CARE HOMES FOR OLDER PEOPLE
Maesbrook Nursing Home Church Road Meole Brace Shrewsbury Shropshire SY3 9HQ Lead Inspector
Pat Scott Unannounced Inspection 22nd August 2007 10:00 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 Maesbrook Nursing Home DS0000068099.V342217.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. Maesbrook Nursing Home DS0000068099.V342217.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Maesbrook Nursing Home Address Church Road Meole Brace Shrewsbury Shropshire SY3 9HQ 01743 241 474 01743 231269 maesbrookcarehome@surfee.co.uk 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) Maesbrook Care Home Limited Mrs Rosalind Wade Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability (2) of places Maesbrook Nursing Home DS0000068099.V342217.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th February 2007 Brief Description of the Service: Maesbrook Care Home is situated in a tranquil village setting on the outskirts of Shrewsbury. It has good transport links to the town and local amenities. The home is set in well maintained grounds that are accessible to service users and car parking facilities are provided for visitors. Maesbrook Care Home Ltd make their services known to prospective service users in an information brochure. The inspection report can be made available. The care home rates are reviewed annually and service users are notified one month in advance. Fees for Maesbrook are: £575-£720. Maesbrook Nursing Home DS0000068099.V342217.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider in the annual quality assurance assessment, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance processes, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. An ‘expert by experience’ participated in this inspection. This is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector, to help them get a picture of what it is like to live in, or use the service. What the service does well:
Significant time and effort is spent making admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support. Personal support is responsive to the varied and individual needs and preferences of the people who use services. The delivery of personal care is individual and is flexible, consistent and reliable. Staff respect privacy and dignity and are sensitive to changing needs. The service listens and responds to individuals’ choices and decisions about who delivers their personal care. People who use services are supported and helped to be independent and can take responsibility for their personal care needs. Staff listen to people who use services and take account of what is important to them. The staff and residents appear to have a friendly relationship and the endeavours to provide activities are to be commended. The ethos of the home is that it welcomes complaints and suggestions about the service, uses these positively and learns from them. Individuals and others associated with the home say that they are extremely satisfied with the service, feel safe and well supported. All Staff working at the service know the importance of taking the views of residents seriously, and of listening to and responding to raised issues. People who use services have confidence in the staff that care for them. The service ensures that all staff receive relevant training that is focussed on
Maesbrook Nursing Home DS0000068099.V342217.R01.S.doc Version 5.2 Page 6 delivering improved outcomes for people using the service. The service puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people using the service. The manager communicates a clear sense of direction, is able to evidence a sound understanding and application of ‘best practice’ operational systems, particularly in relation to continuous improvement, customer satisfaction, and quality assurance. Equality and diversity issues are given priority by the manager who is aware of the varying strands this involves. 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. Maesbrook Nursing Home DS0000068099.V342217.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 Maesbrook Nursing Home DS0000068099.V342217.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): Key Standards 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written records for the admission of new people to the service demonstrate that the process is personalised and that consideration has been given to all aspects of care. EVIDENCE: The service maintains pre-admission and admission records. The records were seen of two new service users admitted. The assessments were personalised and addressed physical health, mental health, social care and spiritual needs of the individual. The manager keeps copies of the assessment summary and care plans of those carried out through care management arrangements. A service user spoken with stated that he had provided information about himself to the manager prior to coming to live at the home. Maesbrook Nursing Home DS0000068099.V342217.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 excellent. This judgement has been made using available evidence including a visit to this service. Service users’ care needs and risk assessments are set out in their individual plans of care which ensures that all care needs have been addressed and will be fully met. The manager understands the need to comply with safe medication systems and staff practice ensures that the home’s procedures are complied with and that service users health matters are safely addressed. The actions of staff and their approach to care ensures that service users are treated with respect and their right to privacy is upheld. EVIDENCE: Three care plans were examined. All had care plans derived from the initial assessments. Each plan had a recorded monthly evaluation of the elements of care. They provide detail in how care is to be delivered by staff.
