individuality’. I feel the service does well at person centred care for the individual, has a very good understanding of the needs of people with dementia, liaison with other agencies, building relationships with carers and proactive problem solving. I do not feel there are any ways in which I can suggest improvement of the service’. The comments above seem to support the views of staff who responded – • ‘We provide a homely environment for the residents and a place of safety. Our home is an easy going home where the wishes of the residents come first. Residents and visitors seem very satisfied with the way the home is run’. ‘We have a good understanding of dementia and are able to assess their requirements and needs because of that’. ‘A home is where the heart is and mine is at Middlecross. The service users are what my job is all about as well as all the other staff and management team’. • • What has improved since the last inspection? • • • • • • As a direct result of its own quality assurance survey and listening people and their relatives the home has made the following improvements: DVDs of MGM musicals are available for both individual and group viewing. Brighter style of redecoration to main corridor. Redecoration and redesign of the visitors lounge. Improved the availability and choice of drink making facilities in the visitors lounge. Review of the activity programme to incorporate less large group activities and more individual time. A recommendation made about making sure the PCT reached its part of the service level agreement for intermediate care has been taken forward with good effect and excellent results for the people receiving the service. This has been greatly developed over the last year with 51 of service users returning with assessed care packages to their own homes. These are some, but not all of the things the home identified in the AQAA as having improved in the last year: • The employment of specialist services has begun to be developed in response to peoples needs and this assists in the reduction of accidents. • Menu choice and range has developed Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 9 • • • • • • • • • Employment of a handy person has led to users becoming involved with the garden area. There has been a low level of complaints There has been a high level of compliments Redecoration of the main communal corridors and one dining area. Continued redecoration of peoples’ bedrooms with their consultation. Restoration of visitors room to create a better environment for residents to spend time with carers if they so desire Secured further places for staff on specialist dementia training courses. Have retained the majority of valued staff The staff team have developed more transferable skills from working alongside physiotherapists, occupational therapists, RMNs and general nursing staff What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 10 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 Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. People who use the service experience good quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. People have clear and accurate written information about the services provided at the home to help them choose about where to live. Peoples’ needs are properly assessed before admission. People who go to the home for intermediate care are properly assessed and helped by a team of healthcare professionals and staff from the home to get better and return home if at all possible. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 12 EVIDENCE: The information provided to potential and actual users is varied and in mutiple forms. Welcome packs and service information is readily available. This is updated regularly with changes to statement of purpose, display boards, brochures, service user guides and newsletters. All permanent and respite users are required to have an introductory assessment and review period. This was evidenced in the four case files that were checked, two from intermediate care and two permanent. This sometimes takes the form of an overnight or short stay. An assessment takes place during these visits and people are encouraged to contribute personally. Relatives/representatives are invited to view and no appointment is necessary, an open door policy is encouraged for potential users. The development of care plans and risk assessment are monitored closely. People are involved in the development of their care plans and key workers provide point of contact for all users of the service. The files showed that as much information as possible is provided before a person being referred for intermediate care is admitted. The manager is quite clear that people will not be admitted unless adequate information is provided. Then people are seen by the relevant health care professionals within 48 hours of admission and care planning meetings take place within 7 days to discuss future care options. The staff are trained in providing enabling therapies and promoting independence. The home benefits from dedicated PCT and Mental Health Trust provision of physiotherapy, occupational therapy, general nursing and RMN hours on a daily basis as well as for training purposes. The intermediate care service has been greatly developed over the last year with 51 of service users returning with assessed care packages to their own homes. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. Peoples’ healthcare needs are met and care plans provide clear and detailed instruction for staff to follow. Staff are aware of peoples’ needs and there is good communication amongst the staff group and with healthcare professionals. Medication policies, procedures and practices are good. People are treated with respect and in a dignified way. EVIDENCE: Each person living at the home has a designated key worker who works along side the individual on developing and reviewing their care plan. The files seen showed the language used is very much focused about the individual and had some good detail so that staff know a lot about the indivividuals’ likes and Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 14 dislikes and this reflects the aims of person centred care that is at the heart of the home’s philosophy. A lot of time was spent in the lounge areas during the inspection visit watching staff practices and this showed that they know the care needs and personal preferences of individuals and are good at identifying non-verbal behaviour that indicates when a resident