Inspection on 23/03/09 for Mayfair Care Home

This inspection was carried out on 23rd March 2009.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mayfair Care Home 02/04/08

Mayfair Care Home 24/05/07

Mayfair Care Home 29/11/05

Mayfair Care Home 21/06/05

Mayfair Care Home 28/10/04

Mayfair Care Home 27/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mayfair Care Home 25 The Avenue Mayfair Care Home Minehead Somerset TA24 5AY     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Poole     Date: 2 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Mayfair Care Home Mayfair Care Home 25 The Avenue Minehead Somerset TA24 5AY 01643706816 01643708855 princessgailyn@hotmail.co.uk 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) : Ms Diane Langdon care home 15 Number of places (if applicable): Under 65 Over 65 15 mental disorder, excluding learning disability or dementia Additional conditions: 15 No persons under the age of 55 to be accommodated at the home. The shared room only to accommodate two people who have made a positive choice to share. Date of last inspection Brief description of the care home 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 people easy access to shopping and other facilities. The building is a former hotel, which has been converted by the current owner to provide 15 bedrooms for single occupancy. 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. Care Homes for Older People Page 4 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for people living at the home and measures the quality of the service under four general headings. These are:- excellent, good, adequate and poor. This inspection was carried out over a one day period by one inspector. During this time We, The Commission, were able to speak with people living and working at the home, observe care practices, tour the building and view records. Care Homes for Older People Page 5 of 28 We were given unrestricted access to all areas of the home and all records requested were made available. Before the inspection the manager completed an Annual Quality Assurance Assessment (AQAA.) This was returned to the Commission in a timely manner and gave clear details about the homes achievements in the past year and their plans for the future. Questionnaires were completed and returned by 10 people living at the home, 6 members of staff and 4 health and social care professionals. Some of their comments have been included in this report. Current fees (24/03/09) range from 368 to 415 pounds per week. The following is a brief summary of the inspection findings and should be read in conjunction with the whole of the report. What the care home does well: What has improved since the last inspection? Since the last inspection the home have produced a refurbishment plan and some works have already been completed. To ensure that the home is able to meet the changing needs of the people who live there, a walk in bath has been purchased and there are plans to enlarge some en-suites. Staff training has continued and staff spoken with felt that there were now better opportunities for training which improved their knowledge and practice. A record of all training is being maintained to ensure that it is easy to identify which staff have completed each training course and which certificates need to be renewed. The home continues to be well managed and some areas of responsibility have been delegated to senior staff. There are regular meetings to ensure that people are involved in decision making and the day to day running of the home. Written records are more comprehensive and demonstrate how health is monitored and the action taken to address any concerns. One health and social care professional wrote I have noticed steady improvements over the past 3 years. Care Homes for Older People Page 7 of 28 What they could do better: 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No one moves into the home without having their needs assessed to ensure that staff have appropriate skills and knowledge. People wishing to move in are able to spend time at the home to make sure that it meets their expectations. Intermediate care is not provided. Evidence: Since the last inspection 2 new people have moved into the home. Care plans seen for these people contained copies of full assessments carried out by professionals outside the home and assessments completed by the home. People thinking of moving in are able to visit and spend time at the home before Care Homes for Older People Page 10 of 28 Evidence: making a decision to move in. Trial visits enable people to spend time at the home and get to know staff and people already living there. Details of trial visits are recorded and evidence was seen that people already at the home are consulted about new people moving in. Staff receive ongoing training about mental health issues and advice is sought from appropriate professionals to ensure that they have the knowledge to care for the people who live at the home. 8 of the 10 people who completed a questionnaire before the inspection said that they had received adequate information about the Mayfair to assist them to make a decision about moving in on a permanent basis. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have access to healthcare professionals according to their individual needs. Peoples privacy is respected and they continue to make choices about their lives. Medication policies and procedures promote safe practice. Evidence: 3 care plans were viewed during this inspection. All were very personal to the individual and gave details about their needs, wishes and lifestyle preferences. There were clear details about physical needs, mental health needs and behaviours. There were risk assessments in place to ensure that people were able to continue with their chosen activities with minimum risk to themselves and others. Care plans contained signs and symptoms of peoples mental health difficulties to assist staff to recognise when people may be becoming unwell. One care plan seen would benefit from further guidance for staff about what to do in a particular situation and this was discussed Care Homes for Older People Page 12 of 28 Evidence: during the inspection. Care plans are being regularly reviewed and there was evidence that people living at the home were involved in their creation and review. All 6 members of staff who completed a questionnaire answered ALWAYS to the question Are you given up to date information about the needs of the people you support? Health and social care professionals who completed questionnaires felt that there was good communication between themselves and the home. One person wrote They contact for advice if any difficulties another said that the home is aware when they can no longer meet needs and seek advice and alternative placement where necessary. Daily records showed that health care needs are monitored and that professionals outside the home are contacted when needed. People living at the home said that staff contacted doctors and other healthcare professionals if they were unwell and assisted them to attend appointments outside the home. Where