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Inspection on 15/10/08 for Mamsey House Nursing Home

Also see our care home review for Mamsey House Nursing Home for more information

This inspection was carried out on 15th October 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Mamsey House has been providing a very good standard of care to people for some time. All people who returned comment cards or were spoken to during the inspection were pleased with the care they received at Mamsey House. One person said "I am more than happy with the care and attention." The home reassures people (and their families) that they are safe and will be well cared for. A relative wrote "We are glad that mother is with you." There were many cards thanking the home for care given to people at the end of their lives. "Thank you for looking after mum with such compassion." "He couldn`t have been in a better place." There was evidence that people receive a high standard of health and personal care. A General Practitioner visits the home weekly. Both long term and short term needs can be addressed. There is evidence of good links to other services. Barbara Kinzett, the manager of the home acts as an advocate for people in the home and is pro-active in ensuring the home is run in peoples best interests . Ms Kinzett actively maintains both her clinical and management skills. Comments from people in the home and their relatives praised the manager and the fact that she "always acts on things promptly". Nursing and care staff have opportunities for training and are well supervised. There was evidence that they understand and promote peoples independence and dignity. There is a real attempt by the home to enable people to live a life that includes some pleasure and social interaction. Visitors are welcome and some people have families that spend a significant amount of time in the home. The chef is knowledgeable and experienced about the needs of people he is cooking for. He was able to talk about recent training and possible future developments to the home catering. The kitchen has been graded as 4 stars by the environmental health inspectors. The home environment is clean, comfortable and homely. People praised the laundry service.

What has improved since the last inspection?

The home reviews and up-dates systems and procedures periodically and is always looking at ways in which the service can be improved. There is a new care planning system in place. There have been improvements to the environment notably the garden room extension. A new medication system has been implemented.Additional trained staff are on duty following a review of staffing.

What the care home could do better:

