Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 10/05/05 for Maristow House Nursing Home

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

This inspection was carried out on 10th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Staff at Maristow House have extensive experience of caring for service users with complex nursing and care needs, including palliative care. The home also has close working relationships with a wide range of healthcare professionals. The managers are keen to support staff in developing and extending their skills. Training is offered both in and out of the home. This ensures that service users are supported by a highly skilled workforce. There are clear systems in place to ensure that all staff work within the home`s own policies and procedures. Although Maristow House specialises in caring for persons with complex needs, the equipment involved does not intrude on what is a homely environment. As Maristow House is small for a nursing home, it means that a family atmosphere can be fostered and service users spoken with said that they felt that staff knew them well as individuals. One service user said "You couldn`t have a better home than this one" another said, "It`s my home, I love this place", another described it as "absolutely brilliant" and another said that staff were "very good, without exception".

What has improved since the last inspection?

All staff files have been reviewed to ensure that they include all required information for proof of identity, criminal records bureau checks and vulnerable adults checks. Staff from abroad are all interviewed, prior to being offered a post, to ensure that they have the skills to perform their roles and their references are directly sourced from aboard. This means that service users are protected by safe employment practice. Mrs Wallace has also further revised and improved the home`s induction programme, to provide a more comprehensive, structured programme to ensure that new staff are fully supported in their roles. Of the twelve requirements identified at the previous inspection, nine have been met in full and one showed progress. Of the eight recommendations identified, four had been addressed in full and four were in progress.

What the care home could do better:

Two requirements from the previous inspection had not been addressed by their compliance dates. Both areas need to be addressed to ensure service user safety. An immediate requirement letter was sent to the home about these two matters. The home needs to develop and improve its documentation on risk assessments. The kitchen continues to have bare surfaces following up-grading and these need redecorating to ensure that all areas can be regularly and effectively cleaned. The laundry is small, it was untidy, with the potential for dirty items to contaminate clean items. Both these areas need attention to ensure that effective hygiene standards are maintained and cross-infection prevented. Staff files did not all consistently include photographs of staff. Photographs are needed to provide full proof of identity. The home were also advised that they should develop practice in some areas. Assessments need to be consistently signed and dated and completed in ink. Service users should be weighed on admission to provide a baseline for future assessments. Where medicines instructions need to be completed by hand, they should be consistently counterchecked by a second person. The washer disinfector machine should be moved to an area separate from the laundry. The policy and procedure on staff uniforms should be revised and two polices on care provision developed. Work permits for staff should be consistently filed in staff employment folders.

CARE HOMES FOR OLDER PEOPLE Maristow House Nursing Home 16 Bourne Avenue Salisbury Wiltshire SP1 1LS Lead Inspector Susie Stratton Unannounced 10th May 2005 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 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. Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Maristow House Nursing Home Address 16 Bourne Avenue Salisbury Wiltshire SP1 1LS 01722 322970 01722 337485 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Lindsey Jayne Wallace Mrs Lindsey Jayne Wallace Care Home with Nursing 17 Category(ies) of OP Old Age (17) registration, with number PD Physical Disability (17) of places TI Terminally Ill (2) TI(E) Terminally Ill (2) Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users who may be accommodated in the home at one time is 17. 2. No more than 2 service users with a terminal illness may be accommodated in the home at any one time. 3. The minimum staffing levels set out in the Notice of Decision dated 16 January 2004 must be met at all times. Date of last inspection 18th January 2005 Brief Description of the Service: Maristow is a small privately owned nursing home. Mrs Lindsay Wallace is the person registered and is also the registered manager. It is registered to provide care with nursing for up to seventeen people. On the day of the inspection there were sixteen service users cared for in the home. Service users may be older people, or those under the age of sixty-five who have significant needs because of physical illness or palliative care, Maristow tends to specialise in providing care to persons who have highly complex nursing care needs. The smaller than usual scale of Maristow is perceived by its owners to be an advantage, they report that it means they can offer more individual input to each resident. Mr & Mrs Wallace have close involvement with all aspects of service delivery. They act as business administrator and nurse manager respectively. Mrs Wallace is supported by a deputy manager, registered nurses, care and ancilliary staff. Maristow House is a Victorian-style dwelling which is situated in a quiet residential road in Salisbury, not far from the city centre. There is off street parking and a bus stop at the end of the road. Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted by Mrs Susie Stratton between 9.40am and 1.40pm on Tuesday 10th May 2004, in the presence of Mrs Lindsay Wallace, registered manager. During the inspection, the Inspector met with Mr Wallace, a registered nurse, three of the care assistants, the chef, the administrator and both domestics as well as touring the building and reviewing records, including the fire log book and the home’s policies and procedures folder. The inspector met with eleven service users, two relatives and observed care for three service users who were unable to communicate. The Inspector reviewed care records and documents for one newly admitted service user and two other service users in detail, she also looked at pre-admission assessments for three prospective service users and considered specific areas of documentation for two other service users. The Inspector looked at the employment records for the most recently employed member of staff and a further six records for permanent members of staff. What the service does well: What has improved since the last inspection? All staff files have been reviewed to ensure that they include all required information for proof of identity, criminal records bureau checks and vulnerable adults checks. Staff from abroad are all interviewed, prior to being offered a post, to ensure that they have the skills to perform their roles and their references are directly sourced from aboard. This means that service users Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 6 are protected by safe employment practice. Mrs Wallace has also further revised and improved the home’s induction programme, to provide a more comprehensive, structured programme to ensure that new staff are fully supported in their roles. Of the twelve requirements identified at the previous inspection, nine have been met in full and one showed progress. Of the eight recommendations identified, four had been addressed in full and four were in progress. 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. Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4, 5 Maristow House is able to meet the needs of service users who have highly complex nursing care needs. Full information on the home cannot be give to service users at present, but through their admissions process, the home ensure that full verbal information is given. EVIDENCE: Maristow House has a service users’ guide, however due to current software problems, the guide is not available and prospective service users are being provided with general information. Mr Wallace anticipated that the software issues will be resolved shortly and that service users will then be given a copy of the guide. Two members of staff meet all prospective service users prior to admission, this means that a comprehensive pre-admission assessment takes place and any newly admitted person will know at least two of the staff when they are admitted. This is particularly important at Maristow, as generally most prospective service users are far to unwell to visit the home prior to admission. One newly admitted service user said that their spouse had “vetted” the home for them and another relative said that a range of family members had visited Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 9 prior to deciding on the home. As many service users have highly complex nursing care needs, Mrs Wallace also insists on detailed pre-admission assessments from relevant professionals prior to admission as well as the home’s own assessments. After admission, further detailed written assessments take place, to ensure that service users’ care needs can be met in full. One pre-admission assessment had been completed in pencil; this is illadvised, as pencil deteriorates quickly and has the potential to be changed. Some post admission assessments had been dated and signed, but not all. This should take place to ensure that the date of the assessment is clear and the person performing the assessment takes full responsibility for the assessment. Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 Service users are generally protected by full nursing and care plans and their privacy and dignity are clearly respected. One service user’s risk of falls has not been assessed and they are at risk, as a care plan on falls management is not in place. Service users are put at risk because the medicines trolley is not properly secured and by a lack of risk assessments for persons who wish to partially self-medicate. EVIDENCE: All service users have full and detailed care plans in place, which set out how their individual care and nursing needs are to be met. Care plans are regularly evaluated and several evaluations included the service user’s comments on how they felt they were progressing. The relative of one service user who could not communicate, said that the home regularly communicated with them about any areas that they needed to know about. Service users who are nutritionally at risk or are at risk of pressure damage, have regular assessments completed and care plans in place indicating how risk is to be reduced. Service users are weighed regularly where this relates to their medical condition, however not all service users are weighed on admission and as weight can be a significant indicator of certain medical conditions, it is Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 11 advisable that all service users are weighed on admission to provide a baseline. Detailed medical and multi-disciplinary records are maintained. Where service users’ conditions are changing, appropriate referrals are made. One service user’s communication had recently been deteriorating and staff considered that this was stopping them from socialising as they used to, so a referral had been made to the speech and language therapist, to try to improve the service user’s quality of life. The accident and daily records of one service user showed that they fell frequently. This service user did not have a written falls risk assessment or a care plan detailing how the risk to them of falling was to be reduced. Two service users