Maesbrook Nursing Home DS0000068099.V342217.R01.S.doc Version 5.2 Page 10 The plans demonstrate contact with healthcare professionals such as district nurse, GP and dietician. Service users spoken with stated that support is flexible as they spoke of the various bed/rising times which are accommodated and always delivered in a way that respects their privacy. One person stated that: “I am very happy with the care that staff give me.” Service users are well groomed with their hair, nails and clothes looking clean. No issues were identified in discussions regarding approach of staff or being assisted with intimate tasks. Staff observed going about their work have a cheerful and professional attitude. Staff spoken with are very knowledgeable about clinical issues and how care is to be structured to address these. The service accepts responsibility for administering medication to service users. One service user is self-medicating and has safe storage facilities in his room. The service has suitable storage facilities for all types of medicines. Written records for receipt and disposal are maintained and the medication reviews regularly take place. The management has identified the need to develop a medication management audit tool to ensure that practice complies with procedures. Maesbrook Nursing Home DS0000068099.V342217.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): Key Standards 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet service user’s expectations through assessment, consultation and choice. Service users receive a healthy diet according to their assessed requirement and preference. EVIDENCE: The expert by experience focussed on the outcomes for service users regarding provision of leisure pursuits at the home. Following his walk around the home he spoke to a number of service users. Among the things mentioned or noted were: • Choice of daily newspaper • Regular physiotherapy visits (Twice weekly) • Excellent food with provision for assistance if required • Hair Dressing available on Mondays. (The lady offering this service is also a member of staff)
Maesbrook Nursing Home DS0000068099.V342217.R01.S.doc Version 5.2 Page 12 • • • • Recently a cat has arrived at the home and decided to stay. This is appreciated by the residents. There is a reasonably well stocked library. There is a music centre and a selection of CDs available in the lounge. Many favourable comments were made about the garden. Many of the residents spend time in the garden when the weather is kind. A service user and his wife spoken with said they are very satisfied with the level of care received at the home. They are aware of the activities available but chose not to join in. A conversation with another service user revealed, “of course it can never be the same as your home but I think it’s the nearest thing you could get”. The home’s quality assurance survey had the following comment: “very homely atmosphere that encourages visitors” The activities co-ordinator was on duty who detailed a number of activities that take place during the afternoons. They include: card making, dress making…last project was making ponchos, bingo, extend exercises (twice weekly), carpet bowls and basketball; wheelchair users able to join in both games, reminiscence corner. A member of staff with a particular interest in this runs this group with the co-ordinator’s assistance. A number of service users are recording their life stories with help from the staff, photography-the coordinator takes photos in the garden and brings in her own developing equipment. Service users stated they are encouraged to join in with activities but never made to feel that they “must” take part. About 22 of the current residents actually sit down for lunch and tea, breakfast is taken in their own rooms. Two new chefs are in post and the service users say that the food has improved and is very good and welcome the opportunity to have a say in what they like to eat. The dining area is attractively laid for meals and menus offer a choice of nutritious, well-balanced food. Maesbrook Nursing Home DS0000068099.V342217.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): Key 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 service has a complaints procedure which is accessible so that people who use the service have information of how to make complaints about the home. Training is provided so that service users are protected from abuse and have their legal rights protected. EVIDENCE: Service users surveys stated they know whom to approach if they have a problem. All expressed confidence that issues would be dealt with. There is a high level of accessibility to the management at this home which ensures that concerns can be dealt with very quickly. The complaint log details all concerns received whether written/verbal or ‘minor’ comments. The last inspection identified that staff needed to have updates on training for safeguarding adults. This training had been provided. Maesbrook Nursing Home DS0000068099.V342217.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): Key Standards 19,26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home has improved, through service user choice, so that they live in a safer, better-maintained and comfortable environment, which encourages independence. EVIDENCE: The manager stated that the refurbishment improvement plan is to upgrade all the bedrooms in which the décor is looking tired and worn. The two multioccupancy rooms have been addressed to create two shared rooms. Old carpets have been replaced where necessary. All areas seen around the home are clean and rooms personalised and decorated according to the wishes of those service users occupying them. This has been welcomed by those living at the home and many favourable comments were made about the decoration. The choice and style of furnishings respects the diversity of service user groups
