CARE HOMES FOR OLDER PEOPLE
Mansion House Nursing Home 164 Main Road Drax Selby North Yorkshire YO8 8NJ Lead Inspector
Mrs Wendy Dixon Unannounced Inspection 8th November 2005 10:30 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 Mansion House Nursing Home DS0000027941.V263364.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. Mansion House Nursing Home DS0000027941.V263364.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Mansion House Nursing Home Address 164 Main Road Drax Selby North Yorkshire YO8 8NJ 01757 618659 01757 618659 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) Roche Healthcare Limited *** Post Vacant *** Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29), Physical disability (24) of places Mansion House Nursing Home DS0000027941.V263364.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Age range 50 years plus with the exception of one service user aged 46 years 10th May 2005 Date of last inspection Brief Description of the Service: Mansion House is a care home registered to care for up to 29 service users over 65 years of age who require nursing care.The service is provided in a detached house built on two floors;the upper floor is serviced by a vertical lift.There are 23 single rooms and 3 two bedded rooms the majority of which are en-suite. The home is set in well kept and accessable grounds located in the village of Drax. The home is close to a local post office and shops. Mansion House Nursing Home DS0000027941.V263364.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection that took place on Tuesday 8th November 2005.The inspection lasted 4.0 hours (10.30am to 2.30pm) and involved 2 inspectors. There were 26 service users resident in the home, 21 requiring nursing care and 5 receiving personal care. The inspection focused on a number of key standards, the areas of concern identified at the last inspection and issues raised in a complaint received by the Commission for Social Care Inspection. An inspection of the premises took place, including a number of bedrooms, the homes bathrooms and lounges. The care records of five service users were examined in detail and where possible these service users were spoken with about the care they receive. A number of staff was spoken to during the course of the inspection and the homes acting manager. The home has had a number of management changes in the past two years and a new manager is now in post this had caused some service users their relatives and staff to feel unsettled as routines have been changed. What the service does well:
The home was clean, tidy and fresh smelling throughout. The home had a calm relaxed atmosphere. Service users looked well care for and were appropriately dressed. Service users stated they enjoyed the meals provided and the homes kitchen was clean and well organised. The inspection took place over lunchtime, there was a choice available and the food looked appetising. Fresh baking had been done for tea. Good pre admission assessment systems are in place and this helps ensure that all the service users health and social care needs are identified before they are admitted to the home and that the staff will be able to meet them. Mansion House Nursing Home DS0000027941.V263364.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
There is a shortage of permanent qualified nurses. One of the service user spoken to stated she felt that if she had a problem she was not sure when somebody she knew and trusted would be available to deal with it. The wrong medication had been administered, one service users involved had realised that the medication was incorrect and informed the nurse involved, another mistake had been recognised by another staff member before the service user took the medication, however they had not reported the error to the manager so action could be taken. Photographs of the service users were not always attached to their drug sheets to help staff ensure they were giving the right tablets to the right service user. A number of the service users at the home would not be able to recognise an error because of poor sight or dementia and all staff administering medication must be competent to do so. When a mistake is made this must be reported to the management so an investigation can take place and proper action taken to stop it happening again. The employment history of a member of staff was unclear, only one written reference had been received and some documentation was contradictory. The registered provider/manager must ensure that all staff employed have the necessary checks and references carried out to protect service users from harm.
