Inspection on 07/02/08 for Merafield View Nursing Home

This is the latest available inspection report for this service, carried out on 7th February 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Merafield View Nursing Home 08/12/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Merafield View Nursing Home Underlane Plympton Plymouth Devon PL7 1ZB Lead Inspector Doug Endean Key Unannounced Inspection 7th February 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Merafield View Nursing Home DS0000065522.V359747.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. Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merafield View Nursing Home Address Underlane Plympton Plymouth Devon PL7 1ZB 01752 348070 01752 346414 merafield@bmlhealthcare.co.uk www.merafieldview-nh.co.uk Stagecare Limited 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) Mrs Sally Philipson Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (6), Physical disability over 65 years of age (40) of places Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Old age, Not falling within any other category (6) Physical disability over 65 years of age (40) Date of last inspection 22nd January 2007 Brief Description of the Service: Merafield View is a purpose built nursing home situated in Plympton St Mary, on the outskirts of Plymouth, in Devon. The home is registered to provide nursing care for up to 40 people, of either gender, over 65 years of age, and personal care to 6 people, over 65 years of age. The maximum number of people who can be accommodated in the home at any one time cannot exceed 40. The home is arranged on 3 floors. The main entrance is on the ground floor and accessed from the large car park. This opens into a reception area with the manager’s office immediately off of this. The main communal area is on this level and consists of a large lounge, dining room and a quiet area with some storage space. This area has recently been extended and opens onto a new patio area. The kitchen is on this level and close to the dining room. There is a conservatory on the lower ground floor that has several uses such as library, activities and watching videos and DVD’s. It also opens onto a patio area. All the floors can be accessed by either a 5-man passenger lift, or by a central staircase. There is reasonable access to the local shops and amenities that are close by. Following the completion of building work the home now has 40 single bedrooms, the majority of which have en-suite facilities. There are no more double bedrooms. Bedroom sizes vary with many being of ample proportions as a result of them originally being double bedrooms. All have access to assisted bathrooms, shower rooms and toilets close by and all of the bedrooms and bathrooms have a nurse call system. The fees commence from £464 a week for nursing care, and are based on the assessed needs of individuals referred to the home. Merafield View Nursing Home DS0000065522.V359747.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 3 star. This means the people who use this service experience excellent quality outcomes. This key unannounced inspection took place on the 7th February 2008 commencing at 09:30 hours and lasted 4.5 hours. In that time we toured the home with the Registered Manager and took the opportunity to speak to 4 people who live in the home. We also spoke to 4 relatives who were visiting, and two staff who work at the home. After the tour we looked at 4 files that were about the people we spoke to who live in the home, this is called case tracking. We also looked at 3 staff files, including those of the staff we spoke to, and several records that verified maintenance and the homes quality assurance checks. Prior to this inspection the Registered Manager returned a completed Annual Quality Assurance Assessment document that told us how the home believe they are performing against the National Minimum Standards, and also gave some factual information about staffing and the people they care for. We also received responses held in 3 staff survey forms, 1 professional survey form, and 6 relative survey forms sent out by the us (Commission for Social Care Inspection) in cooperation with the home. What the service does well: The home provides comfortable accommodation that is well maintained and suitably equipped. The selection of people to live in the home is good and once they are living there the home staff plan the holistic care involving them and their relatives where this is possible. The staff are well trained in how to prove the care that people need and they do this in a respectful way that maintains the dignity of the person being cared for. The completion of building work, and the plans for the future that we have been informed of in the Annual Quality Assurance Assessment show that the management is always looking forward to meet the challenges before them. The home also forges good relationships with the people that live there and with their relatives and friends who were more than enthusiastic to tell us about their experience of the service provided by the home. The food that is freshly prepared by the kitchen has been reported to be of a very good standard by both the people who live in the home and their visitors. Merafield View Nursing Home DS0000065522.V359747.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. Merafield View Nursing Home DS0000065522.V359747.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 Merafield View Nursing Home DS0000065522.V359747.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): The homes performance was assessed against Standards 3. