Care Home: Minsden

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What the care home does well The home is well run and appropriately staffed to meet the needs of the residents. The atmosphere was calm and relaxed, although at times busy. A good training programme is in place with additional training offered to ensure staff are able to meet the resident`s needs. We are appropriately informed of issues that affect the well being of the residents enabling us to monitor the quality of the care provided. Staff were seen to have a good relationship with the residents and treated them with respect. What has improved since the last inspection? A number of areas throughout the home have been redecorated providing more pleasant surroundings for those who live at Minsden. They have arranged outings for the residents, which were reported to have been very much enjoyed by those who took part. Minsden is able to maintain a good level of staff retention, which has provided a better continuity of care for the residents, and staff get to know residents better. CARE HOMES FOR OLDER PEOPLE Minsden Wratten Road West Hitchin Hertfordshire SG5 2AU Lead Inspector Mrs Alison Butler Unannounced Inspection 2nd July 2008 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Minsden DS0000019470.V367604.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. Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Minsden Address Wratten Road West Hitchin Hertfordshire SG5 2AU 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) 01462 450703 01462 427651 minsden@quantumcare.co.uk www.quantumcare.co.uk Quantum Care Limited Ms Elizabeth Grace Street Care Home 48 Category(ies) of Dementia - over 65 years of age (48), Old age, registration, with number not falling within any other category (48), of places Physical disability over 65 years of age (48) Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th July 2007 Brief Description of the Service: Originally built in 1960, Minsden was first registered with Hertfordshire County Council on 1st July 1992. It was refurbished in the mid- 1990s. The home is situated in a quiet residential area within walking distance of Hitchin town centre. The accommodation is on two floors served by a lift. On the ground floor there are 19 single bedrooms, quiet room, a lounge, dining room, Asian elders day centre, kitchen, laundry room, several offices, 3 bathrooms, 2 shower rooms and toilets. On the first floor are 22 single bedrooms, lounge, kitchen diner, quiet lounge, 3 bathrooms, 2 shower rooms and toilets. To the front of the building there is ample car parking and a medium size garden and patio to the rear. The Asian elders day centre is a particular feature of the home, providing a valuable resource for the local community, open Mondays to Fridays each week. The homes statement of purpose states that the emphasis is at all times on making service users feel that Minsden is their home. For a copy of the Statement of Purpose, Service User Guide and up to date fees contact the manager for the service. Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We (The Commission for Social Care Inspection) carried out this key unannounced inspection between 08:00 and 14:00 hours and it took 6 hours to complete. The focus of the inspection was to assess all the key standards We observed what was going on in the home, spoke with residents, staff and management, looked round the home and examined care and administration records. Information received in the form of the Annual Quality Assurance Assessment (AQAA) has also been included where relevant. This is a self assessment document completed by the provider. What the service does well: The home is well run and appropriately staffed to meet the needs of the residents. The atmosphere was calm and relaxed, although at times busy. A good training programme is in place with additional training offered to ensure staff are able to meet the resident’s needs. We are appropriately informed of issues that affect the well being of the residents enabling us to monitor the quality of the care provided. Staff were seen to have a good relationship with the residents and treated them with respect. Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Minsden DS0000019470.V367604.R01.S.doc Version 5.2 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 Minsden DS0000019470.V367604.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are provided with the information to make an informed choice and a comprehensive assessment is carried out to ensure they are able to meet the needs of the resident on admission. EVIDENCE: There is an up to date Statement of Purpose and Service User Guide available to prospective residents and their families that provides them with the information they require to make an informed choice. Pre-admission assessments are carried out and this is the start of the care plan to ensure that individuals needs have been identified and can be met. The annual quality assurance assessment states that they need to improve the short stay admission process to ensure they receive as much information as possible to understand the needs of the residents. Minsden DS0000019470.V367604.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service can be confident that the care is provided to the residents by staff who will treat them with respect and are aware of people’s needs. Medication procedures are in place which, if followed ensure that people are kept safe. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) stated that the home draws up the care plans with the resident, their families and other information gathered from outside professionals. Once complete they ask the resident, or family to read through it and sign it. It is review and updated monthly or sooner if changes in the residents arise. However on taking a look at some of the care plans, one had no evidence that it had been reviewed since October 2007. An annual review had been conducted but this did not demonstrate that they are meeting the needs as it only stated “The family are happy with the care and their resident is putting weight on”. Where additional information is Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 10 added this should be signed and dated by the author and is used to demonstrate review dates. One resident chooses to takes part in household chores for example cleaning the tables and they like also to attend the homes day centre and meet with people with a similar background and speak the same language, as they are only able to understand simple commands in English. The home employ staff who are able to communicate with them and try where possible to ensure that there is someone available during the working day. Risk assessments are in place, some are very clear on managing the risk for the resident, but there are still some generic ones in place which contain a lot of detail and are not personalised. Discussion with the manager took place and as a company they are reviewing the risk assessment format to ensure they are more person centred. The home has a comprehensive procedure in place for the safe management of medication. However, on examination one person is given their medication covertly, (placed in food and/or drinks). This had been agreed by the GP although it had not been reviewed for over 18 months. There was a note to say the next of kin had given permission although there was no name to who they had spoken to and they had not yet signed the form which was due to be done when they next visited after the 16/01/07. There is no protocol in place to say that they are offered the medication on every occasion and only when they refuse is it given covertly. This would ensure consistency is given at all times. Additionally there was no record that the pharmacy had been consulted to ensure that medication properties are not altered by putting it in certain foods. The deputy manager was sorting this out during the inspection. An addition was made to the medication administration record (MAR) sheet but the person had not completed the details as per the dispensing label and it was not clear what medication they are referring to. They had not signed and dated the additional information. One resident during the administration round decided they did not want to take their medication and spat it out. The home are to look at a new protocol, as they were unable to identify which medication was taken, as on counting the tablets that were for disposal there were not the full amount of tablets as per the MAR sheet. The care team manager was addressing this during the inspection. All other records were well kept and there is a procedure in place for responding to errors in medication and it is also dealt with through their supervision and a record will be made as appropriate. We spoke to a number of residents who were very happy with their care “nothing to complain about they are lovely” “they work so hard”. Staff were observed to having a good relationship with the residents and treated them with respect. Minsden DS0000019470.V367604.