Mansion House Nursing Home DS0000027941.V263364.R01.S.doc Version 5.0 Page 7 A number of pieces of equipment were not working, the sluice, the dishwasher and the hoist. On speaking to more senior management repairs had been arranged however staff spoken to were unaware of this. The toilet and flooring in the bathroom of room 22 are in need of replacement/ repair as the toilet is badly damaged and the flooring is stained and has an unpleasant smell. 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. Mansion House Nursing Home DS0000027941.V263364.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 Mansion House Nursing Home DS0000027941.V263364.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): 3 Pre admission assessments contain good information about the health and personal care needs of service users EVIDENCE: The pre admission assessments inspected contained detailed information about service users care needs and been carried out wherever possible by a qualified nurse from the home. Information had also been sought from service users relatives and other professionals such as care managers and doctors. If the admission was at very short notice and a member of staff could not meet/visit the service user an assessment was sought from other health professionals before a decision to admit them to the home was made. Mansion House Nursing Home DS0000027941.V263364.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): 7,8,9 and 10 Service users care needs are met. However medication is not always administered as prescribed by the doctor and service users health could be put at risk. EVIDENCE: At the last inspection one of the requirements was that all the care plans were brought up to date and that all contained the necessary risk assessments (falls, moving and handling, use of bedsides, prevention of pressure sores) A number of the service users care plans had been up dated and reflected their current care and support needs. However this has not been fully completed and some care plans still need to be updated including the risk assessments (in some cases risk assessments were not present). It is important to make sure that the care plan gives clear up to date information about how service users are cared for especially when a lot of agency and temporary staff work in the home, which is the case at present. Mansion House Nursing Home DS0000027941.V263364.R01.S.doc Version 5.0 Page 11 Part of the complaint received by the Commission for Social Care inspection was that service users could only have a bath once a week due to lack of staff and the routines in the home on speaking to service users this had been a problem but was now said to have been resolved. None of the service users manage their own medications. One service spoken to during the inspection stated she had been given the wrong medication, on discussing this further with staff it was apparent that there were some concerns about this nurses level of competency however these concerns had not been reported to the homes management. This could have led to serious health problems for service users. Service users photographs were not displayed on the front of all medication charts, which helps to ensure that medication is given to the correct service users. It is important to make sure that the photographs are in place to ensure service users are given the correct medication especially when a lot of agency and temporary staff work in the home, which is the case at present. On inspecting medication charts in one case medication that was to be given had not been recorded on the administration sheet meaning mistakes could have been made. Service users and visitors spoken to during the inspection stated staff were kind, professional and courteous. However one of the issues received in the complaint received was communication problems service users were having with some overseas staff. Service users confirmed this during the inspection. It is recommended that during the induction of overseas staff communication skills are part of the competency assessment program before they work with service users. Mansion House Nursing Home DS0000027941.V263364.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): 12,14 and 15 Service users can choose to spend their days as they wish, and there is a range of activities service users can participate in if they want to. EVIDENCE: The home had a relaxed atmosphere. Though some service users said they were finding it hard to used to the new lounge and dining room arrangements Service users were at different points in their morning routine, some in their rooms listening to the radio and reading the newspapers. Others seeing family and friends or watching television showing that support for service users is individual to them and not based on fixed routines. The meal served during the inspection was lunch; this was nicely presented and enjoyed by the service users who commented generally the food was good at the home and recently a choice had been introduced at each mealtime. Service users can eat in either the homes dining room or their rooms. Mansion House Nursing Home DS0000027941.V263364.R01.S.doc Version 5.0 Page 13 There was a flow of visitors to the home during the inspection that were made to feel welcome and able to see the service user in their room or the homes lounge. A number mentioned the recent bonfire and fireworks that they had very much enjoyed. Mansion House Nursing Home DS0000027941.V263364.