is happy or unhappy. They were good at making sure nobody was isolated and got as much positive attention as possible. The case files showed regular review of each person’s care needs and all people in intermediate care get a weekly evaluation, those in permanent care monthly evaluations and major six monthly review. The manager reported that the lifestyle plans currently used will be replaced at departmental level with what is hoped to be a more efficient format which is more user led. For one person from intermediate care who was case tracked the daily recording was clearly aimed at the main needs that had been assessed and needed to be worked on to get her home. It showed regular communication with the person’s daghter and both the daughter and mother were spoken to during the visit. Both were delighted with the care and support received and their description of the period spent at the home accurately reflected the assessments and recording on the file. They had experienced respite care in other homes but said that Middlecross was ‘absolutely wonderful’, care staff are ‘lovely and can’t do enough for you’, ‘ring and let me know problems and update me’, ‘the food is excellent’, ‘it’s just a lovely place’. A range of risk assessments were seen in each of the files looked at and these are monitored and reviewed. Comments made by healthcare professionals in surveys that were returned reflected positively about the way the home worked and cared for people with demntia and these are outlined in the summary at the start of this report. The case files showed evidence that the needs of those residents whose behaviour is challenging or presents with multiple needs is supported by the good working relationships with the local mental health team and contact with Doctors and Community Nurses. The manager said that training in key areas will continue to be a high priority for all the staff team. This will include training in specific areas such as palliative care, enabling skills and customer focus training. Training in care planning is ongoing to further improve the record keeping. The last inspection involved a pharmacy inspector who gave the home a thorough specialised check of policies, procedures, practices, and record keeping in relation to medication. The outcomes last time were good and no changes were reported. Some records were checked during this visit, Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 15 specifically the people whose care plans had been checked and also staff were observed administering medication. Records and practices were sound. The postive comments made by healthcare professionals who are in the home on a regualr basis reflect well on the way that staff make sure people live a dignified life despite their problems. The relationships between staff and the people they care for are warm and friendly with some residents obviously enjoying some tactile reassurance. Clothing was clean and all of the residents looked well cared for with their hair attended to, ladies ‘made up’ and nails polished. Staff were careful to make sure doors were closed at times when personal care was delivered and were seen knocking on doors before entering rooms. They were attentive to people and some overheard conversations showed staff to have a nice manner that people appreciated. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. Peoples’ social expectations and personal preferences are met and they are able to exercise choice in their daily routines. People living at the home are provided with a varied and nutritious diet. EVIDENCE: The home provides a varied range of activities which are based on life histories and information from ‘lifetime matters’. Both external and internal events are supported with specific resident/family/friend events being well attended. These are published/announced in the home’s newsletter and a number of people talked about a barbeque that had taken place during the summer. Activities are evidenced in an activities file and individuals’ case records. The vacant handyperson post has been filled and the postholder has Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 17 been able to get some people involved in the garden area. During the inspection visit people were in and out of the safe garden area enjoying the sunshine, chatting and watching the world go by. Links with the local community are maintained and encouraged, like churches and schools. Some people get out with their families in some instances or with staff to shops, churches and places of interest. People are consulted about day trips. Visitor facilities are provided and there are no restrictions on visiting unless requested by service users. This is made clear in the written information about the home and the surveys that were returned confirm this was the case with a number saying they were always made to feel welcome by the staff. Families/friends are encouraged to maintain involvement and actively participate in the care of their relative/friend. This was the case on the day of the inspection visit with two husbands joining their wives for lunch and assisting them to eat. The information provided before the inspection in the AQAA said that service user choice is at the forefront of all actions within the home. It was clear through sitting in the lounge areas and chatting with people that they get up when they like and breakfast was available (with a wide choice available, including cooked) at everyones own pace. Overheard conversations showed that staff encourage people to say what they would like to wear (with assuarances about how they looked when dressed), where they would like to be and what they would like to do. The home’s approach to menus is to consult people in an informal way as this appears more meaningful. Menu choices are made at each meal time and these were shown on the menu boards in each dining area. Changes to the menu are piloted and further consultation takes place before impementation. One of the development the home wants to make is a picture menu to assist people in making choices at meal times. At the lunchtime meal people were informed in a cheery way about what was available and sensitively encouraged to make their choice. Staff kept a watchful eye and supported where necessary. People who needed it had protective smocks and it was good to see some residents with their ‘comforters’ at the table, like small teddybears. One wing of the home has a large open plan dining/lounge area. Everyone agrees this is not ideal and there are plans to alter this and creat smaller more cosy areas. One member of staff has come up with the idea of making one area into themed 1940/50’s dining area with furnishings of the time. The manager is hopeful that this alteration and refurbishment will take place next year and the City Council is encouraged to support the good care delivery by providing facilities more suitable for people with dementia and the dual role of the home in also providing intermediate care. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. There is a clear complaints procedure available to the people at the home. The people who live at the home and their relatives feel confident that they will be listened to and that appropriate action will be taken when necessary. There are adult protection procedures that staff have awareness of and understand. People can be assured that they can feel safe at the home. EVIDENCE: The surveys that were returned indicate that people are made aware of the complaints procedure. Speaking to people and visitors showed that at the initial contact with the home and settling in period, they are encouraged to come to staff at the earliest possible moment if they are upset about anything so that the problem can be resolved. People felt reassured by this and the ever vigilant approach of the staff in asking if individuals were okay and were comfortable or did they need anything that was seen during the inspection visit provides further reassurance. Staff were good at identifying the non-verbal communication to determine if anyone was unhappy. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 19 The AQAA confirmed that the home has a complaint and an adult protection procedure. The complaints procedure is appended to the written information about the home and the welcome pack given to each person. The manager is fully aware of the adult protection procedure and how to report any allegations of abuse. Adult protection training has been provided for staff working at the home but the manager has identified that further update training is necessary. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at the home live in a safe, properly manitained and comfortable environment. Bedrooms suit personal needs, are en-suite and can be personalised with individuals’ possessions and made private. The gardens are safe, interesting and well maintained. EVIDENCE: Middlecross is a purpose built care home providing a selection of small and larger seating areas within each section of the building. Although most people have a preferred sitting area more able people were seen to move around if they wished, some going out to the garden area. Communal spaces include small lounges and a dining area in each section and a large room near the bar area. This area combines as a dining, lounge and activities area. There are Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 21 plans to alter this and create smaller ‘cosier’ and intimate rooms. The Snoezelen room adjacent to this area is rarely used and part of the plan is to convert this into a small dining room with a 1940/50’s theme. One kitchenette is to be altered to create an area where people and carers can make drinks and snacks. Within this development consideration is also being given to the facilities for intermediate care, including a tracking hoist in one room. These plans are encouraged as are the plans to upgrade the communal bathrooms. Each bedroom has an en-suite toilet and wash hand basin but residents have the choice of four bathrooms and access to five toilets positioned on the corridors near communal areas if they do not want to return to their own rooms. There are aids, adaptations and specialist hoists to make things safe for staff and residents moving about the building, toileting and bathing. The tour around the building found good standards of cleanliness and no unpleasant odours. There are high levels of incontinence and the housekeeping team do well to keep the home clean and odour free. People are able and encouraged to bring their own items of small furnishings, pictures, photos, ornaments and electrical gadgets, so that their bedrooms are personalised, homely and familiar. There is an ongoing programme of redecoration and people are involved in picking the décor. The gardens are well maintained, interesting and provide some stimulation and are a safe outdoor space for residents to enjoy. Some people get involved in small gardening projects. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. People living in the home are cared for by experienced staff who are trained and qualified for the job. Recruitment procedures protect the people living at the home. EVIDENCE: During the inspection visit a large part of time was spent on the communal areas watching staff at work including during the meal-time. There seemed to be enough staff to make sure that people were looked after and where possible staff spent time with individuals. In their surveys two relatives commented that they felt the home could do with more staff and this would no doubt be a bonus, but from what was seen during the visit people were well cared for by the experienced staff on duty. Most of the staff have worked at the home for a lengthy period and know the people they care for extremely well and this counts for a lot. Most of the staff on duty were spoken to individually and some returned surveys. The surveys showed that staff felt that they had been Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 23 properly trained and conversations with one who had recently started work at the home showed that she had been through an induction period. This was despite the fact that she had good experience and training in her previous job. The numbers of staff having achieved National Vocational Qualifications far exceeds the 50 targets set in National Minimum Standards. In addition to basic training a large percentage of staff have completed the Dementia Care Certificate and those spoken with said how valuable this had been. Surveys returned from healthcare professionals acknowledged the expertise of the staff in caring for people with dementia. Some basic training updates have been identified and the manager is keen to get people on the City Council Programme but sometimes places are limited. From the conversations with staff there is a clear commitment throughout the staff team to personal development. Some staff felt they would benefit from training in managing aggression as this was