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Inspection on 07/02/06 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 7th February 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 nursing care to a group of service users with a wide range of nursing care needs. Some care needs are complex however the care staff are able to manage the care appropriately and know the care needs of the service users very well. Service users were very complimentary of the care provided and the support that the staff provided to them. Maristow House is a homely environment, which was clean and provided a safe home for service users to live in. Service users were complimentary of the food provided and service users were observed being fully supported by the care staff with intake of fluids.

What has improved since the last inspection?

The infection control practices within the laundry area have improved reducing the risk of cross infection. The kitchen has been refurbished. The medication trolley is now secure. Risk assessments are now in place for any portable heaters used and the lifting hoist is regularly serviced.

What the care home could do better:

The care plans for each service users must be inclusive of a pressure area risk assessment, manual handling risk assessment and reviewed on a monthly basis ensuring that all aspects of care are fully met. Care Staff should not be walking through the kitchen to access other areas of the home.

CARE HOMES FOR OLDER PEOPLE Maristow House Nursing Home 16 Bourne Avenue Salisbury Wiltshire SP1 1LS Lead Inspector Karen Mandle Unannounced Inspection 7th February 2006 10.15 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.V275526.R01.S.doc Version 5.1 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.V275526.R01.S.doc Version 5.1 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.V275526.R01.S.doc Version 5.1 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 10th May 2005 Date of last inspection 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 DS0000015926.V275526.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection commenced at 10.15am and was completed at 2.35pm. The General Manager Maria Langworthy was available to assist the inspector. The inspector was able to freely tour the home and visit with many service users. However the communicate with some service users was limited or service users were unable to communicate. Care records were seen and the medication procedure reviewed. What the service does well: What has improved since the last inspection? The infection control practices within the laundry area have improved reducing the risk of cross infection. The kitchen has been refurbished. The medication trolley is now secure. Risk assessments are now in place for any portable heaters used and the lifting hoist is regularly serviced. Maristow House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 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. Maristow House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 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.V275526.R01.S.doc Version 5.1 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 the following standard(s): 3 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. Due to the complex needs of the service users that Maristow House provides care for, two members of the care team will conduct the pre admission assessment ensuring that the home is able to meet the nursing care needs 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 of the prospective service user are asked to provide written information about the service user. Maria Langford informed the inspector that this process has only recently been implemented but has found the process to be positive gaining more information about the service user whilst involving the family from the beginning. 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 House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 Page 9 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 All service users are provided with a care plan, however the care plans do not fully cover all aspects of care. Service users health care needs are closely monitored, appropriate action is taken when health care needs change. The medication procedure is safe. The privacy and dignity of service users is supported by the care team. EVIDENCE: Each service user is provided with a care plan. The inspector reviewed three care plans following visits with the service users. The information provided in the care plans was variable. Detailed information relating to clinical areas of care was seen and the daily statements were informative. However the pressure area risk assessments had not been completed for two service users although both service users were provided with pressure relieving equipment. The manual handling assessments had not been completed and one care plan did not provide any information relating to long-term care needs. Evidence of monthly reviews taking place was not seen. Detailed medical and multidisciplinary records were seen. Health care needs are closely monitored with appropriate action taken when needs change. Many of the service users have complex nursing needs however Maristow House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 Page 10 the care provided appeared to be individualised. Service users who were able to communicate with the inspector were very complimentary of the care provided and of the support provided to them by the staff. The medication procedure was seen which was satisfactory with medications stored safely and the medication administration records were maintained apart from handwritten orders being countersigned by two members of staff. Through observation of the care team it was evident that all service users were treated with respect and good interaction was seen between the care staff and the service users. All care was provided behind closed doors in the privacy of the service users bedrooms. Maristow House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 Page 11 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): 13 and 15 Service users are supported by the home to retain links with family and friends. The food provided by the home is enjoyed by the service users and is supported by a varied and balanced menu. EVIDENCE: Service users can receive family and friends at any time in the privacy of their own rooms or in one of the two communal rooms. The