The home will be reviewing the system used to manage peoples personal allowances as discussed with the manager and administrator during the inspection. Some areas of the home are due to be refurbished. Whilst there is evidence that all staff are well supervised a review of the recording system for experienced staff should be undertaken to ensure that there are clear records and that manual handling up-dates are included.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mamsey House Nursing Home Priest Street Williton Somerset TA4 4NJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Shelagh Laver     Date: 1 5 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Mamsey House Nursing Home Priest Street Williton Somerset TA4 4NJ 01984633712 01984632281 mamseyhouse@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Barbara Mary Kinzett Type of registration: Number of places registered: Clinida Care Ltd care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 33 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Mamsey House Care Home is a converted vicarage with an additional purpose built extension. The home is registered to provide general nursing care and personal care to older people. Accommodation is arranged over two floors of the original building and on one floor in the extension. The extension was registered in 1998. All rooms are for single occupancy and vary in size. All rooms except one have en suite facilities; this room has a wash-hand basin only but is adjacent to a disabled toilet facility. Communal areas comprise of two dining areas and a lounge and activities area. The Care Homes for Older People Page 4 of 27 Over 65 33 0 Brief description of the care home lounge has been extended to provide an open conservatory area with views of the countryside. The home has been adapted to meet the needs of residents who require nursing and personal care. There is independent wheelchair access to the main entrance and level access to some of the grounds. There is a ramp leading from the lounge to the patio where residents can enjoy the well-maintained gardens in finer weather. There is a fishpond, garden seating gazebo and raised flowerbeds. The home is set close to a main road a few hundred yards from the village of Williton and the local shops. The home has dedicated administration staff and a nurse Manager. There is a Registered Nurse on duty 24 hour a day. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key Unannounced inspection took place over one day by one inspector. A second short visit was made to complete the review of documentation. The registered manager was available throughout the inspection and provided all assistance. Before the start of the inspection comment cards were received from 24 people who live in the home and 11 staff who work there. The home asked an Age Concern advocate to assist with the completion of the cards. The manager of the home had completed a detailed Annual Quality Assurance Assessment prior to the inspection and this contained factual information about the service and an indication of plans for the future. Care Homes for Older People Page 6 of 27 We visited the home and talked to people who lived there, the manager and staff. We asked to see care and staff records and reviewed other documents. A tour of the home gave the opportunity to see the communal areas and some peoples bedrooms. This gave the opportunity to see the standard of cleanliness, maintenance and decoration. The range of fees is currently 595-640. Additional charges are made for newspapers and hairdressing. What the care home does well: What has improved since the last inspection? The home reviews and up-dates systems and procedures periodically and is always looking at ways in which the service can be improved. There is a new care planning system in place. There have been improvements to the environment notably the garden room extension. A new medication system has been implemented. Care Homes for Older People Page 8 of 27 Additional trained staff are on duty following a review of staffing. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home understands the importance of having sufficient information when choosing a care home. All people who come to the home have a full needs assessment. Evidence: The home produces a comprehensive pack of information for people who might be interested in coming to the home. This includes an attractive easily understood printed brochure, sample contract, the statement of purpose and a summary of the last CSCI report. Four people were case tracked. Assessment documents were seen in their individual care files. There were a range of documents that enabled a skilled assessment of peoples needs to be made. These included an assessment completed by the manager or senior nursing staff in the home, hospital discharge documents and Standard Assessments completed by social services. There was also additional information Care Homes for Older People Page 11 of 27 Evidence: regarding specific care needs for example relating to enteral feeding or pressure relief requirements. The home does not provide intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are comprehensive, person centered and well maintained. People receive an excellent standard of health care as a result of the home staff working in partnership with a regular General Practitioner service. Medication is administered safely. Peoples privacy and dignity is well maintained. Evidence: The care plans examined were detailed and comprehensive. They contained clear information that would enable staff to deliver a high standard of personal and nursing care. There is a visit by a GP weekly that ensures regular reviews of medical needs are undertaken. There was evidence that people are referred for appropriate specialist attention and services promptly and that visits were followed up with action by home staff. There were particularly clear records of visits by health and social care professionals that enabled the level of health care to be reviewed. For example one record showed Care Homes for Older People Page 13 of 27 Evidence: that visits by doctors addressed both short term and long term needs. The dietitian and specialist nurses had visited and the person was receiving regular aromatherapy. It was clear that medical help in emergencies was sort promptly. There was evidence that care needs identified had been addressed in a thorough and professional manner. Manual handling and pressure relief assessments and recording were comprehensive. Peoples weights and blood pressure are recorded monthly. if there are concerns about peoples weight they are weighed weekly and a detailed food diary is kept. All people who returned a comment card said that they always received the medical support that they needed. Staff comment cards stated that they always or usually received all the information that they needed about people. They felt supported by clear hand overs and up dates available in the care plans. Throughout the inspection there was evidence that people are treated with respect and kindness. Peoples preferred term of address is clearly stated in the admission and care plan documents. Doors are always closed when people are receiving care. Staff were heard speaking to people kindly and with respect. There was evidence that some people who came to the home improved and planned to return home following nursing care at Mamsey. Some wound care plans could have been improved by indicating more clearly how the wound was progressing as well as the treatment given. A review of the medication administration system showed safe practice and a good standard of recording. Nurses have received training up-dates and a new system of medication supply has been put into practice. People are able to self medicate when appropriate and records supported this practice. Medication is reviewed regularly by the visiting GP to ensure best practice. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged and supported to make choices about their daily lives in the home. There is a range of social events and activities availble to people. People enjoy a choice of well prepared nutritious meals in the home. Evidence: People spoken to were able to describe the choices they could make in daily living. One person spent each afternoon with a relative and was able to go out in the car. Some people spend a lot of time in their rooms, others particiapte fully in the activities programme. People were seen resting quietly during the day or accessing music in their rooms. Recent group exercises included Flexercise and a fondue party. Records showed that people had the chance to see films, play games and try crafts. There are trips out in the mini bus. There was an advertisement for the Turkey and Tinsel party held in the community for people who wanted to go. People wrote in comment cards There are plenty of activities. Others wrote I dont mix. I am happy watching my TV. The home is a member of the National Association for Providers of Activities for Older Care Homes for Older People Page 15 of 27 Evidence: People and staff felt this was useful. A leaflet for relatives giving 101 suggestions of things to do visiting a relative is included in the admission assessment pack. Three visitors spoken to during the inspection confirmed that they were always welcome in the home. The home makes links with the local community whenever possible. Entertainers and services are brought in and people living in the home go out for local trips and to access social events when possible. People liked the food in the home. Comment cards and people spoken to during the inspection confirmed that there was a choice of meals and that food was interesting and varied. One person eating a late full cooked breakfast told us it was lovely. In a comment card someone wrote Nice not to have to cook. The home is continually looking at ways to improve the food service to people. Currently photographs of all meals are being prepared to aid choice and the timing of the main meal of the day is being reviewed in line with recent research. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home welcomes complaints and suggestions about the service and uses them positively to develop new ways of working. Individuals in the home say that they are extremely satisfied with the service, feel safe and well supported. All appropriate action is taken to keep people safe. Staff are aware of their role in protecting people . Evidence: The home has a robust complaints procedure. A copy of the policy is included in the service user guide and displayed in the home. A record of the one complaint received had been fully documented and appropriate action taken. 22 of 24 people who returned a comment cards indicated that people knew how to make a complaint and would be confident in doing so. People identified the manager as being always accessible. There are residents meetings when any issues of concern are discussed and addressed. There is an emphasis on sorting things out whenever there are concerns by people in the home or their relatives. One person wrote Any complaints are adequately resolved by the staff. A visitor said Almost as soon as you ask something gets done. The manager and staff receive regular Safeguarding Adults training and were able to talk during the inspection of the ways that people would be protected. Communications Care Homes for Older People Page 17 of 27 Evidence: with us have shown that the manager understands how behavior of people who live in the home can sometimes cause upset and may need prompt action. There was evidence in care plans that staff are aware of the care needed when using bed rails and the need to complete assessments and gain consent. All people spoken to during the inspection were very happy with the care and support provided. People said that they felt safe. Relatives were happy that their relative was safe and quite contented. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is comfortable and clean and has been adapted to meet their needs. Policies and procedures are in place to control the spread of infection. Evidence: Overall the home is clean, well maintained and comfortable. All except two people who returned a comment card said that the home was always fresh and clean. two people said it usually fresh and clean. The communal sitting room has been extended by the addition of a pleasant garden room. There are some pleasant views from some windows and the outside of the home is attractive and welcoming. Bedrooms vary in size and outlook but are all personalized. Some people particularly enjoyed a view over open countryside. There is continued investment in the home including replacement of carpets and purchase of new profiling beds. Some dining room furniture is looking battered and could be repaired. There is a program of regular maintenance and a full time maintenance person is employed. There is evidence of a range of equipment to promote safety and mobility. Throughout the home there is evidence of measures in place to control the spread of infection including appropriate staff hand cleansing supplies. Care Homes for Older People Page 19 of 27 Evidence: People commented that the laundry was very good. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have confidence in staff who care for them. There is a robust recruitment system and opportunities for training appropriate to staff roles. Evidence: Staff rotas indicate that there are sufficient staff on duty to meet peoples needs. The home has increased the number of staff on duty so that there are usually two trained nurses on the day shifts. Managers and staff work together to cover sickness or short term staffing problems. People who returned comment cards said that staff were always or usually available when needed. Two people of the 24 who returned cards said sometimes and said that there could be a delay in answering bells at times. One person said that staff were very good but would like more time to chat. Staff are offered the opportunity to gain qualifications at National Vocational Qualification level 2 and 3. The deputy manager will commence her NVQ4 training in the near future. Four staff files examined showed that the home had a robust recruitment system. There is a detailed employee check list that records references and Criminal Record Bureau checks. Staff comment cards and staff spoken to during inspection confirmed that they had received a thorough induction. Records of induction and supervision Care Homes for Older People Page 21 of 27 Evidence: during the first weeks of employment were seen in peoples files. Records showed that staff received regular training. Most recently staff had received training in food hygiene, protection of vulnerable adults and infection control. There are opportunities for the nurses to access appropriate updates such as medication and diabetes seminars. One member of staff wrote in the comment card I am provided with both in-house training and can go to training courses outside work which allows me to continuously improve and up-date my practice. The home has trained manual handling trainers who assess people in the home and provide staff training and up dates. It is recommended that the dates of training for staff are kept in their training files. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home benefit from a manger who is qualified and highly competent. The manager communicates a clear sense of direction and promotes best practice throughout the home. There is an established quality assurance system in place based on seeking the views of people in the home and their relatives. There are a comprehensive range of health and safety measures in the home aimed at promoting the safety of both staff and people who live in the home. Evidence: The manager Barbara Kinzett continues to run the home very well. She is particularly pro-active in ensuring that she is up-to-date with clinical and managerial issues. There is a clear staff structure in the home. Staff are encouraged to access training and to accept responsibility for outcomes in the home. Staff who returned comment cards all said that they met with the manager regularly to receive support and discuss how they were working. Care Homes for Older People Page 23 of 27 Evidence: The views of people who live in the home are sort formally through service users meetings and through individual monthly questionnaires. Evidence was seen of the review and action planned as a result of these questionnaires. There are two meetings held for relatives each year and questionnaires are sent out to coincide with these meetings. The home has recently arranged a lap top computer link to the INTERNET so that people in the home can maintain contact with relatives and friends if they wish. The manager was able to describe the financial procedures in place to ensure the effective and efficient management of the business. The manager and the administrator agreed during the inspection to review the current administration of peoples pocket money records to bring this in line with current best practice. Staff are supervised regularly and records were seen. Whilst the records for newly recruited staff were comprehensive some established staff were supervised more informally. There was evidence of attention to health and safety. Contracts are in place to ensure servicing of lifts and hoists is undertaken according to regulations. The home takes precautions to ensure staff are trained in fire safety and there are regular checks on equipment. The home has three in house manual trainers who receive formal annual training updates. They assess people in the home and ensure staff have annual training up-dates. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 35 As discussed and agreed during the inspection the manager and administrator should review the policy and procedures governing the management peoples money with a view to some changes in monitoring. Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!