an increasing feature of their work and this should be arranged. Staff talked about there being good morale and team spirit and said that the manager was good and very approachable. This extended to the ancillary staff spoken with, who are an equally committed and integral part of the staff team and service offered. The surveys that were returned acknowledged the cleanliness of the building and the quality of the food, not forgetting the work of the handy person in making sure that general day to day maintenance is kept up to scratch. The shift handover during the afternoon was observed and good quality information was passed on so that the oncoming staff were aware of people who may need some additional oversight for one reason or another. Staff were clear about which part of the building they were working in and what their responsibilities were. The staff files available for inspection show that the home follows City Council policies and procedures to make sure that staff who are appointed have gone through a process that makes sure that they are properly appointed, referenced and checked with Criminal Records Bureau. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. People who use the service experience good quality outcomes in this area. We have made this judgment using available evidence including a visit to this service. The home is well managed. The interests of the people who live there are seen as very important to the manager and her staff. There is a clear approach to resident care that is person centred and puts the best interests of individual residents central to staff practice. Regular auditing and checking of facilities, equipment and services make sure the home is a safe place to live. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager continues to be ‘hands on’ to make sure there is personal ‘on the job supervision’ and checking, as well as the established formal supervision system of the staff team. The conversations with staff, people living at the home, CSCI surveys and the home’s satisfaction survey show a high regard and appreciation for his management style. He has yet to complete the Registered Manager’s Award. Surveys and conversations also indicate that the home is meeting its aim to provide person centred care. This was acknowledged by more able people, relatives, healthcare professionals and by members of staff who returned surveys. To make sure it is achieving its aim, the home conducts its own quality survey and this is currently being done. Surveys are sent to each service user and their families or representatives. The feedback from these is used in the development plan and quality assurance analysis. As well as this to promote the views of the people who live at Middlecross a variety of methods and techniques are used like holding small informal group conversations as part of the activity programme to try and encourage people to express their views on all aspects of their lives. For example discussing the meal that has just taken place and what people thought of it or would like instead. These views are then either recorded on individual care plans to promote a person centred care approach, or used as part of the homes development plan. People are supported to make choices in all aspects of their lives in a manner and at a pace appropriate to them. They are involved in the choosing of the decoration of both communal and private areas of the building, the plants in the garden and other choices regarding the fabric of the building. This is achieved by showing the individual resident the books of wallpaper samples or paint colour cards. Peoples’ views have also been sought about the proposed redesign of one of the communal areas of the building. The City Council has vigorous policies and procedures in respect of any personal money held for safekeeping for individuals. The home also benefits from having a part time administrator who manages much of this. No specific individual checks were made other than for the manager to confirm that methods of accounting for and holding personal money are unchanged. Periodic checks and audits are made by the City Council. Staff confirmed in surveys and in conversation that they receive regular oneto-one supervision although this is not always with the regularity outlined in National Minimum Standards. They did however say that where they felt they needed a one-to-one session and this was not scheduled, this would be accommodated straight away. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 26 The AQAA that was returned showed that safety checks are made of facilities services and equipment as they should be. There is some good work going on in introducing gadgets and equipment through Telecare that reduces the risk of accidents or alerts staff to people who have falls and accidents. This is in its early stages and part of the initiative is for intermediate care people who return home and tests can be made at Middlecross that the equipment is suitable and will make things safer at home. There are benefits also for people living permanently at the home who can be made safer. All of the management team for the home have a qualification in health and safety. All staff are trained in safe working practices. The regular checks that are made and the training of the staff, monitoring of accidents and incidents make the home a safe place to live and work in. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP31 Regulation 9 Requirement The manager must complete the Registered Managers Award or other recognised qualification. (Outstanding from inspection report of 19/07/05. New timescale set.) Timescale for action 01/06/08 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 OP19 Good Practice Recommendations The City Council should get on with development of lounge areas and other planned improvements for undoubted benefit of people living and working at home. The provision of walk in shower facilities would beneficial and give residents an alternative to bathing. the the the be 2. 3. OP19 OP30 A number of staff said in conversation that they felt they would benefit from training in managing aggression. This should be arranged. DS0000033202.V353266.R01.S.doc Version 5.2 Page 29 Middlecross 4. OP36 The management team should try to make sure that staff have one-to-one supervision sessions at least six times a year. Middlecross DS0000033202.V353266.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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