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): 16 and 18 The home has comprehensive polices and procedures to deal with complaints However people may be left vulnerable to the risk of abuse being missed or inappropriate action taken should it occur due to the lack of training for new staff in adult abuse issues. EVIDENCE: The Commission for Social Care Inspection has received one complaint since the last inspection. The complaint was anonymous and the issues/concerns raised have been investigated as part of the inspection process. The complaints procedure is displayed in the home and a copy contained in the service user guide. A number of staff have received training about abuse and how to report it if it should occur. However not all new staff have had the training. All staff must have adult abuse training to ensure service users receive appropriate action is taken if abuse should occur and understand what exactly constitutes abuse. Mansion House Nursing Home DS0000027941.V263364.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): 19,22 and 26 The home is generally well maintained but there were some problems on the day of inspection that need to be addressed EVIDENCE: The home is an old large converted building and is generally well maintained, rooms are pleasantly decorated and service users can personalise their rooms with small items of furniture, photographs and mementoes. The home was clean, tidy and fresh smelling (apart from the identified bathroom) and gloves, aprons and antiseptic hand rub in good supply to help in stopping the spread of infection. However the sluice disinfector was not working, this could increase the risk of the risk of infection and must be repaired. Also in need of repair was One of the lifting hoists
Mansion House Nursing Home DS0000027941.V263364.R01.S.doc Version 5.0 Page 16 The homes dishwasher The toilet and floor covering in bathroom 22 During the inspection staff stated this equipment was not working however during discussions with more senior managers it they stated they were aware and had authorised repairs. This information needs to communicated to staff working in the home so they are aware of progress being made. Mansion House Nursing Home DS0000027941.V263364.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): 27,28,29 and 30 There is a shortage of permanent qualified nurses in the home. Not all staff were competent to do their jobs EVIDENCE: The acting manager and one member of night staff are the only full time permanent qualified members of staff employed at the home. The necessary hours are made up with agency and bank staff however service users stated they did not always have confidence in all staff to report problems and concerns as they might not be passed on. One member of bank staff did not report the drug error she observed (and prevented) however this could have led to a more serious incidents occurring. One member of staffs employment file inspected only had one written reference and some employment information was contradictory. There were also some communication problems between service users and overseas staff. The registered provider must ensure that the home has a stable staff team, who are competent to do the job, understand how and the need to report untoward incidents and can communicate well with the service users. Mansion House Nursing Home DS0000027941.V263364.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): 31,35 and 38 The home is generally well maintained and safe however maintenance and repairs must be planned and communicated to affected service users and staff EVIDENCE: The new acting manager has been in post for approximately 2 months and is a first level registered nurse. An application will be forwarded to the Commission for Social Care Inspection to become registered in the near future. The home is generally well maintained however the complaint received by the Commission stated that service users had been put to a great deal of inconvenience during the recent redecoration of the lounge and dining rooms. The maintenance man had started this and then gone on holiday before it was completed meaning service users could not use a number of rooms. Also the progress of repairs must be communicated to service users and staff affected.
Mansion House Nursing Home DS0000027941.V263364.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 3 X X 1 X X X 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 3 X X 1 Mansion House Nursing Home DS0000027941.V263364.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard Regulation 15 2 b Requirement All service users care plans must be reviewed on a regular basis so care plans reflect service users current care needs All care plans must contain up to date risk assessments regarding falls, pressure sores and bedsides where identified as a problem. All prescribed medications must be documented on the administration sheet. All service users must have a recent photograph on the front of the administration sheet to help identify them. All drug errors must be reported and appropriate action taken. The Registered Provider must provide training in abuse awareness to all new staff and ensure all staff working in the home are aware of the updated abuse policy/ procedure The registered provider must employ sufficient suitably qualified and competent staff to meet service users needs Timescale for action 06/01/06 2 OP8 12 1 a 06/01/06 3 OP9 13 2 24/11/05 4 OP18 13 6 06/01/06 5 OP27 18 1 a 24/11/05 Mansion House Nursing Home DS0000027941.V263364.R01.S.doc Version 5.0 Page 21 6 OP29 19 sch 4 7 OP26OP22 OP38 16 2 c j 23 2 k Two satisfactory written references must be received before any care staff are employed in the home and employment history fully checked. The following maintenance issues must be addressed • • • • The repair/ replacement to the toilet and flooring in room 22 The repair of the homes sluice The repair of the homes dishwasher The repair of the hoist 24/11/05 01/12/05 And a communication system re maintenance established. 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 OP30 Good Practice Recommendations The overseas staff induction program should include assessment of communication skills and ensure staff are competent before they work with service users. Mansion House Nursing Home DS0000027941.V263364.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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