people have refused treatment or support with healthcare this is recorded in the care plan. One health and social care professional wrote I have never had any concerns about care needs not being met, always contact the GP or other professionals for advice if necessary. People living at the home are treated with dignity and their wishes are respected. People are able to spend time in communal areas or in the privacy of their rooms. Staff were observed to interact well with people living at the home and respected their views and wishes. The home uses a Monitored Dosage System for medication. There is appropriate safe storage including storage for items that require refrigeration. All staff who administer medication have undertaken training in this area and their competence has been assessed by senior staff. Medication Administration Records were seen. All medicines are signed for when they arrive at the home and when they are administered, refused or handed to the individual to self administer. This gives a clear audit trail of all medication coming into the home. During the inspection it was observed that one person living at the home asked for medication that was prescribed on an as required basis and this was made available without question ensuring that they remained in control of the medication that they took. Care Homes for Older People Page 13 of 28 Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are no strict routines in the home and people are able to choose how they spend their time. Visitors are welcome at anytime with the agreement of the person living at the home. Evidence: There are no strict routines in the home and people are able to make choices about what time they get up, when they go to bed and how they spend their day. During the morning of the inspection it was observed that people got up at a time of their choosing and staff assisted people when they were ready to be assisted. People asked said that they could please themselves what they did and who they spent time with. Everyone living at the home has a long term mental health difficulty and therefore activities are arranged on an individual basis depending on the health and mood of the person at the time. Some people living at the home are able to use local facilities without staff assistance and it was observed that some people went out shopping Care Homes for Older People Page 15 of 28 Evidence: during the inspection. Other people said that staff assisted them to go shopping and to the bank whenever they requested it. Two people living at the home have volunteers who support them to access community facilities. One person said that they often went to a local coffee morning and regularly attended a local church. Three members of staff commented, under the what the home does well section of the questionnaire, that they treated everyone as an individual. One person wrote the home promotes individuality and empowers service users another said a very people orientated home. People are able to have visitors at anytime and some people enjoy trips out with family and friends. Staff were aware that people did not always wish to see visitors and this is respected. It was observed that one person had written in their care plan the visitors they did not wish to see at any time. There are no set menus at the home and people decide on a weekly basis what they would like to eat that week. People are then asked each morning to choose between a variety of meals. This results in a very wide choice of food each day. Since the last inspection people living at the home have become involved in the weekly shopping and some people go out daily to purchase fresh food such as bread and milk. Everyone asked said that the quality of food served in the home was good and it was observed that people receive ample portions. There are facilities in the dining room for people to make drinks and snacks throughout the day. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home know how to make a complaint. They feel that they would be listened to and that action would be taken to address any issues raised. Staff have received training in abuse awareness and know what to do if someone raises concerns with them. Evidence: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. The procedures are clearly displayed in the home. All staff receive information and guidance about recognising and reporting abuse during their induction programme and many have undertaken additional training in this area. Staff were aware of the ability to take serious concerns outside the home. People who completed questionnaires before the inspection said that they knew who to talk to if they had any worries or concerns about the home. Staff answered YES to the question Do you know what to do if a service user or advocate has concerns about the home? Everyone living at the home answered YES to the question Do staff listen and act on what you say? Care Homes for Older People Page 17 of 28 Evidence: People spoken with during the inspection said that they would be comfortable to raise any concerns with a member of staff. No complaints have been received by the home or the Commission since the last inspection. People living at the home have unrestricted access to all communal areas and their personal rooms. It was observed that people moved freely around the home and were able to come and go as they pleased. 2 staff files were viewed and both demonstrated that appropriate checks had been carried out before the person began work in the home. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is ideally located to enable people to access all local amenities and maintain independence where possible. Work has begun on the refurbishment of the home to up grade all areas and ensure that facilities are appropriate to the people who live there. Evidence: The Mayfair is located in a central area of Minehead. It is within easy walking distance of local amenities and the sea front. All areas of the home are fitted with a call bell and fire detection system. Since the last inspection the home has produced a refurbishment plan to up grade all areas. Works to improve the heating and lighting have been completed. People living at the home have been consulted on the refurbishment and involved in choosing colours and furniture. Accommodation is arranged over three floors with a passenger lift giving access to all areas. Communal rooms are located on the ground floor and are accessible to all. Care Homes for Older People Page 19 of 28 Evidence: There is a large lounge and a lounge/diner meaning that people have a choice of where they spend time. There is a garden to the front of the home and since the last inspection a decking area has been created to the rear of the property. There are also plans to develop a garden to the back of the house in time for this summer. There is an assisted bathroom and level access shower that can be used by anyone living at the home. To meet the changing needs of people, a walk in bath has been purchased and some en suites are being enlarged. All bedrooms are for single occupancy and all seen had been personalised to reflect the tastes and needs of each individual. Since the last inspection some furniture has been replaced and the home is in the process of building built in wardrobes for everyone. People spoken with were happy with their personal rooms. There is a small laundry area at the back of the home and this was being refurbished at the time of the inspection. To promote good infection control practices there are hand washing facilities throughout the home. On the day of the inspection all areas seen were clean and fresh. 