Random inspection report
Care homes for older people
Name: Address: Marray House 12-14 Essa Road Saltash Cornwall PL12 4ED one star adequate service 28/07/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Gail Richardson Date: 0 7 1 2 2 0 0 9 Information about the care home
Name of care home: Address: Marray House 12-14 Essa Road Saltash Cornwall PL12 4ED 01752844488 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Enid Robertson Crofts,Mr Peter William Crofts care home 23 Number of places (if applicable): Under 65 Over 65 23 old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 2 8 0 7 2 0 0 9 Marray House is registered to provide personal care and accommodation for up to 23 older persons. It is a detached house situated near the centre of Saltash, close to the shops, public transport and community facilities. Peoples bedroom accommodation is provided on the ground and first floors. Stair lifts are provided to assist peoples mobility. Two Communal lounge/dining rooms , kitchen and laundry areas are provided on the ground floor. Mrs Crofts has been registered as a care provider for 28 years. The fees range from 314.25 to 325 pounds per week ( Awaiting confirmation of accuracy as of July 2009 ) and the fees do not include hairdressing, chiropody and newspapers. A brochure is provided for those wanting more information about the home and its facilities. Care Homes for Older People Page 2 of 12 What we found:
This was a random unannounced inspection, which took place over 3.5 hours on the 7th December 2009 by Regulation Inspectors Gail Richardson and Antonia Reynolds. The purpose of the inspection was to ensure that peoples needs are properly met in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that the requirements made at the previous key inspection 28/07/09 had been met within the timescale stated. We spoke to four people using the service and three members of staff. The senior member of staff on duty, whose title is Matron, was available throughout the inspection. One of the Registered Providers attended for part of the inspection. On the day of inspection there were fifteen people residing at the home with one person being in hospital. On duty was one of the Matrons, three care staff and one cook. The laundry and cleaning is currently being undertaken by the care staff. We looked at care records for two people, two recruitment files and further documentation relating to the management of health and safety. We found that four requirements had been met, some had been partially addressed and some requirements had not been addressed despite confirmation from the provider that they had been met. The requirements about pre admission assessments could not be reviewed as there have been no new admissions to the home since the last key inspection. We were advised that no accidents had happened since the last key inspection and so this area will be reviewed at the next key inspection. The recommendations may have been met but were not inspected on this occasion. What the care home does well:
The Matron on duty told us that another Matron had started to review and update the care plans. Not all care plans have been completed. We looked at two updated care plans and found that they have improved and identified the majority of areas of need. The format was clearer and included risk assessments for areas of identified risk and an appropriate plan of care to meet that risk safely. We saw that there is now a daily record for each person which records, for most days, the health and wellbeing of the person using the service. We saw that people using the service are now signing their agreement of the care plan. We discussed with the Matron that, should the signature not be possible, she should record that the discussion and verbal agreement had been reached. We recommended that further development is needed of the care plans to include all the areas identified in the National Minimum Standards and this should include the management of peoples spiritual needs. We required at the last key inspection that the provision of hand washing facilities be reviewed to ensure that there is no risk of cross infection. There was seen to be hand wash and paper towels in all bathrooms. The geographical layout of the home creates a
Care Homes for Older People Page 3 of 12 difficulty in ensuring that hand washing facilities are available for staff in all areas. This must be kept under review to ensure that all risks of cross infection are minimised. We reviewed how the home manages in one instance, the use of a bucket for urination and how this is managed to reduce any risks of cross infection. The staff records indicate that all staff have now received training in infection control and the management of waste products. The Matron told us that the bucket is emptied when the person using the service alerts staff. The Matron told us that they have accessed a copy of the Safeguarding Vulnerable Adults Policy for Cornwall. This could not be found although there was a leaflet on the subject as well as clear instructions available for staff should an allegation of abuse be made. We had been advised in writing by the registered provider that staff instruction in this area is re-enforced through regular staff supervision. We reviewed all supervision records and found that this subject is not recorded as being addressed with staff. We noted that the home now displays the complaints procedure for the home in both public hallways. This will enable anybody who wishes to do so, to raise a concern/complaint and have clear expectations of the action that would be taken. What they could do better:
Whilst reviewing the care plans we found that the home continues to use a diary to record personal and confidential information about all people using the service. This is used as a means of reference and communication for staff. This record is then transferred to peoples own daily record. This is poor practice and must be discontinued. This current practice breaches the Data Protection Act by having shared information stored publicly. This does not allow for free access by people using the service to all of their records without compromising the confidentiality of other people at the home. Furthermore there remains a risk of information being put in the diary which is not being transferred to the persons daily record and care plan. This was identified at the previous key inspection and at this inspection and may place people using the service at risk. The home has not addressed the management of activities provided for people using the service. Whilst the updated care plans identify a partial life history this information is not being used to develop a person centered activity for each person. There is no current activity organiser role and events are currently being booked by a Matron. There is no designated time for activities and currently no staff training in activity provision has been undertaken. People using the service told us that there is little to do. They told us that outings are usually undertaken by family members. On the day of inspection, no activities were planned and people either remained in their rooms and three people were seen sitting in the lounge watching the television. We toured the home and looked at the ongoing maintenance and refurbishment. We have not received any short or long term maintenance plans, however the Matron said that four bedrooms had been repaired or redecorated. We looked at all the bathrooms identified at the previous key inspection. It is apparent that no action has been taken to address shortfalls in the maintenance of bathrooms. There remains one bath hoist in use that was serviced by an external contractor in October 2009. The servicing document
Care Homes for Older People Page 4 of 12 identified that the bath hoist should be replaced. The hoist seat is chipped on the front and covered with sticky tape and there was no seat belt seen for use with the hoist. Bathrooms/ shower room are outdated and in need of refurbishment and pose a risk of cross infection to people using the service. We saw a member of staff wheeling a green plastic bin, with a lid, containing soiled clothing/linen through the kitchen to the laundry. The lid was upside down on the top of the bin so that rubbish from peoples bedrooms could be carried as well. When asked about this practice the staff member said that taking the bin through the kitchen was the only way of getting into the laundry room from one half of the house. We intend to contact the Environmental Health Department of the Local Authority and ask them to review this practice as it may pose a risk of cross infection within the home. We also found that at least one fire door did not close properly and one fire door into the kitchen was wedged open, despite having a sign on it that said it was to be kept shut at all times. We intend to contact the local fire service to ensure that fire safety practices in the home are satisfactory. As we toured the home we observed that information about care needed and given is stored in an unsecured manner which may compromise the dignity and confidentiality of people using the service. This must be addressed and records must be stored securely to ensure that each person can be confident that their personal details have not been inappropriately accessible. We reviewed the recruitment procedures of the two most recently employed staff members. We found that the requirements made at the previous key inspection had not been met. The employment checks required include two references which must include the persons most recent employer. We could not identify the date the references were received as they were only dated when sent out as a request. This means we cannot identify if the references were received prior to the person starting work at the home. We also found that one person had started work before the service had received their Protection of Vulnerable Adults Check (POVA), there was no record of the POVA check for the second person, and both of them had started work before a full Criminal Records Bureau (CRB) check had been received. This is poor practice and may place people using the service at risk. All recruitment checks must be received prior to people starting work at the home, this means that any issues identified can be risk assessed. It was also identified that should staff start work at the home after the POVA check had been received but before the CRB check is received that there must be an clear audit trail of how staff were supervised and this supervision must be recorded. This practice is not currently maintained. It was identified that prior to appropriate checks being received staff members started training at the home. This practice is not acceptable and should not be undertaken as it may place people using the service at risk. We reviewed the staff induction records and identified that the initial one page check list had been completed but the Matron told us that the Skills for Care Common Induction Standards induction was not available to view. We will review this area at the next inspection. We reviewed the health and safety records relating to emergency lighting, hot water and
Care Homes for Older People Page 5 of 12 call bell checks which should be undertaken regularly. Emergency lighting was recorded as checked monthly. No checks have been recorded for hot water temperatures to ensure that they are within the Health and Safety Executives recommended upper limits and therefore may place people at risk of burns and scalds. Call bells are not recorded as checked to ensure that they are all in full working order. It was however noted that at the inspection a visiting electrician was repairing a call bell. We were advised in writing by the registered provider that these checks had been recorded but we found this was not the case. The checks required must be undertaken to ensure the safety and well being of people using the service. We required at the previous key inspection that all areas within the scope of notification under Regulation 37 of the Care Homes Regulations 2001 be forwarded to the Commission within a short timescale. This would appear to have not happened at this inspection when a delay in notification was identified as one week. The management of the home must review this practice and ensure that we are advised promptly of all areas within the scope of notification to ensure that we can monitor the service. We had required that staff training be updated in all mandatory areas. All staff at the home now have individual training records which demonstrate that staff training has not been updated for a period of years. The home has booked training in moving and handling, medication management and three people are booked to attend a course about safeguarding vulnerable people. We intend to review staff training at the next key inspection to ensure that all staff have received the appropriate updates. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person is 11/09/2009 required to ensure that each person is assessed prior to admission. This is required to include the consultation with with the prospective person or their representative. A record of that assessment must be signed and dated to evidence when the assessment took place. 2 10 12 The registered person is 11/09/2009 required to review the use of buckets for storage and transfer of urine. An alternative is recommended to be sought to ensure that there is no risk of cross infection to people using the service and staff. 3 12 16 The registered person is required to ensure that a programme of activities is planned for the recreation and enjoyment of people using the service. The programme is required to include social interaction for all people using the service at a level of their 17/09/2009 Care Homes for Older People Page 7 of 12 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action participation and enjoyment. 4 19 12 The registered person is 20/11/2009 required to implement a repair / refurbishment programme to all areas of the home needed repair. This is with particular reference to all of the bathrooms / shower room which pose the risk of cross infection. This is required to ensure the maintenance of an environment which is safe for use by people using the service. 5 29 12 The registered person is required to record the date and details of all staff members Criminal Record Bureau and Protection of Vulnerable adults checks. This is required to provide a clear audit trail of all recruitment checks to ensure the safety of people using the service. 6 30 18 The registered person must ensure that staff training is provided for all staff to ensure that they remain updated on current good practice. This is needed to ensure that people using the service receive a good standard of care which promotes their safety and wellbeing. 22/10/2009 11/09/2009 Care Homes for Older People Page 8 of 12 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 7 36 37 The registered person must 17/09/2009 ensure that all matters under the scope of notification are forwarded to the Commission as part of a Regulation 37 notification. This is required to ensure that the Commission can monitor the actions taken by the home. 8 37 12 The registered person must 25/09/2009 ensure that all records relating to people using the service are stored securely in line with the Data Protection act. This is needed to ensure that the dignity and confidentiality of people using the service is not compromised. 9 38 12 The registered person must ensure that all health and safety checks are undertaken. These include monthly emergency lighting checks, monthly hot water checks and call bell checks. This is required to ensure the health and safety of people using the service. 18/09/2009 Care Homes for Older People Page 9 of 12 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 2 The registered person is recommended to include the room number on each persons contract of residency to ensure that the terms and conditions for each room are clear. The registered person is recommended to ensure that people using the service have the opportunity to lock their rooms should they want to. These locks must be accessible to staff in an emergency. The registered person is recommended to ensure that wheelchairs seen at inspection which did not have foot plates attached are not used as they may pose a risk of injury. The registered person is recommended to provide lockable storage for people who store medications within their rooms. Further lockable storage is needed for medications stored in the kitchen fridge. The registered person is recommended to ensure the safety of people using the service and staff by making sure that all hand transcribed medications recorded on the medication administration record are signed by two staff.
Page 10 of 12 2 8 3 8 4 9 5 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 6 9 The registered person is recommended to ensure that all prescribed creams are dated when opened to ensure the opened shelf life is not exceeded. The registered person is recommended to ensure that activities are recorded and used to promote regular, relevant social activity provision for each person. Care Homes for Older People The registered person is recommended to undertake risk assessments for the transfer of people using the service through the kitchen/staff area to avoid any risks to people using the service. The registered person is recommended to risk assess all free standing units and ensure that any tip risk is addressed. The registered person is recommended to develop the induction process to include the Common Induction Standards to ensure a clear and detailed induction to care practices at the home. The registered person is strongly recommended to ensure that staff recruitment files contain a contract of employment, job specification, interview record and medical history. A clear photograph of the staff member is also needed. The registered person is recommended to ensure that any gaps in the prospective staff members recruitment file are explored and the reasons documented. The registered person is recommended to provide all staff a minimum of three days paid training each year. Each staff member should have an up to date individual training and development assessment and profile The registered person is recommended to provide an overview of staff training to identify any shortfalls in training updates and enable appropriate training to be provided. The registered person is recommended to ensure that quality assurance audits are used to promote changes to reflect the opinion of people using the service. 7 12 8 19 9 24 10 29 11 29 12 29 13 30 14 30 15 33 Care Homes for Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - 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!