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager gathers a suitable amount of appropriate information about people before they are accepted into the home. EVIDENCE: The Registered Manager will make arrangements for any prospective client to be assessed at the place they are resident in, prior to coming to the home. We saw 3 sets of people notes that showed that a full assessment of need had been carried out so that the home were aware of the individuals present health and socials care needs. The homes own assessment recorded information about personal care needs, nutritional needs, mobility, moving and handling, eliminations, environmental factors to providing care, and social needs that Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 9 were covered in the “work and play” section. Where a person had been in hospital there was a discharge summery and care management records/care plan. This information collectively provided enough information for the home to make a decision about the appropriateness of the admission, and also to allow them to prepare for an admission such as arranging for a pressure relief mattress. The fourth set of notes was for a person who was in the home for a short admission before returning home. There admission was part of an agreement with the local Primary Care Trust who provided their professional nurse assessment before the admission. This was seen alongside the discharge summery. We spoke to the person and her family who were in the home at the time of the inspection. They voiced their satisfaction with the admission and said that the Registered Manager had provided them with full information about the home on their first meeting. Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 10 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): The homes performance was assessed against Standards 7, 8, 9 & 10. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The general management of peoples care, through good assessment, planning, special skills, and the use of other health care professionals, is excellent. EVIDENCE: As a part of the case tracking exercise we looked at the notes of 4 people that we had spoken to. The notes were kept securely in an area of the treatment room. They were well constructed and included risk assessments for such things as tissue viability, moving and handling, falls assessment, nutritional assessments using the MUST (Malnutrition Universal Screening Tool) tool, and the need for a bed rail. This information, and that initially gathered in the preadmission assessments were used to produce care plans, one for each issue. The plans were clear and gave detail about what was needed to address an issue, who was to be involved, i.e., a trained nurse, two care staff, etc, and how often the problem was to be addressed each day. Further to this there Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 11 was a copy of the moving and handling assessment in every bedroom. Each plan was also reviewed on a regular basis and a record made of this on the plan. This information was seen being used in the monthly dependency profile that covered 21 points, and produced a score that shows whether a person is responding to the care that is being provided. In addition to the day care plan each person has a night care plan that covers medication, and sleep. The home record what individuals like to wear to bed, whether they sleep with the light on or off and how often they would like to be checked unless there is a medical reason for very regular check’s. The signing of care plans is a subject that is covered in the home quality assurance procedures with people being asked if they wish to be a part of care planning and care plan reviews. The home has made satisfactory arrangements to meet the health care needs of those people who live there. All the people in the home are registered with a General Practitioner. We received a response from a General Practitioner on the Commission for Social Care Inspection survey of professionals that said the staff, “Are very caring and have good clinical skills, they are very capable and professional”, and they meet the health care needs of the people who live in the home wherever possible. The response also commented that the staff also maintain the dignity of the “patients” by making sure that any consultation is carried out in the privacy of a persons room, and said this was excellent. There are also regular arrangements for Chiropody, 6 monthly visits from the Dentist and the nurses have access to other nurse specialists if they need their advice, such as tissue viability. The General Practitioner will make referrals to physiotherapy, speech and language therapy, audiology, or occupational therapy. Where specialist equipment has been assessed as needed we saw that the home had provided this, such as pressure relief mattresses and hoists in rooms and bathrooms. When interviewing the Clinical Nurse Manager we were told that one of the improvements has been the in the use of the Liverpool Care Pathway, a tool that has transferred the model of excellence for care of the dying from hospices into other healthcare settings. Further to this 80 of the staff have had a 2 days course held by the Hospice entitled, “Care for someone with a life threatening Illness”. We looked at the medication management arrangements and found them to be satisfactory. The medications are stored in a securely locked room when it is not being used. Medications are either is securely locked cupboards or in the locked medicines trolley that is also securely tethered to the wall by steel cable when not in use. A monitored dose system of medication supply is in use and every medication that comes into the home is recorded on the medication administration record sheet. For further safety the medication charts have a picture of the person that they refer to and there is a list of staff names that administer medication with a copy of their signatures to help provide a full administration trail. Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 12 The people we spoke to were clear that the staff did treat them with the dignity and respect that they expected. They knocked bedroom doors and asked to enter. Where it was necessary to help with personal care this was carried out in the most appropriate place and without fuss. We observed staff going about their duties and interacting with the people who lived in the home. They had a comfortable relationship that made people smile. The people we spoke to, including relatives were very complimentary about the staff. One relative said, “I have been to quite a few homes and not found one that has come up to the standard of this one”. Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 13 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): The homes performance was assessed against Standards 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. The people that live in the home are treated as individuals, whose needs and views are listened to, and met where this is possible by a caring staff team. Service Users receive a wholesome appealing diet and are not rushed, and meets their nutritional, and personal needs. EVIDENCE: Prior to admission the home gathers information about the individual who is to move into the home. This includes not just the medical and nursing problems that are to be addressed, but also information about them as a person. This includes what they like to eat and how often, what they like to dress in by day and also by night. They find out about past hobbies and interests either at the pre-admission stage or as time progresses through their stay. The staff are as key workers for small numbers of people. Individuals also have a named nurse. This means that they have a responsibility to get to know people in their care and what there views are on such things as there daily routine. This is Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 14 recorded in the files and also shared with colleagues during handovers. They participate in care planning, charts, and looking after personal issues like clothing, toiletries and replenishing these stocks. This information is also shared with the homes Activities Organiser who works 4 days a week. We were told that she meets new people who move into the home and asks about what they like to do with their time such as hobbies and interests. She has a record of these and also records the individual involvement that she has with people in the home. A wide variety of things are set up that have an entertainment and therapeutic aspect to them such as reminiscence sessions that is carried out with people from the Plymouth Museum. There is also craftwork, coffee mornings, bingo, fund raising events and BBQ’s. The home has a DVD and video player that can be used, a small library with talking books and also arranges a monthly bus trip, at no charge to the people who live in the home, when the weather is reasonable. They have been to local pubs, places for a cream tea, and a local garden centre. The home also facilitates residents meetings and several people we spoke to said that they were involved in these. A record of the meeting is made at each meeting. During the tour of the home we spoke to several people in the privacy of their bedrooms. We saw how some people had made their rooms very homely and comfortable with furniture, pictures and ornaments. Some people had their own telephone lines to make and receive calls. These are private lines with their own numbers for which they are billed in the normal way. One lady was waiting to go out, something she does several times a week. Others were receiving their visitors in their rooms or in one of the communal spaces. Where people were in their room they had the nurse call button with them so that they could choose when to call staff if they wished. People were asked about the food that they receive. The 4 who were spoken to at length did say that they enjoyed the food. One said that she was fed, the food was not “mashed up”, and it was nicely presented. She was also not hurried to eat her meal. Another said the food was nice most of the time and that she had nothing to complain about. When in the kitchen we found out that the staff have had basic food hygiene training and the Head Cook has the Intermediate Food Hygiene Award and that she has also had training in “Safe Food, Better Business” by the local authority. The records were show to us as evidence that she does complete the process of managing the kitchen every day. The cook has also had training in nutrition. She discusses the dietary needs of individuals with the Registered Manager and there was a list of peoples preferences and needs in the kitchen. The Head cook does talk to people about the food they enjoy which helps in meal planning so that she is aware of more than just a persons physical needs are in their diet. The religious and cultural needs are also considered in the planning of a meal. Rotating menus are used as a guide. Meals are prepared from fresh produce and where an item has to be pureed it is then served up from a mould that Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 15 improves its appearance making it look similar to the original produce. We spoke to one visitor who spends a lot of time in the home and does have dinner on occasions. He reported that, “The food was excellent, and this is the best place I have been in. He feels more at home here than other homes he has been in”, and said that as an entertainer he had been in more than 20 homes in the past. Meals can be eaten in the dining