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that they will be supported to have contact with their family and be offered a choice of activities to ensure that their recreational interest and needs are met. EVIDENCE: Mindsen have recently lost their daily activity co-ordinator, but interviews have been arranged for day following the inspection. Care staff are trying to ensure that various activities are offered to maintain social interaction and some one to one support for those who require it. They have recently been a boat trip to Broxbourne where 41 residents chose to go they were supported by 8 staff and 6 relatives. All had a good day and they took photos of the day, which are displayed in the entrance to the home. Quantum Care holds a yearly tea dance held in Hitchin, 2 residents and 2 staff attended and had thoroughly good time. A monthly tea dance is held at a local centre and where possible residents are able to choose to go and get involved in the community. The home hold a monthly church service were residents are able to choose to join in or not. There is a corporate rolling menu which was designed by a dietician, they have daily sheets in place which are displayed on the white board. Although these Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 12 may not be easily understood by those who have dementia, a picture format should be considered to provide them with the information of the meal of the day. Following a change to the main meal being offered at teatime this proved successful and people were more alert during the afternoon by being offered a light lunch during the week. They have their main meal in the evening and appear to be more settled during the night. If the meal of the day is not to their taste then alternatives are offered based on their likes and dislikes, which is taken on admission. Residents were happy with their meals and felt they were given plenty if not sometimes too much. The tables on the ground floor were nicely laid and had condiments and sauce, where as the tables upstairs although laid with linen did not have condiments and sauce available. One table being used by two residents in a small dining room had not been laid with table linen or condiments. The manager stated that this was the next room to be redecorated to make it more pleasant but addressed the issue with staff during the inspection. Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 13 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service can be confident that they will be listened to and the information acted on, they are also safeguarded from the risk of abuse. EVIDENCE: A complaints procedure is in place. The AQAA states they have an open door policy and have good relationship with families and other professionals. They believe in responding to complaints as promptly as possible and maintain records to demonstrate this. All staff receive safeguarding training and have regular updates to ensure they are clear on the types of abuse and how to respond if they hear or observe any possible type of abuse. A whistle blowing policy is in place and this is covered as part of the staff induction. Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 14 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident the Minsden is clean and well maintained, and provides an environment which meet people’s needs. EVIDENCE: A tour of the home showed it was clean and well maintained. Over the last 12 months they have redecorated the hallways, lounges and most bedrooms. New flooring has been laid in the sitting rooms downstairs, bedrooms and bathrooms and toilets. There is an ongoing programme in place to replace worn and tired furniture as required. They received a grant, which has allowed them to provide some new specialist baths and redecorate bathrooms, and these looked more pleasant and meet Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 15 the needs of the residents and assist staff in providing a more relaxed experience. Appropriate procedures and staff training is in place for dealing with the laundry in order to prevent the spread of infection. Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 16 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service can be confident that the residents will be supported by appropriate numbers of competent staff who have been robustly recruited to ensure that people are kept safe and their care needs are met appropriately. EVIDENCE: Staff files looked at showed that all the required information had been obtained prior to staff commencing their employment at Minsden. Rotas showed that adequate numbers of staff are deployed throughout the home to meet the personal care needs of the residents. The AQAA states they have been able to retain staff for longer by offering excellent training and staff are able to develop through the company. There is a rolling training programme in place and additional training is provided depending on the needs of the residents. Records showed that staff receive regular supervision and support from the management team and training needs can be identified. Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 17 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, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the home is run for the benefit of those who live there, there is a good management structure in place to support this and health and safety procedures are in place to protect all those who live, work and visit the home. EVIDENCE: The management structure appears to be working well and each person has their own area of responsibility and feedback to the manager on any issues to ensure she is kept up to date with issues and events in the home. Regular meetings are held to keep everyone informed of any changes within the home. Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 18 The manager regularly walks around the home and assists where necessary, for example on the day of the inspection she was assisting residents who required support whilst eating their breakfast. The home hold an annual forum were the results of the surveys are shared with residents and their families. This forum is also used to discuss improvements that they have identified and how they can work on making it happen. The company have representatives who carry out the proprietors Regulation 26 visits but the report for these were not available since February 2008, the manager addressed this with head office during the inspection to ensure these are available for inspections in the future. Policies and procedures are in place to safeguard residents financial interests and information is available for advocacy services for those who may require it. The company auditor carried out his yearly visit in May 2008 and no recommendations were made. Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 X 3 X 3 X X 3 Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Requirement To ensure the safety and protection of the residents Appropriate procedures must be in place for the use of covert medication. Additional information that is added to the administration records must be copied as per the prescribing label. Timescale for action 11/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Minsden DS0000019470.V367604.R01.S.doc Version 5.2 Page 22 - 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. 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