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Inspection on 31/07/07 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 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Maristow House provides an individual approach to the nursing care needs and social needs of the service users. Health care needs are well-monitored and appropriate action taken when the health care needs of the service users change. The home provides a good standard of nursing care. The environment is homely and the bedrooms are personalised. The home benefits from a small stable staff group who know the service users care and social needs well. The staff interacted well with service users.

What has improved since the last inspection?

The management team had worked in hard in several major areas to improve standards; the care records are now of a very good standard. A training coordinator had been employed and had developed a good training programme. The majority of care staff had, or were in progress of obtaining NVQ Level2 or 3. The quality assurance systems had been further developed ensuring that service users and relatives are provided with an opportunity to express their views and opinions. Much work had been put into the rear garden, that when finished, will provide a very nice outdoor area for service users. The recruitment procedures were robust and protected the service users as much as possible.

What the care home could do better:

Whilst generally health and safety issues were addressed, several window restrictors on the first floor were broken. A member of staff should have observed and reported this. A problem with the roof had caused some internal damage to room 11, which will need to be refurbished.

CARE HOMES FOR OLDER PEOPLE Maristow House Nursing Home 16 Bourne Avenue Salisbury Wiltshire SP1 1LS Lead Inspector Karen Mandle Unannounced Inspection 09:50 31st July 2007 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 Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maristow House Nursing Home Address 16 Bourne Avenue Salisbury Wiltshire SP1 1LS 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) 01722 - 322970 01722 337485 Mrs Lindsey Jayne Wallace Mrs Lindsey Jayne Wallace Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17), Physical disability (17), Terminally ill (2), of places Terminally ill over 65 years of age (2) Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users who may be accommodated in the home at any one time is 17 No more than 2 service users with a terminal illness may be accommodated in the home at any one time The minimum staffing levels set out in the Notice of Decision dated 16 January 2004 must be met at all times 11th August 2006 Date of last inspection Brief Description of the Service: Maristow House Nursing Home is an older building located in a residential area, which has been converted for use as a care home. The home is situated in the city of Salisbury, Wiltshire. The home is within easy reach of the city centre. The accommodation is provided over 2 floors of the home, with the majority of the bedrooms provided being single. The home provides a comfortable communal room on the ground floor, which is inclusive of a dining area. Maristow House is registered to provide nursing care for 17 older people. The home is privately owned by, Mrs Lindsey Wallace who is also the registered manager. Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place on the 31st July 2007. Maria Langworthy assisted the inspector and was open to the inspection process. The inspector was able to freely tour the home, visit with many service users to gain their views and opinions of the services provided by the home. Comments received from service users are contained in this report. Prior to the site visit-taking place, surveys were sent to the home. Four surveys were returned providing positive fed back of the service provided at Maristow. A range of documents were reviewed such as the care plans, medications records, complaints record, staff employment records, staff rosters and the accident record. Two requirements were made following this inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? The management team had worked in hard in several major areas to improve standards; the care records are now of a very good standard. A training coordinator had been employed and had developed a good training programme. The majority of care staff had, or were in progress of obtaining NVQ Level2 or 3. The quality assurance systems had been further developed ensuring that service users and relatives are provided with an opportunity to express their views and opinions. Much work had been put into the rear garden, that when finished, will provide a very nice outdoor area for service users. The recruitment procedures were robust and protected the service users as much as possible. Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clear admission procedure is in place and all care needs are fully assessed during the admission process ensuring the home is able to meet the often, complex needs of the service users. EVIDENCE: All service users are fully assessed prior to admission, by the registered manager, Lindsey Wallace. Two pre admission assessments were seen. The pre admission assessment ensures that the home is able to meet the nursing and social needs of the service users. The written assessment is detailed providing information relating to long term and short term care needs. As part of the assessment process the relatives or next of kin of the prospective service users are asked to provide written information about the service user to support the assessment. Maristow is able care for service users with high care needs, Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 9 therefore due to the health care needs of the service users, pre admission visits may be difficult, however relatives and friends are encouraged to visit the home prior to the admission taking place. Maristow is not registered to provide intermediate care therefore standard 6 is not applicable. Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are provided with care plans, which gave clear directions on how to provide the nursing care required. The care plans are of a good standard. Health care needs are monitored and action taken when health care needs change. The medication procedure was safe. Service users feel they are treated with respect. EVIDENCE: Each service user is provided with a care plan. The inspector reviewed four care plans following visits with the service users. The information in the care plans was good, giving clear guidance to staff on how to meet the care needs of the service users. Detailed information relating to clinical areas of care was seen and the daily statements were informative. The manual handling and pressure risk assessments had been completed and reviewed. The care records Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 11 were reviewed monthly. A good record of GP visits was maintained. The care plans were of a good standard. Health care needs are closely monitored with appropriate action taken when needs change. Evidence was seen in the records of other health care professionals being very much involved in the services users care when needed. Many of the service users have complex nursing needs however the care provided appeared to be individualised. Due to the high level of care needs, communicating with service users was limited. However the inspector spoke with three service users about their care and received positive comments such as “The nurses always call the doctor if I am not well and help me with washing and dressing everyday, and The staff are all very good here, we are well looked after”. All service users had been provided with nursing profile beds to ensure that all physical care needs are met. The medication procedure was seen which was safe. All medications were stored safely. The medication administration records were well maintained and up to date. The controlled medications were correctly stored and recorded in the controlled drugs register. The inspector was able to visit with many of the service users some of which by choice spent much of their time in the privacy of their own rooms. These service users expressed how much they appreciated the care staff respecting their privacy and dignity. A service user said “I like spending most of my day in my room and they don’t mind”, and another said, “They always knock on the door before coming into my room”. Service users also confirmed that all personal care was provided in the privacy of their bedrooms or bathrooms. Good interaction was observed between the care staff and the service users. Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activities provided suit the social needs of the service users group. A record is now maintained of the activities. Service users are supported to maintain links with family and friends. The food provided is of a good standard with varied menus supporting the dietary needs of the service users. EVIDENCE: An activities programme is provided. Mixed opinions were received about the activities programme, two service users said the amount of activities provided was satisfactory, whilst one service user said, “I would like a bit more to do during the day”. Many of the service users at Maristow House would have difficulty participating in group activities due to their complex health care needs. However the staff were observed making frequent visits to the service users and interacting well with them. A record of the activities and outcome is maintained. Service users were observed watching TV and DVDs, reading the newspapers and listening to the radio. They also confirmed that they enjoyed outside entertainment that came into the home at least once a month. Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 13 Service users were able to confirm that they could receive visits from family and friends at any time, in the privacy of their bedrooms or in the communal room. A record is maintained of all visitors to the home. A family member from a service user who passed away continues to visit the home weekly. The inspector was able to speak with the visitor who said, “Lindsey and the staff here are the kindest people you could meet”. The service users were very complimentary of the standard of food provided. Comments were received such as “The food is lovely” and “I love the food here”. Nutritional assessments are in place and food supplements given when needed. Two service users were fed via gastric tubes with correct procedures in place. The inspector was invited to lunch, which was well presented and very nicely cooked. Service users requiring assistance with their meals were provided with help on a one to one basis. Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints policy and procedure is in place. The management team are open to complaints and respond positively. The staff had received training in “Abuse Awareness” and the local vulnerable adults procedure. EVIDENCE: A complaints policy and procedure is in place. A copy of the complaints policy and procedure is openly displayed in the entrance hall to the home. Service users said, “I would talk to Lindsey”. Another said, “I don’t have any complaints but if I did I would talk to one of the girls”. The manager provided evidence that the home was able to investigate a complaint and respond openly to any complaint received. Maria Langworthy confirmed that a policy and procedure is in place for dealing with any allegations of abuse. A copy of the “No Secrets” document was seen. The staff had been provided with training in the local vulnerable adults procedure and abuse awareness. Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Maristow House provides a homely environment for service users to live in and is generally well maintained, apart from some window restrictors. Good improvements to the garden had been made. The home was clean throughout. Infection control measures are in place. EVIDENCE: Maristow House is a large older detached building, which has been converted for use as a care home. Maristow provides a homely environment for service users to live in. The extension on the ground floor provides a comfortable communal room. A separate dining room has been provided in the front communal room. The home is generally well maintained apart from several Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 16 window restrictors on the first floor, which were broken. A bedroom needed decorating due to a leak in the roof, which had caused some damage. The Providers had put a lot of work into the rear garden during the summer, which when the works are completed will provide a lovely out door seating area for service users. The inspector was able to visit many of the bedrooms, which were homely and personalised. Service users were happy with the accommodation provided, one said “I like my room and they keep it clean for me”. The home was cleaned to a good standard. Infection control measures were in place with hand washing facilities adequately provided around the home for care staff. Disposable gloves and aprons were observed being worn by the care staff whilst carrying out personal care duties. Clinical waste is dealt with and stored appropriately. Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing levels provided met the care needs of the service users. The recruitment procedures were robust and protected the service users as much as possible. The staff-training programme had been very well developed. All staff had been provided with mandatory training and supported with NVQ training. EVIDENCE: Four surveys were returned, all of which indicated the staffing levels provided met the needs of the service users. A qualified nurse is on duty at all times, supported by a team of carers, domestic and kitchen staff. A service user said, “The staff are always around and answer my buzzer quickly when I ring”. The staffing levels provided were meeting the care needs of the service users. The home benefits from a stable staff group. Due to the smaller size of the home, the staff knew the needs of the service users well. The recruitment files of three members of staff were reviewed. All three files were of a good standard providing references, appropriate Criminal Records Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 18 Bureau (CRB) checks, contracts of employment and proof of identity. Service users are protected by the homes’ recruitment procedures. The home had worked hard to develop the staff-training programme since the last inspection. A training coordinator had been employed for a minimum of 14 hours a week, overseeing all training requirements. Training files were in place providing clear evidence of all training provided. The majority of care staff had obtained or were in the process of obtaining NVQ Level 2 or 3. The home had achieved the “Investors in People Award”. All mandatory training was up to date and other training had been provided in line with the care needs of the service users needs such as, wound care, continence management and nutritional needs of the elderly. An induction programme is in place, which the home is currently reviewing. Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Lindsey Wallace, the registered manager and provider, manages the home very well and is committed to updating and improving all areas of the service provided at Maristow. Safe systems are in place for the management of service users’ money. Quality assurance systems are in place. The home had systems in place to meet health and safety issues. EVIDENCE: The registered manager, Lindsey Wallace, who is also the provider has a good understanding of her responsibilities in both roles. Lindsey is a qualified nurse who maintains good clinical updated skills. Lindsey shows evidence of Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 20 continuing to improve all areas of the service provided to benefit the service users. The quality assurance systems are in place. Surveys are now being sent to relatives and service users where possible, to gain their views and opinions of the service provided. Mrs Wallace remains very much involved in the day-today management of the home and continues to work clinical nursing shifts, providing an opportunity for service users and relatives to raise any concerns regarding the service at Maristow House. The home also had the “Essence of Care” quality assurance system in place, which are conducted 6 monthly. The home will not take responsibility for service users personal money. All personal items and hairdressing bills are billed through the service users’ account. A record of accidents is maintained along with the action taken following the accident. The fire log indicated that the fire alarm system had been tested weekly and the emergency lighting tested monthly. The staff had been provided with fire training. Risk assessments for the premises had been completed. The home is well maintained, apart from several window restrictors on the first floor which were broken. Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 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 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 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 2 Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 23(2,b) Timescale for action The registered person will ensure 31/07/08 that all window restrictors are fit for purpose and protect the service users. Room 11 will be refurbished 30/09/07 following the damage caused through the roof problem. Requirement 2. OP19 23(2,b) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Maristow House Nursing Home DS0000015926.V341191.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 DS0000015926.V341191.R01.S.doc Version 5.2 Page 24 - 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. 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