room, or in peoples own room, whatever is their choice. The home also cooks birthday cakes and include families in these celebrations. There is a small hairdressing room with a hairdressers sink. The hairdresser attends every Wednesday and will do both men’s and woman’s hair with price’s commencing at £5.50 for a shampoo and set and £18 for a perm. We received 6 responses to the Commission for Social Care Inspection relative’s survey. To the question, ”Do you feel that the care home meets the needs of your relative”, 3 said usually and 3 said always. One qualified the comment with such things as they involve the person in entertainment, give her a choice of meals, give her the correct drugs and arrange regular Doctors visits. To the question, “Do you feel staff have the right skills and experience to look after people properly”, 3 said usually and 3 said always. The comments included, “They have the right skills. Staff changes, length of experience and training do vary and they make every effort”. Another felt that the younger staff could do with more training, whilst another relative said that the care staff are well trained and senior staff are knowledgeable and experienced in dealing with the elderly. Finally to the question, “What do you feel the home does well”, there were several answers such as, “They are always on call and very helpful at all times. The staff are dedicated and I am very happy my relative is in this care home”. Another said, “They make the resident feel at home”, and, “ All staff are pleasant. They have a lovely lady who organises games, day trips, events and entertainers for those who can participate. In my opinion this is key to the patients well being”. We saw the results of the homes own quality assurance surveys. One person who lives in the home wrote, “This is the third home I have been in, and it’s the best”. Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 16 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): The homes performance was assessed against Standards 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has made good arrangements for people to voice a concern, or raise a complaint if they wished to do so. The safety of people has been addressed through good vulnerable adults training for all staff. EVIDENCE: The complaints procedure is well written and on display on the notice board inside the front entrance. It provides the reader with information about whom to speak to if they wish to raise a complaint or a concern and time scales that the home will meet when making their response. It also gives them the contact details of the local Commission for Social Care Inspection office if they wish to discuss their concerns with the regulating authority. The procedure is also part of the information pack that is given to all prospective resident, or their advocate. The home has a system of recording and investigating complaints that concludes in the quality assurance process that audits complaints on a regular basis. The people we spoke to during this inspection each indicated that they would know how to make a complaint if they needed to. In the survey forms 4 relatives said they knew how to make a complaint, 1 said they Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 17 did not, but would go straight to the Registered Manager, and 1 said they would not know how to make a complaint. The Registered Manager provided evidence in staff files, and in the training record to show that staff have attended vulnerable adults training, mostly within the last 12 months, which is carried out by an external trainer. The staff also have knowledge of the local authorities, “Alerters Guide”. Protection of people through recruitment practices is dealt with in the section entitled, “Staffing”. Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 18 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): The homes performance was assessed against Standards 19, 20, 21, 24, 25 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good accommodation that is well maintained, and suitably equipped, making it a safe environment for people to live in and staff to work in. EVIDENCE: Merafield View is a purpose built nursing home situated in Plympton St Mary, on the outskirts of Plymouth, in Devon. It is close to the main shopping facilities of the suburb that are a short distance away. The home is arranged on 3 floors. The main entrance is on the ground floor and accessed from the large car park. This opens into a reception area with the manager’s office immediately off of this. Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 19 The main communal area is on this level and consists of a large lounge, dining room and a quiet area with some storage space. This area has recently been extended and opens onto a new patio area. It is planned to reorganise the space so that the dining room opens out onto the patio. There is a large screen television in this lounge that is to be utilised to provide therapeutic entertainment using the latest gaming technology. The area is fresh and new looking following the building work and use of new furniture and carpeting. There is a conservatory on the lower ground floor that has several uses such as library, activities and watching videos and DVD’s. It also opens onto a patio area. The grounds are not extensive but the best use is made from the limited space. All the floors can be accessed by either a 5-man passenger lift, or by a central staircase. The shaft lift allows access to the whole of the home by people who may have mobility problems and use a frame, and wheelchair users. Following the completion of building work the home now has 40 single bedrooms, 26 of which have en-suite facilities. There are no more