90 of people who completed a questionnaire answered ALWAYS to the question Is the home clean and fresh? Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is adequately staffed to meet the needs of the people who live there. All staff now receive appropriate training to carry out their roles and support the people living at the home. Evidence: The home employs 11 care staff, 3 have completed National Vocational Qualifications in care at level 2 or above. A further 6 members of staff are currently working towards this award. The home also employs a cook and a domestic assistant. Staff who completed questionnaires thought that there was either ALWAYS (67 ) or USUALLY (33 ) enough staff on duty to meet the needs of the people living at the home. The duty rotas show that there is a minimum of two staff on duty between 8am and 8pm. The registered manager and home managers hours are in addition to this. Overnight there is one waking night staff and one person sleeping in. There is always a senior member of staff on duty who co-ordinates the shift and offers support and guidance to less experienced staff. Staff were happy with the training opportunities in the home and felt that they received a good induction and ongoing training that was relevant to their job. The Care Homes for Older People Page 21 of 28 Evidence: home uses the Red Crier training system, which is a distance learning system marked and certificated by an organisation outside the home. The training covers a variety of subjects such as induction, health and safety issues, protection of Vulnerable adults, the Mental Capacity Act and dementia care. Since the last inspection the home have up dated all training records so that it is easy to see what training each member of staff has completed and when courses need to be up dated. 2 staff recruitment files were viewed during the inspection. Both contained written references, completed checks against the Protection Of Vulnerable Adults (POVA) register and enhanced Criminal Records Bureau (CRB) checks. In one file a written reference was dated after the start date. The manager gave assurances that a verbal reference had been received before being followed by the written reference. Staff spoken with during the inspection and those who completed a questionnaire were very positive about their jobs and the support that they received. Comments included there is good communication in the home, its a happy place to work and staff always have a chance to discuss issues with seniors and manager. One person wrote I am happy to work in a very relaxed and professional home. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Mayfair is effectively managed taking account of the views of people living at the home and other interested parties. Appropriate monitoring systems are in place to ensure the health and safety of people in the home. Evidence: The registered manager/provider is Diane Langdon who is a registered psychiatric nurse and holds a National Vocational Qualification in management at level 4. In addition to the registered manager there is a home manager who is responsible for the day to day running of the home. Both managers have many years experience of working with people who have mental health needs. There is always a senior carer on duty giving clear lines of accountability and responsibility within the home. Various responsibilities in the home have been Care Homes for Older People Page 23 of 28 Evidence: delegated to senior members of staff. Prior to the inspection the manager completed an Annual Quality Assurance Assessment (AQAA) setting out the homes achievements in the past year and their plans for the future. The AQAA was well completed and demonstrated a commitment to ongoing improvement. The home has some quality assurance systems in place to monitor the quality of care and ensure ongoing improvements. These include regular meetings for people living and working at the home, six monthly questionnaires to interested parties and in house audits. Currently many of the audits carried out are not recorded and therefore do not demonstrate measures that are put in place to achieve improvements. People living and working at he home said that the management were very approachable and shared information. People said that they were able to make suggestions about the running of the home and felt that their opinions were listened to. The home do not act as a power of attorney or financial appointee but assists some people to collect money from the banks in the local town. Appropriate measures are in place to ensure the health and safety of people in the home. A fire risk assessment has been carried out and equipment is regularly tested in house and serviced by outside contractors. All portable electrical appliances are tested annually and other equipment, such as the lift, is serviced on a regular basis. All accidents are recorded and records seen show a low level of accidents within the home. Up to date certificates of registration and insurance are displayed. Care Homes for Older People Page 24 of 28 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 23 (2) bd The registered manager 15/08/2008 must ensure that all areas of the home are kept in a good state of repair and reasonably decorated. (Previous date of 04/10/07 not met.) To minimise the spread of infection the registered manager must ensure that hand washing and drying facilities in the laundry are easily accessible. 31/05/2008 2 26 13 (3) Care Homes for Older People Page 25 of 28 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, Care Homes 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 1 19 23 (2) bd The registered person 24/07/2009 must ensure that all areas of the home are kept in a good state of repair and reasonably decorated. To provide a comfortable and safe environment for people. 2 26 13 (3) The registered person must ensure that hand washing and drying facilities in the laundry are easily accessible. To promote good infection control practices and minimise risks to people living and working at the home. 24/04/2009 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 Care Homes for Older People Page 26 of 28 1 7 The registered person should ensure that care plans give clear guidance for staff where particular needs are identified. The registered person should ensure that verbal references are fully recorded, signed and dated. The registered person should record all in house audits to ensure that they influence ongoing improvements. 2 3 29 33 Care Homes for Older People Page 27 of 28 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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