Maesbrook Nursing Home DS0000068099.V342217.R01.S.doc Version 5.2 Page 15 regarding preference; for example not all service users wanted ‘older style’ bedding and lampshades and wanted a fresh modern feel to their private space. The service has respected this viewpoint. The expert by experience noted that although some major building work was taking place on the first floor there was no evidence of dust or debris spreading to other areas. The bedrooms that he visited were light and airy with lovely views from large windows. There was adequate space in the majority of the rooms for treasured personal possessions such as photographs to be displayed. He spoke briefly to the gardener and the beauty of the garden is a credit to them, which includes a pond, and ‘dig for victory’ garden. It is the intention of the manager to create a fragrant garden for those with sensory impairment. An infection control audit was underway during the inspection. Clothing is removed individually from bedrooms for laundering rather than putting it all together in one skip. Maesbrook Nursing Home DS0000068099.V342217.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): Key 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. Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of service users. EVIDENCE: The home has a good staff to service user ratio to care for service users with complex needs. Agency staff are never used. Two new recruit files were examined. All checks required by Regulation were in place but full criminal record checks had not been received before the people commenced employment. POVA first checks had been carried out. The management input is supernumerary to care staff numbers although the manager does directly supervise staff during their shift-work. Staffing rotas are in place and a board in the foyer displays the daily staffing compliment for the attention of anyone who wishes to view it. NVQ training is provided and the minimum ratio of 50 trained staff being at level 2 has been achieved. Staff turnover in the home is low so that continuity of care is provided. The service users know the staff very well and observation showed that they provide a personal but professional service.
Maesbrook Nursing Home DS0000068099.V342217.R01.S.doc Version 5.2 Page 17 Service users are very complimentary about the way staff care for them. One commented that “Maesbrook provides a very homely environment and that staff are genuine in their care” and “staff made dad feel wanted and at home”. Maesbrook Nursing Home DS0000068099.V342217.R01.S.doc Version 5.2 Page 18 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): Key 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 management and administration of the home is based on openness and respect and with effective quality assurance systems in place, service users are assured that the overall conduct of the home is being well managed. EVIDENCE: The organisation, Maesbrook Care Home Ltd, is competent to provide the service and demonstrates the ability to continually improve the service to provide value for money. The management is aware of the running costs of the home which they have effectively used to provide better outcomes for service users, e.g. the injection of cash to fund the redecoration and refurbishment of
Maesbrook Nursing Home DS0000068099.V342217.R01.S.doc Version 5.2 Page 19 the premises. The service is good at identifying any shortfalls and is keen to explore ways of improving the care provided. Staff practice is very service user focussed and customer satisfaction is high on the agenda. This is evidenced by the commitment to conducting service user surveys and including service users ideas in management decisions. Service users stated that they trust the staff and feel safe in the home. The manager demonstrated a commitment to the equality and diversity of service users by addressing needs arising out of age and disability. Good record keeping systems are in place. All records seen are written in a way that shows the service listens to the people who use it. What people say is heard, acted upon and reviewed and elements of the annual quality self assessment were seen to be in place. E.g. consultation with service users, reviewed policies, revised quality systems etc. Maesbrook Nursing Home DS0000068099.V342217.R01.S.doc Version 5.2 Page 20 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 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Maesbrook Nursing Home DS0000068099.V342217.R01.S.doc Version 5.2 Page 21 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. 1 Refer to Standard OP37 Good Practice Recommendations The person conducting the visits in accordance with Regulation 26 should prepare a written report on the conduct of the home and supply a copy to the registered manager. The registered manager should make sure that full criminal record bureau checks are returned before employment of staff begins. Only in exceptional circumstances i.e. when low staffing is detrimental to service user care, can new staff start following just the POVA first check. 2 OP29 Maesbrook Nursing Home DS0000068099.V342217.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.shrewsbury@csci.gsi.gov.uk Web: www.csci.org.uk
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