double bedrooms. Bedroom sizes vary with many being of ample proportions as a result of some of them originally being double bedrooms. The toilets in ensuites, and in corridors that are for general use, had various levels of assistance such as handrails and raised height toilet seats. Bedrooms are all were equipped with at least a wash hand basin, towel dispensers, basic furniture appropriate to the individual needs of the person in the room, and nurse call system. Where people had lived in the home for a while they had personalised their rooms to look attractive and homely. We saw that throughout the home radiators were guarded with suitable covers and the temperature can be altered in each room. There was evidence provided of the general maintenance of the building, and the equipment in both the Annual Quality Assurance Assessment and also during the inspection. The tour of the building also provided visual evidence that the home is well maintained by the in house maintenance staff, which also have their own workshop. Where specialist skills are needed the home employ competent people under contract for servicing such things as the shaft lift and hoists and we saw dates that these services had last been carried out. All the people who live in the home have access to assisted bathrooms, shower rooms and toilets close by and all of the bedrooms and bathrooms have a nurse call system. One assisted bath also has a hydrotherapy system that is regularly enjoyed by the people who use it. Bath temperatures are regulated whilst some sinks also have thermostatic control valves fitted. There are risk assessments in place for those sinks that do not have these valves and there were clear posters alerting the user that the water will be hot from those sinks. Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 20 There was evidence that the maintenance men make regular checks on water temperatures and that the system is sampled for legionella on an annual basis. We visited the laundry and spoke with the laundry lady. She gave us a description of the procedure for managing the homes laundry including people’s personal laundry. Personal laundry is ladled. The 2 washing machines both have sluicing cycles and washing is dried in the commercial dryers. The laundry is then ironed and placed in baskets to go to individual’s bedrooms. One person operates the laundry 6 hours a day, every day of the week. The walls were washable and the floors impermeable to water. Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 21 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): The homes performance was assessed against Standards 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. There are sufficient numbers of staff with appropriate skills and knowledge to meet the needs of people who live in this home. The homes recruitment procedures, and staff training, protect the people who live in the home from being placed at risk of harm or abuse. EVIDENCE: The home employ’s staff in suitable numbers, and with sufficient skills, each shift, to meet the nursing cares needs of the people who live there. We discussed the staffing arrangements with the Registered Manager and how staff are deployed through out the day. The home is always in the control of a Registered Nurse as it provides nursing care. In addition to the nursing and care staff the home employs an administrator, catering staff, domestic staff, laundry staff and 2 maintenance men. We looked at the training that staff complete, and the Registered Manager provided a copy of the training matrix that records the type of training carried by each individual employed at the home, and when the training took place. From this we saw that everyone has had a full induction period that extends over the 3-month probation period and that there performance is monitored for this period before a decision to fully employ them is made. We saw that staff have had fire training, moving and Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 22 handling, infection control, and that many have had Health & Safety training. The level of National Vocational Qualification training for care staff exceeds 50 with care staff continually being involved in this training. When looking in the 3 staff files that we sampled we saw certificates that verified that the training mentioned had taken place. The home has a recruitment procedure that provides suitable protection to the people who live in the home from inappropriate being employed. It includes a full application form that asks for a 10-year employment history. There are 2 references taken, a Criminal Records Bureau and POVA first check and an interview that includes a series of areas that are covered for each person that in seen. There were also copies of the individual’s terms and conditions of employment. All of the staff receives a “Staff Handbook” that includes information about their employment at the home and policies and procedures that reflect on how their behaviour will be addressed if it does not meet with the expectations of the home. During the inspection we spoke to 3 staff members from different areas of work within the home and who each had different lengths of service and qualifications. Collectively they felt that the Registered Manager did support them to receive a good level of training that is appropriate to their role in the home. One person who was recently employed told us that their induction included shadowing someone for a week before they could undertake any duties, as they were new to care work. They said they had had a good induction that prepared them for the work that they would do. They said that they liked everything about the workplace, the staff and the people who live there. The