had been left with their tablets and although no service users were observed in the home with wandering or restless behaviours, this is illadvised practice. If service users wish to partially self-medicate, a written risk assessment must be made and evaluated regularly. The registered nurse must not sign the MAR sheet if she has not observed the service user taking their tablets and must use the home’s coding system to indicate how the service user has taken their tablets. Drugs and medicines were generally safely stored and all requirements apart from one, from the last inspection had been met. The medicines trolley continued to be left in a corridor and is not fixed to a wall. The home were advised at the previous inspection that all medicines trolleys must be securely fixed to the wall when not in use, to ensure the safety of service users and others. An immediate requirement letter was sent to the home after the inspection to ensure that this work takes place promptly. Medicines records are generally properly maintained, but not all staff ensure that evidence is available of a counter check when medicines’ instructions are written by hand. As transcribing mistakes may occur when medicines instructions are written by hand, all such hand written instructions should always be countersigned. Some service users at Maristow have highly complex nursing needs and a range of technical equipment is provided for service users. This equipment does not dominate in their rooms so bedrooms for such service users remain individual. Staff were observed to knock prior to entering rooms. All of the service users who were able to communicate knew who their key worker was. Staff, including domestic staff, were observed to be kindly and supportive to service users, calling them by their preferred names. Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 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 standard(s) 12, 13, 15 Maristow is a small home, a family atmosphere is evident and much social support comes from networks within the home. Visitors are encouraged and service users can go out of the home, all this prevents social isolation and improves well-being for service users. Choice and flexibility at meals are regarded as a key part of maintaining service users’ health and well-being. EVIDENCE: All service users have a social care risk assessment. Many of the service users reported that they did not feel able to leave their rooms, one such service user said that they were content with their television and wide range of videos and DVDs, another said they preferred the quiet of their room and appreciated the way that staff popped in and out to see if they were alright and to have a chat. Other service users spend most of their time in the sitting room. As Maristow is a small house, most service users gave the impression of knowing each other, enjoying sitting and chatting. One service user said “There’s plenty of people to talk to here.” Another service user commented particularly on how much they enjoyed the home’s dog. An activities co-ordinator visits the home regularly and provides small group and one-to-one activities. There was evidence that service users who wish to, are regularly taken out of the home. One relative said that they had a specially adapted car and took their relative out on trips regularly. Two of the staff had recently taken a service user out for a Chinese meal as they had said they would like to. One Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 13 relative said that their relative was too unwell to go out of the home, so they visited every day, this included the family dog. This person said that they were made to feel welcome at all times. Service users were complimentary about the food, one said “We’ve good food here” another described the meals as “very good”. The chef has a detailed list of likes and dislikes, this included details such as that one person liked to have a small plate with their meal and that they would put on to it any part of the dinner that they did not want to eat that day. Many of the service users need support and encouragement to eat, where this is the case their dietary intake in monitored by food charts. Where service users are fed via a PEG feeding system, full records are maintained. All service users spoken with felt able to say if they did not like a meal and were confident that an alternative would be provided whenever they asked, one said “If I don’t like the meal, I tells them and they gives me just what I want.” The chef is prepared to cook individually for service users and provides a range of fresh fruit “smoothies” where service users feel unable to eat. Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 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 standard(s) 16, 17 Service users are protected by a complaints procedure, which service users report worked in practice. EVIDENCE: All service users are given a copy of the complaints procedure on admission. Service users and relatives spoken with all knew who to bring up issues with. One relative said that they felt able to bring “anything” up with Mrs Wallace and that she would address the matter. A service user said “I talks to the lady in charge if I’ve a problem”, another said that they could talk to anyone and if it was more important, they would speak with Mrs Wallace, or if she was not there, her deputy. Another service user said that they always mentioned things to their key worker and that they sorted it out for them. Mrs Wallace is aware of local advocacy services and has used them in the past to support service users in complex situations. None of the service users spoken with reported that they had decided to vote at the last election although they said that they were confident that the home would have supported them if they had wished to. Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24, 26 Maristow House is well-maintained, clean and provides comfortable furniture and equipment to give service users a homely setting in which to live. Appropriate equipment is provided to support service users with highly complex nursing care needs. Service users are put at risk by a kitchen which cannot be fully cleaned and unsafe practice in the laundry. EVIDENCE: Maristow House has recently been improved by an up-grading to facilities, including an extension to the lounge, two improved bedrooms and improved sanitary facilities. There is one double room in the house; all other bedrooms are single occupancy. Two bedrooms do not have level floor access, one of these service users does not leave their room by choice and the other said that they could manage a short flight of stairs with assistance. All other rooms have level floor access to a lift. One service user described the view from their bedroom window as “Lovely”. One relative commented on how they appreciated the smaller environment of Maristow, in comparison to the other Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 16 larger nursing homes they had looked at. The back garden is to be landscaped shortly, the front and side garden and terrace are wheel-chair accessible. There is one assisted shower and one assisted bath to provide choice in bathing facilities for service users. As Maristow cares for some service users with highly complex needs, a range of equipment to suit their needs is available. Where service users care needs indicate, fully profiling electrical beds are provided. Service users at risk of pressure damage are provided with low airloss mattresses. One service user who has complex care needs has been provided with a Possum, which improves their independence. All service users had been left with access to their call bells and all spoken with were confident that staff came promptly when they used it. One service user said that night staff were “just as good” as responding as day staff. The kitchen was improved as part of the up-grading of facilities. Following this, there are some bare areas on the walls and flooring and staining is appearing above the cooker where a hood is not in place. All catering areas must be easy to clean to ensure that contamination is not possible during meal preparation. Mr Wallace reported that they are planning a full re-decoration programme for the kitchen. The home was clean throughout and the two domestics were observed to perform their work in a thorough manner. There is a wide range of equipment and disposables stored in the clinical room, as would be anticipated in a home where service users with complex nursing care needs are cared for. The clinical room was tidy and well organised, this ensures that service users are not put at risk by poor rotation of stock, or disposable items which have been damaged or contaminated by inadequate storage. The home’s staff uniform policy should be revised to reflect current Health Protection Agency guidelines. The system for clothes which have been laundered has improved, with a specific cupboard identified, away from the laundry area, however the laundry area itself continues to be a cause of some concern. The laundry room is small. The washer disinfector is placed in the laundry, this is not ideal and Mr Wallace reported that he has identified an alternative area for this machine. On the day of the inspection, used laundry bags were placed on the floor in a jumble, one red cloth bag had tipped over so that there was potential for its contents to spill out onto the floor. Articles had been left on top of the washer disinfector and so would have to be moved every time the machine was needed. Washed laundry had been left on top of the drier. There was a high risk of used laundry contaminating clean laundry. Used and potentially infected laundry must be appropriately stored while awaiting laundering. The washer disinfector must be easily reachable and clean laundry must be appropriately stored while it is awaiting drying. Re-organisation of the laundry may involve changing staffing responsibilities and/or provision of appropriate equipment. Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 A full range of staff, with a skill mix to meet residents’ needs are in post. Service users are protected by staff who have the benefit of extensive training programmes. The majority of required records are now maintained on files and service users are protected by full pre-employment checks, including foreign nationals. EVIDENCE: Maristow is required to staff the home in accordance with a Condition of Registration set out by the Commission. They were meeting the requirements of this Condition. As part of the home’s philosophy, training for staff at all levels is encouraged and a wide range of opportunities, not only NVQ training, is offered to all staff. As the home admits service users under the support of the palliative care team, regular training is provided for all staff in this speciality. Mrs Wallace maintains a library in the office, to which all staff have access. Staff are allowed access to the internet to research on how to meet service users’ care needs, for example the chef had recently researched dietary advice for a service user with a particular and complex palliative care need. Staff spoken to were aware of how to access training and research information when they needed it. Staff files showed that nearly all relevant information required by regulation is now maintained. The exception to this are photographs, where half the files reviewed did not include a photograph of the member of staff as proof of identify. Evidence of work permits are also not consistently tiled in the same place and it is recommended that full evidence is maintained on staff files. It Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 18 was noted as good practice that where staff are engaged to work in the home from aboard, that Mrs Wallace now always directly sources references from referees from aboard and always interviews staff, prior to offering them a post, to ensure that their English language skills are adequate for their roles. Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36, 37 & 38 Service users are protected by an experienced manager and staff who are supported and regularly up-date themselves on a range of areas relating to service user nursing and care. Service users are further protected by the system for ensuring staff work within the home’s policy and procedures. Service users are put at risk by lack of servicing of the home’s hoist and lack of risk assessments for free-standing radiators. EVIDENCE: Mrs Wallace is an experienced nurse and manager, as well as currently undertaking the registered managers’ award, there is evidence that she has maintained her nursing skills in a wide range of areas, including palliative care. Mrs Wallace has an established supervision system for staff. One staff member’s supervision record showed that it was a two-way process, with both Mrs Wallace and the staff member putting forward ideas for their future development. All staff also receive an annual appraisal, a copy of which is retained on their file. Mrs Wallace has recently further revised the home’s Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 20 induction programme and the most recent employee’s programme, showed that this was being worked through in a staged manner. This employee will work fully supervised until the programme is complete. The home have a policy and procedures manual which is available to all staff in the main office. All employees have signed a sheet and dated it when they have read each policy and procedure. There is a clear policy on acceptance of gifts and donations. It was advised that at Maristow cares for and employs persons of either sex, that a cross-gender care policy is put in place. As staff take service users out of the home, a policy and procedure to support this should also be put in place. The fire log book was examined and showed that staff training and regular checks on the fire safety systems take place to protect service users. Two service users were observed to have free-standing oil-filled heaters in their rooms, this is regarded as ill-advised as it may cause an increased health and safety risks to service users, staff and visitors. Neither of these service users were able to mobilise, however they were not protected by a risk assessment on the use of free-standing heaters. At the previous inspection, the hoist was noted not to have been serviced for over a year and it was required that, to ensure the safety of service users it be serviced and a system for regular serving be put in place. This has not taken place, so service users continue to be at risk. An immediate requirement letter was issued immediately after the inspection, to ensure that action takes place promptly, to ensure service user safety. Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 x 2 STAFFING Standard No Score 27 3 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 x x x x 3 3 2 Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 22 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. 1. Standard 1 Regulation 5(1)(d)(f) (2) Requirement The homes software must be mended so that all service users/representatives can be given a copy of the service users guide. Service users must be assessed for risk of falls and if a risk is identified, a care plan must be put in place to direct staff on how to manage the risk. If a service user wishes to partially self-medicate, a risk assessment must be completed and appropriate records made on the medicines adminstration records. The medicines trolley must be securely fixed to a wall. (This was identified at the previous inspection, with a compliance date of 31/1/05). A cooker hood must be provided and the bare walls and floor in the kitchen redecorated, to provide surfaces which can be effectively maintained at high standards of cleanliness. The laundry must be properly organised, so that the is no potential for used laundry to spill on to the floor, for used laundry Timescale for action 31/5/05 2. 7 13(4)(c), 15(1) 31/7/05 3. 9 13(2), 15(1) 31/7/05 4. 9 13(2) 31/5/05 5. 19 23(2)(c) 31/7/05 6. 26 13(3) 30/6/05 Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 23 7. 29 8. 38 9. 38 to contaminate clean laundry and to ensure that the washer disinfector can be reached without moving any articles. 19(1)(b) Photographs of each staff (i) scedule member must be retained on 1(1) their file as part of proof of identity. 13(4)(a) Where free-standing oil-filled (c) radiators are in use, there must be a full risk assessment, to ensure that service users, staff and visitors are protected. 23(2)(c) The hoist must be regularly serviced and written records maintained. (This was identified at the previous inspection, with a compliance date of 30/4/05) 31/7/05 31/7/05 31/5/05 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 3 7 9 Good Practice Recommendations Assessments should always be completed in ink and dated and signed. All service users should be weighed on admission to provide a baseline for future assessments. The person registered should ensure that if medicines’ instructions need to be made by hand, that the record is signed by the registered nurse taking the instruction and counter checked by a second person. (This was identified at the previous inspection and some progress has been made but the recommendation has not been met in full) The uniform policy should be reviewed to reflect current Health Promotion Agency advice. The washer disinfector should be moved to an identified area away from the laundry. Work permits for staff should be consistently filed in staff employment folders. Policies and procedures on cross-gender care and staff taking service users out of the home should be developed. D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 24 4. 5. 6. 7. 26 26 29 37 Maristow House Nursing Home Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 25 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Maristow House Nursing Home D51_D01_S15926_MARISTOWHOUSE_V214948_130505_Stage4.doc Version 1.30 Page 26 - 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!