visitors signing in book provided evidence of this taking place. Due to the smaller size of the home Maria Langworthy informed the inspector that the relatives of the service users become very much part of the home. The kitchen was not fully inspected on this occasion however it was evident that the kitchen had been recently refurbished. Service users reported the food as “good home cooking” with no complaints. The inspector was invited for lunch, which was a hot meal, well presented and nicely cooked. A dining area is provided in the communal room, however service users appeared happier to have their lunch either in their rooms or sat together in the communal lounge Maristow House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 Page 12 area. It was observed how well service users were supported with fluids and being frequently asked if they needed a drink by the care staff. Maristow House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 Page 13 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 A complaints policy and procedure is in place. A vulnerable adults procedure is in place. EVIDENCE: A complaints policy and procedure is in place. It was recommended that a copy of the complaints policy and procedure is openly displayed in the entrance hall to the home for visitors or any other interested parties ensuring that the complaints policy and procedure is obtainable. Two service users confirmed with the inspector that if they had any concerns or complaints that they would talk to the Manager Lindsey Wallace. 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. However it will be recommended that all the staff should be provided with training in the local vulnerable adults procedure. Maristow House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 Page 14 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, 24 and 26 Maristow House provides a homely and safe environment for service users to live in. The home was clean and bedrooms personalised. Infection control practices were satisfactory apart from care staff entering the kitchen. EVIDENCE: Maristow House provides a homely environment for service users to live in. The furnishings and décor are domestic. The home provides two comfortable communal rooms on the ground floor, one of which offers a dining area. The home is well maintained. All bedrooms are single apart from one bedroom, which provides accommodation for a married couple. The inspector was able to visit many of the bedrooms, which were well furnished and homely with many personal items of the service users seen. Several service users made positive comments about the accommodation provided with two making a reference to the smaller size of the home and how they preferred living in a small care home. Maristow House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 Page 15 The home was clean through out with no unpleasant odours apparent. Infection control measures were in place with clinical waste be dealt with appropriately and adequate hand washing facilities provided. The laundry area was seen and dirty laundry bags were now managed appropriately. However the care/nursing staff were observed walking through the kitchen to access other parts of the home which could pose a risk of cross infection through out the home. Maristow House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 Page 16 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 The number of staff available is sufficient to meet the care needs of the service users. EVIDENCE: The staffing level is provided by the home at the time of the inspection were in accordance with a Condition of Registration set out by the Commission. The staffing rotas provided evidence that a trained nurse is on duty at all times supported by a team of carers. Domestic and kitchen staff was also available. The home was organised with call bells being answered in a reasonable amount of time and care being delivered to service users at an appropriate time during the morning. The staff were observed to be interacting well with each other and communicating with each other information relating to service users care needs. Maristow House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 Page 17 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): 38 Health and safety issues are addressed. The fire records were up to date and staff had been provided with fire training. Regular servicing of the lifting hoist now takes place. EVIDENCE: The home is well maintained and health and safety issues addressed. The fire log indicated that regular checks were made to the fire alarm systems and staff had been provided with appropriate fire training. Accidents were recorded. The lifting hoist had been serviced ensuring the safety of service users. Maristow House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Maristow House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 Page 19 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. 2. 3. 4 Standard OP7 OP7 OP7 OP7 Regulation 15 15 15 15 Requirement The care plans of service users will be reviewed monthly. All service users will be provided with a completed manual handling risk assessment. All service users will be provided with a completed pressure area risk assessment. 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. 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. Inspectors Comment. Requirement in progress. 6. OP26 16 The Registered person will ensure that the care staff do not walk through the kitchen to access other parts of the home. All service users will be provided with a completed nutritional risk assessment. DS0000015926.V275526.R01.S.doc Timescale for action 07/03/06 07/03/06 07/03/06 07/03/06 5. OP19 23 07/03/06 07/02/06 7. OP7 15 07/03/06 Maristow House Nursing Home Version 5.1 Page 20 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 OP9 Good Practice Recommendations 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 Register Manager should consider providing further training in the local vulnerable adults procedure. 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. 2. 3. 4. OP18 OP26 OP29 Maristow House Nursing Home DS0000015926.V275526.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham 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 DS0000015926.V275526.R01.S.doc Version 5.1 Page 22 - 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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