professional nurse we spoke to said that she enjoyed her work in the home and has recently gained new skills in compression bandaging. The Commission received just 3 completed staff survey forms. One was well written and gave very positive feedback about their experience of working at the home. They said that they received adequate training and support, regular supervision/appraisals, and that if a problem arises they are able to discuss the issue at any time with a senior member of staff. They said that they feel that the home provides, “The highest quality care to be given, as well as supporting and looking after the staff”. The 2 others felt that they had a good induction but that they could benefit from training that brings a better understanding of issues equality and diversity, such as disability, race, ethnicity, faith and sexual orientation. One person qualified this with wishing to have training in, “How to help blind and deaf people”. Another comment was that the staff could encourage people to come out of their rooms more to socialise in the communal area. The Registered Manager said during the inspection that the improvements to the communal areas, including the outside areas, plus new activities that are planned, are aimed at providing more incentives for people to socialise in the home. Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 23 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): The homes performance was assessed against Standards 31, 33, 35 & 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The overall management of the home and the care of the people who in it is excellent. The planning of the safe functioning of the home, including maintenance and staff training is excellent. EVIDENCE: The Registered Manager is an experienced nurse and she has been in charge of the establishment for several years. She holds the Registered Managers Award, a Diploma in Higher Education in Nursing and an ENB certificate in Care of the Elderly. She is competent at her role and showed during this inspection that she has an excellent overview of all the areas of the home that collectively help the home to meet its aims and objectives. There are clear lines of Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 24 accountability both within the home and with the external management. The Registered Manager has a team of people who assist her in meeting the needs of the people who live in the home and also the business. They include the Clinical Nurse Manager who has worked in the home for about 18 months, the Head Cook, and the Administrator who we saw working efficiently on tasks during the inspection. She includes the staff to become involved in the home through the use of regular staff meetings. There is an open door policy that also allows visitor to the home to speak with the Registered Manager should they wish to do so. Visitor’s whose relative had just been admitted said that the Registered Manager had told them all about the home, and the complaints procedure, before they had read the statement of purpose, and that they valued this contact with her so early in the admission. We received 6 completed survey forms from relatives, and one from a health care professional. The majority of responses were giving praise for the way the home. One person wrote, “An apparently well run and well staffed care home, with plenty & varied facilities and additional services & activities. There seems to be a high percentage of permanent staff, so they must be doing something right”. Another said, “They make the resident feel at home. They do there best to make them happy and wanted”. The home has its own quality assurance systems that include obtaining the view of the people who live in the home, and their relatives, about the quality of the service they receive from the initial admission process to the ongoing care that is provided. We saw the questionnaires and the responses were of a positive nature. The home does not manage the financial affairs of any of the people who live there. They do hold some pocket money in a secure place for some of the people who live in the home. This was well recorded showing what was held, what had been spent, the balance, and receipts for any expenditure. During the course of this unannounced key inspection the Registered Manager was able to provide evidence to show that the home has managed the risks to people who live there through good management arrangements. The staff has received good levels of training and have suitable equipment to meet the needs of the people who live in the home. The home is well maintained by in house maintenance staff and also by competent people who the home contracts with. The equipment is also kept in good order using the same arrangements and we saw evidence of this in service sheets and invoices. There have been assessments carried out on the building and also the people who live in it to allow the reduction of any risk that was identified that included such things as what equipment to use, or not use such as bed rails. The Annual Quality Assurance Assessment also provided the Commission with good information about the work being undertaken by the home to enable a judgement to be made following this inspection. Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 25 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 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 3 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 4 X 3 X 3 X X 4 Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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 Merafield View Nursing Home DS0000065522.V359747.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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