CARE HOMES FOR OLDER PEOPLE
Mayfair Care Home 25 The Avenue Minehead Somerset TA24 5AY Lead Inspector
Jane Poole Unannounced 21 June 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. Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Mayfair Care Home Address 25 The Avenue, Minehead, Somerset, TA24 5EP 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) 01643 706816 Ms Diane Langdon Ms Diane Langdon Personal care home only 15 Category(ies) of Mental Disorder - over 65 (15) registration, with number Mental Disorder (15) of places Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No persons under the age of 55 to be accommodated at the home. 2. The shared room only to two people who have made a positive choice to share. Date of last inspection 28th October, 2004 Brief Description of the Service: The Mayfair is registered to provide care for up to 15 people over the age of 55 who require care because of mental health difficulties. The home is located in the centre of Minehead, giving it easy access to shopping and other facilities. The building is a former hotel that was converted by the current owner to provide 14 bedrooms, 13 for single occupancy and one shared. service user accommodation is arranged over three floors with a passenger lift between. All communal areas are located on the ground floor. The registered manager/provider is Diane Langdon. Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over a 6 hour period. The inspector was given unrestricted access to all areas of the home, was able to talk with staff on duty and service users, observe care practices and view records. The manager, although not on duty, came into the home to meet with the inspector. All staff and service users were welcoming and co operative with the inspection process. What the service does well:
There are no set routines in the home and service users stated that they are free to choose when they get up, when they go to bed and how they spend their day. There is an obvious respect for individuality and service users stated that they are encouraged to maintain their hobbies and interests. Individual rooms seen by the inspector had been personalised to reflect service users tastes and wishes. The home is ideally located to enable people to access local facilities. Many service users are able to go out unaccompanied by staff and the inspector noted that people moved freely in and out of the home. During the inspection some service users who wished to go out but required staff support where assisted. In addition to accessing the local town, people attend church, go to day centres and one person goes to a cookery class. Two activity workers are employed for three sessions a week. These workers mainly focus on arts and crafts, examples of work is displayed in the home and is of a very high standard. There are regular staff and service user meetings where people can express their views. Service users spoken to stated that their privacy was respected and that they felt comfortable with the staff who assisted them with personal care. Service users spoke highly of the staff in the home and described them as ‘kind’ ‘helpful’ and ‘patient.’ Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
Written records in respect of service users is of a variable quality. The file for the newest service user did not contain a pre admission assessment, a full assessment or a care plan. The overall quality of care plans in the home is poor. This was discussed at the last inspection and a requirement made to ensure that all care plans were up dated to reflect changing needs and give evidence of service user involvement. This has not been complied with. The care plans do not provide staff with adequate information to meet service users needs. At the last inspection a requirement was made for the home to keep clear records of all staff training. These records are not in place so it is difficult to ascertain which staff have undertaken appropriate training. Currently no care staff at the home have an NVQ in care at level 2 or above. The National Minimum Standards state that at least 50 of care staff should have this qualification by 2005. The inspector viewed the Medication Administration Records and noted that medication was not signed for as soon as it was administered and there was no record of the dosage given when the prescription was for a variable dose i.e. give one or two tablets.
Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 7 Most areas seen appeared clean, fresh and well maintained. One carpet was in need of replacing and this was discussed with the manager. There are plans to replace the furniture in the communal lounge and the inspector observed that communal areas, particularly the dining room would benefit from redecoration. 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. Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 &5. The home’s statement of purpose sets out the scope of the service offered. There was no written evidence that a pre admission assessment had been carried out for the newest service user. EVIDENCE: There have been no changes to the home’s statement or purpose or service user guide since the last inspection. These documents continue to reflect the service offered at the Mayfair. Each service user has an individual contract with the home or a financial agreement with the relevant social services department. The inspector was able to speak with the newest service user who stated that the management of the home had visited them before they moved to the home and that they had been able to visit the Mayfair. There was no evidence in this service users personal file that a pre admission assessment had been carried out. Assurances were given by the manager that an assessment had been made and that the home felt confident that they were able to meet the service users needs.
Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 10 The home provides care to people over the age of 55 who require care because of mental health difficulties. Both the manager and the deputy are registered psychiatric nurses and the home provides basic training for staff in mental health issues. Various aids and adaptations have been put in place to assist people to move around the home independently. These include a passenger lift, level access shower, hand rails and individual walking aids. Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 11 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. The overall quality of care plans is poor and does not provide staff with adequate information to meet service users needs. Errors in the recording of drug administration were found. EVIDENCE: The inspector looked at the personal file for the most recently admitted service user. This file contained only very basic personal information but no assessment of need and no care plan. A further 4 care plans were viewed and the quality was found to be variable. One contained evidence that the care plan had been fully discussed with the service user and another gave evidence that the staff had made contact with family to discuss various issues. Care plans seen focussed on physical and mental health needs and there was evidence that some care plans were being reviewed regularly. Service users spoken to felt that their health needs were being met. People stated that they have access to GP’s, dentists, district nurses, chiropodists and community psychiatric nurses. Service users stated that they are able to see
Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 12 health care professionals in the privacy of their rooms. 13 of the 14 bedrooms are for single occupancy, the one shared room is adequately partitioned. A district nurse visited one service user on the day of the inspection and they both went to the service users room without disturbance from staff. Service users stated that their privacy was respected and that they were comfortable with the ways in which staff assisted with personal care. All service users have en suites and there is a communal bathroom and shower room. All healthcare appointments are recorded in personal files and 4 of the 5 care plans seen contained assessments of tissue viability and moving and handling needs. The home uses a monitored dosage system for the administration of medication. The inspector viewed the Medication Administration Records at approximately 9.45am. At this time there was no signatures to evidence that medication prescribed for 8am had been dispensed. Two service users are prescribed a variable dosage of medication i.e. “take one or two tablets” there was no record of how many tablets had been taken by the service user. Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 13 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, 14 &15. Routines in the home are flexible to suit the needs and wishes of service users. All service users, who choose to, have ample opportunity to access community facilities. EVIDENCE: Service users stated that the routines in the home are flexible to fit in with their likes and dislikes. There are no set times to get up or go to bed and service users choose how they spend their day. The inspector noted that people got up and came down to breakfast at different times. The home is located in the centre of the town and many service users are able to go out without staff supervision, support is provided for other people to access community facilities. Service users stated that they go to church, attend social clubs, visit local pubs and shops and take part in college courses. Two service users stated that they enjoy going out together to a local café most days. People stated that they are encouraged to take part in activities that they enjoy and continue with personal interests. Local events are advertised on the notice-board in the dining room. At the last service user meeting trips out were discussed. Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 14 There are two activity workers employed by the home for three sessions a week. These workers mainly focus on arts and crafts, which was very popular with service users spoken to. Examples of work produced are displayed in the home and is of a very high quality. Service users observed interacted well with staff and other service users and there is a very social able atmosphere in the home. Some people go out regularly with volunteers. Everyone spoken to stated that they are free to have visitors at any time. A full time cook is employed who works Monday to Friday. Additional care staff hours are made available at weekends to undertake cooking duties. Since the last inspection a new cook has been employed. The inspector was able to talk with the cook who stated that currently all menus are being revised in line with service users wishes. The inspector noted that food cupboards were well stocked and fresh fruit and vegetables were available. Service users stated that there was always a choice of main meal and the food was generally good. Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 15 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 & 18. The home has taken steps to minimise the risk of abuse to service users. There is an open and relaxed atmosphere in the home enabling people to feel comfortable to raise concerns. EVIDENCE: The home has policies and procedures in respect of recognising and reporting abuse. There is a copy of the complaints procedure in the entrance hall. Service users spoken to stated that they would be very comfortable to approach a member of staff with any worries or concerns. Since the last inspection a keypad has been fitted to the front door to improve security and protect vulnerable service users. Due to the nature of the service user group their abilities can vary with their changing health and therefore risk assessments are completed in respect of some people who access the community without supervision. Any restrictions on movements are discussed and agreed with care managers and relevant interested parties. The home carries out Criminal Records Bureau checks on all staff. Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 16 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, 25 & 26 The Mayfair provides comfortable, homely accommodation for service users. EVIDENCE: The home is located in a central position in the Seaside town of Minehead. The main shopping area and the sea front are within walking distance. A call bell and fire detection system is fitted throughout the home. On the day of the inspection a new hot water system was being installed throughout the house. Various aids and adaptations have been put in place to assist people living at the home to maintain their physical independence. These include an assisted bathing facility, a level access shower, a passenger lift and handrails. The inspector viewed a sample of service users private rooms and noted that all had been personalised to reflect the needs and personalities of their
Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 17 occupants. One bedroom is shared by two service users but is divided to promote the privacy of each person. All rooms have en suite facilities and as mentioned above there are communal bathing and showering facilities for those people who prefer or require additional support. The communal rooms are on the ground floor, these consist of a large lounge and a dining room. One end of the dining room is a smoking area for service users and staff when meals are not being served. Service users and the manager told the inspector that new seating is on order for the lounge. Regular maintenance checks are made of communal areas and personal rooms and appropriate measures have been taken in respect of health and safety. All windows above ground floor have been restricted and radiators have been guarded. The home is generally clean and well maintained, however the inspector noted a mal odour in one personal en suite and suggested to the manager that the carpet in this room be removed. The communal lounge and dining room would benefit from redecoration. Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 18 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. There is no clear evidence in the home that staff have received training appropriate to the needs of the service users. EVIDENCE: There have been no changes to the staffing levels in the home since the last inspection. During the week there are two members of staff on duty between the hours of 8am and 8pm, overnight there is one waking night staff and one person sleeping in. The manager’s hours and all ancillary workers are in addition to this. At the weekends there are two staff between 8am and 8pm and one additional person from 8am and 2pm. A requirement of the last inspection was that the home kept clear records of all staff training. This has not been complied with and it was difficult for the inspector to ascertain what training hand been undertaken by which staff. The manager stated that all staff have undertaken infection control training and the majority had completed courses in the administration of medication. The fire log gave evidence that all staff received training in fire safety in May this year. The home has training videos in respect of mental health issues but there appears to be no written records of how these are used. No member of the care staff team has an NVQ qualification in care. Staff spoken to appeared well motivated and happy in their work. The inspector viewed the recruitment file of the most recently employed member of staff. It contained all information required and there was evidence
Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 19 that a Protection Of Vulnerable Adults check had been made before the person commenced work. The home uses the Residential Care Providers Association as an umbrella organisation for Criminal Records Bureau checks. Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 20 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, 32, 35, 36 & 38. The management style is open and approachable with regular meetings to enable people to share ideas and opinions. Record keeping in the home needs to be improved to ensure that there is easily accessible, up to date information for staff and service users. EVIDENCE: The registered manager and provider is Diane Langdon. She is a qualified psychiatric nurse and has many years experience of owning and managing care homes. She demonstrates an excellent knowledge of individual service users and staff. The manager is currently undertaking the registered managers award (NVQ Level 4.) Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 21 There is a relaxed atmosphere in the home and all described the manager as very approachable. The inspector was given unrestricted access to all areas of the home. Staff and service users appeared comfortable to speak with the inspector in private and in communal areas. The manager does not act as an appointee or power of attorney for any service user. The home does hold personal allowance in respect of service users. Clear records are kept of individual’s personal monies but these records are not currently signed by staff or service users. There are regular staff and service user meeting, which are opportunities for people to express their views. The home also operates a keyworker system that enables service users to spend time on a one to one basis with a member of staff and express their views on the care that they receive. In one personal file the inspector saw a summery of a meeting between a keyworker and service user where the service user had been encouraged to express their opinions about the home and their care. The care worker and service user had signed the summary. All keyworkers should be encouraged to record meetings with service users as a form of quality assurance. Records in respect of health and safety are well organised and up to date. They give evidence that fire alarms, extinguishers and emergency lights are regularly tested by the home and by outside contractors. All portable appliances are checked annually. A visual safety check of all rooms is carried out and recorded on a monthly basis. All accidents are recorded. As previously stated care plans are not well maintained and there is no written records of staff training undertaken or planned. Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 22 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 3 3 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x 2 x 2 2 Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 23 yes 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 3 Regulation 14 (1) [a][b] Requirement Written pre admission assessments must be carried out with all prospective service users to ensure that the home is fully able to meet their needs. All Service users must have a full assessment of needs and a plan of care. The care plans must be up dated to reflect changing needs. (This requirement was made at the previos inspection.) All medication must be signed for at time of administration. The home must ensure that medication administered clearly states the dosage given when the prescribed dosage is variable. The manager must provide written confirmation to the CSCI of all training undertaken by individual members of staff. (This requirement was made at the previous inspection.) The manager must ensure that all records in the home are well maintained and up to date. (This requirement was made at the previous inspection.) Timescale for action 30/06/05 2. 7 15 (1) (2) 24/06/05 3. 9 13 (2) 21/06/05 4. 30 & 38 18 (1) [a][c] 31/07/05 5. 37 17 (3) 31/07/05 Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 24 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. 4. Refer to Standard 20 26 28 35 Good Practice Recommendations The home should redecorate the dining room. The en suite carpet discussed at the inspection should be replaced. At least 50 of all staff should have an NVQ in care at level 2 or above. Records in respect of service users financial transactions should be signed and dated. Mayfair Care Home D53 - D02 S46793 The Mayfair V226124 210605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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