CARE HOMES FOR OLDER PEOPLE
Mamsey House Nursing Home Priest Street Williton Somerset TA4 4NJ Lead Inspector
Clare Medlock Unannounced Inspection 7th December 2005 12:00 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 Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 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. Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Mamsey House Nursing Home Address Priest Street Williton Somerset TA4 4NJ 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) 01984 633712 01984 632281 Clinida Care Ltd Mrs Barbara Mary Kinzett Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability over 65 years of age of places (33) Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Elderly person of either sex, not less than 60 years, who require general nursing care. Up to 3 beds for personal care Date of last inspection 4th October 2005 Brief Description of the Service: 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, a lounge and activities area. Residents are also able to sit in the entrance of the home to watch the comings and goings’. 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. Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place between the hours of 12.00pm and 14.30pm on Tuesday 7th December 2005. The inspection was performed to follow up outstanding requirements and recommendations. It found that all requirements and recommendations had been met and that the overall quality of care provided was very good. This inspection consisted of speaking with Service Users (Who have requested to be called Residents), relatives, staff and management within the home. A full tour of the premises was conducted. Care records, and other records were inspected. Four of the Residents, two relatives, and five staff were spoken to. Not all standards were inspected on this occasion. All standards were inspected at the previous inspection in October. It is therefore recommended that the reader obtains previous inspection reports to gain a full picture of life at the home. What the service does well:
Mamsey House Nursing Home provides a very good level of nursing and personal care to all residents including highly dependent residents and to those who are unable to express their needs. There is a dedicated, friendly and motivated staff group who ensure that Residents have all their needs met and ensure residents access a full variety of services. Residents like the friendly and caring staff. Relatives feel welcomed at the home and are confident that their relatives are in good hands. The extensive, varied and well-organised activities programme within the home is full of varied Festive entertainments, which residents are enjoying. Staff encourage residents to maintain contact with friends, family and the local community. Bus Trips are arranged and Specialist activities are also arranged to meet the needs of residents. The home is clean, tidy, very well maintained and equipped to ensure Residents have a homely place to live and are helped to maintain as much independence as possible. Mamsey House is an efficiently run, organised home, which has routines which are flexible depending on the needs, choice and requests of the residents. The staff group are actively involved in maintaining the high standard of care. This is done by ensuring they are ‘up to date’ with the current trends and practices Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 6 in health care and listening to new ideas and ways to improve the delivery of care. What has improved since the last inspection? What they could do better:
Records need to be improved to show the high standard of care that is actually given. This will enable the home to provide evidence of what care has been given to residents. Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 7 Infection control measures are good within the home; however, small changes could also be made to help protect residents from infection. This could include ensuring that when creams are opened the date is recorded which will enable creams to only be used for a specified length of creams. 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. Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 8 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 Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. 1,3,4 and 5 were met at the last inspection. 6 is not applicable. Residents are thoroughly assessed prior to admission, which ensures the home is the right place for them to be. EVIDENCE: The Manager has improved the assessment tool used so that it now contains prompts to ask about foot care, oral care, family involvement and history of falls. This ensures staff within the home gain a full picture of the residents before they are admitted to the home. Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8. Elements of 9. 10 and 11 were met at the last inspection The satisfactory care planning system means that the health and social needs of Residents are fully planned and delivered. The way care is recorded does not always reflect the high standard of care that is actually given. EVIDENCE: All Residents seen on the day of inspection looked very well cared for with the finer details of care attended to. Examples included nail, hair and eye care. Very frail residents and those being cared for in bed appeared warm, pain free and well cared for. Care plans confirmed that the staff ensure pain levels are under control and the General Practitioner and family are informed of changes in condition. Specially designed ‘turn charts’ are used to ensure frail residents are regularly moved to prevent pressure sores. Observation confirmed this specific care was being given but this was not always recorded to provide evidence that the care had been given. Care Plans were examined on this visit and these did not always clearly show short term changes in care needs although the care was being given. Some documents within care plans had not been reviewed and needed to be updated.
Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 11 Records and discussion with Residents confirmed that NHS services are accessed and that staff contact the General Practitioner and other multi disciplinary health care professionals promptly. All residents spoken said they felt very well cared for and that that staff were always very kind and cheerful. Laughter from residents and staff was heard during the inspection. Staff were seen to knock on doors before opening, however residents said they preferred the doors to be open so they could ‘see what was going on’. Residents said they receive their post unopened and have a private telephone line inserted in their room if they choose. Relatives spoken to were very complimentary about the care their relatives received. One relative said his wife always looked clean and tidy when he visited and that the staff were like family now and made him feel very welcome. Thank you cards seen on the day of inspection read: ‘Thank you for looking after mum, making her so comfortable. We can’t thank you enough’ and ‘Thank you to all the staff who care for my relative with such dedication’. A tour of the building showed that nursing staff within the home now ensure the sharps bins are now handled and labelled correctly. Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 15. 14 was met at the last inspection Social activities are creative, well managed and varied. Links with the community and families and friends is supported well at the home. Residents enjoy the food provided and have choice and control over their lives whilst living at the home. EVIDENCE: Discussion with Residents, the manager confirmed the activities programme continues to be full and varied at the home. The homes diary, activities programme and discussion confirmed that the activities programme is full and includes: Christmas card sale, a trip to see the school nativity play, a concert performed by staff at the home, school carol singers, another group of carol singers, Christmas theatre production, Christmas party, Christmas raffle, singer, and Christmas day activities. Residents spoken to said a recent shopping trip to a supermarket for shopping and a supper was good fun. Staff went to assist around the store and ‘a lot of fun was had’. Other activities since the last inspection included visits from the guide dogs for the blind, animal welfare trust and a fashion show. The Home have a disabled mini bus, which is owned, by home. This bus is used for trips which residents said were ‘marvellous’.
Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 13 A tour of the building confirmed that residents are able to bring in personal possessions with them when moving into the home. Residents spoken to like this. Residents said the food continued to be very good. Residents are offered three full meals a day and snacks are available at all other times. Residents who were being assisted with their meals were done so in a discreet unhurried, sensitive manner. Records were kept of what was offered and taken by the more frail residents. Nutritional assessments were seen in care plans although not all of these were up to date. Discussion with the chef confirmed that recent Environmental Health Office checks have been satisfactory with no recommendations set. The Manager and chef stated that a recent ‘kitchen meeting’ had recently taken place and has resulted in a decision to rotate the menus four times a year to provide variety for the residents and include seasonal produce. Cleaning temperatures and fridge and freezer temperatures were maintained and the kitchen area appeared well managed. The dining areas were both attractively presented, which provides an attractive setting and helps meal times become a social event. Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. 16 and 17 were met at the last inspection. Mamsey House complaints procedure allows Residents and Relatives to be confident that their concerns are listened to, taken seriously or acted upon. EVIDENCE: The improvements in Staff knowledge of how to report adult protection allegations helps protect residents and staff from risk. Discussion with the Manager confirmed that there have been no complaints regarding Mamsey House since the last inspection. The Commission for Social Care Inspection have not received any complaints regarding Mamsey House. A complaints procedure is displayed within the Service User Guide and entrance hall. This includes contact details and timescales. A complaints register is kept within the office areas and details of action taken and follow up information. Residents spoken to said they did not have anything to complain about and that they were happy living at the home. One Relative stated that he would speak with the manager if he was unhappy but has never needed to because he is happy with the care and has no worries. Observation confirmed that Manager has displayed notices throughout the home so staff are aware of how to contact the Commission for Social Care Inspection if abuse is suspected. Staff at the home have access to a set of policies which include prevention of abuse and whistle blowing. The home also have a copy of Somerset county council vulnerable adult policy.
Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. 20,21,22,23,24 and 25 were met at the last inspection Mamsey House provides a safe comfortable home in which Residents are able to stay as independent as possible. The home has a good standard of décor, furnishings and fittings, which provide a comfortable pleasing environment for residents to live in. EVIDENCE: Mamsey House Nursing Home is accessible, safe and well maintained. A programme of routine maintenance was being performed by the maintenance man. The Gardens were attractive and well maintained. Environmental Health Office reports were seen on this inspection. The home was clean and tidy and free from offensive odours on the day of inspection. The home has two comfortable dining rooms, one lounge downstairs with level access onto a patio area, and a small quiet upstairs lounge. Some residents chose to stay in their rooms or within the entrance hall so they could watch the ‘comings and goings’. All furnishings are domestic in style and of good quality. The communal rooms are well lit.
Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 16 The premises were clean and free from unpleasant odours. The homes staff manage the control of infection to a high standard. This could be improved further by ensuring creams and lotions have the date of opening written on the lid to prevent use after the shelf life and would prevent any risk of infection. There are hand-washing facilities throughout the home. Gloves and aprons are available for staff to use and there are safe systems for the disposal of waste for example foot operated flip top bins are used and the home has waste collection contracts. There are sluice facilities. The laundry systems are well managed. No concerns were raised with the inspector about the management of clothing or the laundry process. Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29. 27,28 and 30 were met at the last inspection The Improvements in the way Nursing Midwifery Council PIN checks are validated will ensure Nurses have a valid registration. EVIDENCE: The administrator stated that she now checks Nursing Midwifery Council PIN numbers on line and finds this method efficient. The two staff files that did not have valid PIN checks on file were checked at this inspection. These were found to be correct and valid. Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Elements of 33,36,37 and 38 The Manager continues to manage the home well. EVIDENCE: Mamsey House Nursing Home is owned by Clinicare Ltd. The organisation has clear lines of accountability and is directed by a retired local General Practitioner. The clinical management for the home is provided by the Manager, who is an experienced Registered General Nurse. The Manager keeps updated though study days, peer discussion and keeping up to date with changes in health care practices. Discussion with staff within the home confirmed all staff are aware of making sure residents are happy with the care they receive. The Chef stated he was due to see residents soon to check that they are happy with the food provided. The Chef stated that he sees residents frequently and they often stop him in the corridor to comment on the food. The recent ‘kitchen meeting’ has resulted in a change in menus.
Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 19 Residents are issued with a monthly newsletter, which informs them of forthcoming activities and special events and other news. The November newsletter reported on the last inspection. Residents spoken to said they did not have formal meetings but that any news was shared by the staff on an informal basis. Residents and relatives also said the Manager was always there when they needed. The ‘Home Diary’ and staff files confirmed staff have appraisals and staff supervision sessions and are well supervised by the Manager. All records seen on the inspection were is good order and stored securely. The Manager stated that all staff were up to date with mandatory training. This was not closely inspected on this occasion. All equipment within the home was seen to be in good order. Fire extinguishers and hoists had evidence that they had been recently checked. First aid boxes and accident books were seen within the home but not closely looked at on this inspection. A tour of the building confirmed that the staff within the home maintain a safe environment for the Residents despite a shortage of storage space. Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 3 3 3 Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? 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. 2. 3. Refer to Standard OP7 OP7 OP26 Good Practice Recommendations The Manager should ensure care plans and records reflect the level of care that is given The Manager should ensure resident weight and skin assessment charts are kept up to date The Manager should consider writing the date of opening on the creams used at the home Mamsey House Nursing Home DS0000003270.V269668.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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