CARE HOMES FOR OLDER PEOPLE
Mayfair Care Home 25 The Avenue Minehead Somerset TA24 5AY Lead Inspector
Jane Poole Announced Inspection 29th November 2005 09:30 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 Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 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. Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Mayfair Care Home Address 25 The Avenue Minehead Somerset TA24 5AY 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) 01643 706816 01643 708855 Ms Diane Langdon Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (0) Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 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. 21st June 2005 Date of last inspection Brief Description of the Service: The Mayfair is registered to provide care to up to 15 people over the age of 55 who require care due to mental health difficulties. The building itself is a former hotel set in the centre of Minehead, within easy walking distance to the sea front, shopping facilities and all other local amenities. Service user accommodation is set over three floors with a passenger lift between. All communal areas are on the ground floor and are assessable to people with all levels of mobility. The registered manager and provider id Diane Langdon. Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. At the time of this inspection there were 15 service users living at the home. No new service users had been admitted since the last inspection. The inspector spent 6 hours in the home and was able to speak with staff and service users in communal areas and in private. The inspector was given unrestricted access to all areas of the home and was able to view records and observe care practices. Prior to the inspection one comment card was received from a medical practitioner, 4 from service users and 5 from relatives or visitors to the home. What the service does well:
The home is situated in the centre of the town of Minehead, which enables service users to have easy access to all facilities. Some service users are able to go out without staff supervision and others require assistance. Service users are encouraged to maintain their chosen lifestyle when they move to the home. There are no strict routines. The inspector observed that people are able to come and go as they please and have free access to all communal areas of the home. Service users stated that there are no set times to get up or go to bed. Some activities are provided in house but service users are encouraged to use local facilities and clubs. Many of the service users regularly attend church, many use the pubs and cafes in the town, one person attends a cookery class and swims once a week and others go shopping and on trips with staff. The home has links with independent advocacy services and three people regularly go out socially with their advocate. Service users were happy with the quality of the food and stated that there is always a choice of meal. There is evidence of a robust recruitment procedure which minimises the risk of abuse to service users. Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
At this inspection six requirements and two recommendations for good practice have been made. Care plans need to be further developed in full consultation with service users. The home must to put in place quality assurance systems to ensure that the service is reflective of the needs and wishes of service users and interested parties outside the home. Currently one end of the dining room is used as a smoking area for staff and service users. At the time of this inspection all windows were closed, due to the cold weather, and the room became very smoky. The manager needs to review the smoking policy and take action to ensure that the dining room remains a pleasant place for service users to eat meals. It was also noted that after lunch staff spend a high proportion of their time in the dining room writing records and smoking. The manager needs to ensure that staff appear available to service users at all times and provide social stimulation. A recommendation has been made that all staff should receive formal recorded supervision at least 6 times a year.
Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 7 The home is in the process of updating and sorting their policies and procedures but currently there is more than one policy in respect of some areas of care. This could be confusing and staff need to be made aware of which policy or procedure the home are working to. 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 DS0000046793.V258191.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 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 the following standard(s): 1. The home’s statement of purpose sets out the scope of the service offered. EVIDENCE: The statement of purpose for the home has been reviewed and updated since the last inspection. It is available to visitors and service users in the main hall. No new service users have moved to the home since the last inspection therefore the majority of standards in this section have not been assessed on this occasion. Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. Care plans have improved since the last inspection but these need further work focussing on involving service users. Service users receive support to attend medical appointments if they require or request this. EVIDENCE: Each service user living at the home has a personal file containing an assessment of need and care plan. Since the last inspection the care plan format has been changed to create more up to date information about the needs and wishes of service users. The inspector viewed 4 care plans and discussed this issue at length with the manager. It is acknowledged that staff have put a lot of work into updating these plans and they form an excellent basis for very person centred plans. The quality of the information was variable with some giving excellent personal information. Ways to develop these care plans further were discussed and the home should focus on involving service users more fully in this process. Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 11 As part of the review of care plans staff have discussed fully with service users and/or their representatives their wishes in respect what should happen at the time of their death. All expressed wishes have been clearly documented. Risk assessments in respect of tissue viability, falls and nutrition have been carried out and the results of these need to be fully integrated into the new care plans. Currently no one living at the home takes full responsibility for administering their own medication although some self administer creams and lotions. The home uses a monitored dosage system for all medication and staff stated that they had received full training in this area and felt confident to administer medication. There are suitable storage facilities and Medication Administration Records viewed appeared well maintained. Some minor errors were noted and these were raised during the inspection. Service users spoken to stated that staff assisted them to attend medical appointments if they requested them to do so. On the day of the inspection one service user and a member of staff walked up to an appointment at the local surgery. Some people stated that they choose to attend appointments alone or with a friend. Records are kept in all personal files of appointments attended and all relevant information documented. One person at the home has joined a walking for health group organised by the local GP surgery. One healthcare professional completed a comment care prior to the inspection and stated that they were always able to see their patient in private. 13 of the 14 rooms are for single occupancy and all have en suite facilities were personal care can be carried out in private. People are free to spend time in communal areas or in their own private rooms if they choose to. 3 of the 4 service users who completed comment cards answered YES to the question “Is your privacy respected?” Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Service users are encouraged to maintain their chosen lifestyles and pursue their own interests and hobbies. Service users are able to make choices about their every day lives and are free to come and go in line with their abilities and assessed abilities. EVIDENCE: The home encourages service users to maintain their chosen lifestyles when they move to the home. There are not set time to get up or go to bed. Preferred times are recorded in care plans but people have freedom to choose on a daily basis. On the day of the inspection one elderly service user had chosen to spend the day in bed. The inspector visited this person who stated that sometimes they just felt like having a complete break. The home organises some activities, there is a person who facilitates a craft class once a week and an activities organiser who spends two mornings a week at the home. Some service users stated that they enjoy playing cards and games in the evening. Many of the service users continue to pursue their own interests, one person attends a cookery class and goes swimming weekly, three people go out to church, three people have advocates from MIND and regularly go out socially
Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 13 with the advocates and to group activities, one person has a befriender and many people go out with out staff assistance to the shops, pubs and cafes. The inspector noted that on the day of the inspection that service users were free to come and go as they pleased. All those asked stated that they were able to have visitors at any time. 5 visitors completed comment cards prior to the inspection all stated that they were made welcome in the home at any time and all stated that they were able to see their friend or relative in private. Service users are able to personalise their rooms with their own furniture and possessions if they wish to. The home assists some service users with personal finance and records of all transactions are maintained. Records seen showed that service users sign for money where appropriate and where this is not appropriate two staff signatures are obtained. The home has formed links with advocates from Age Concern and MIND. Service users stated that food in the home was good with a choice at every meal. The main meal of the day is at lunchtime and the inspector observed that this was a calm unhurried occasion. The cook stated that there is an adequate budget and that they are able to make suggestions about meals. There is a large dining room in the home but service users are free to eat where they choose. One end of the dining rooms is used as a smoking area by staff and service users when meals are not being served. The inspector noted that as all the windows were closed due to the weather the room became very smoky and may not have been a pleasant environment for service users, particularly non smokers, to eat in. The manager must look at how this area can be better ventilated. Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18. The home have taken reasonable steps to minimise the risk of abuse to service users. EVIDENCE: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. Service users stated that they would be comfortable to raise any concerns or complaints with the manager or a member of staff. Staff are made aware of the ability to take serious concerns outside the home during their induction period. As previously stated service users have access to independent advocates. All are on the electoral role and able to vote if they wish to. All staff have enhanced Criminal Records Bureau checks. Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. The Mayfair provides comfortable, homely style accommodation for service users. A new heating system has been installed but some upstairs rooms remain cold. 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. Since the last inspection a new heating and hot water system has been installed. 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, handrails and a ramp at the main entrance.
Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 16 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 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 there are communal bathing and showering facilities for those people who prefer or require additional support. The inspector noted that many of the upstairs bedrooms were very cold (one room thermometer showed 13 degrees centigrade) and would not provide a suitable environment for service users to spend time in. The manager is aware of this and is looking at ways to improve the heating in these rooms. The communal rooms are on the ground floor; these consist of a large lounge and a dining room. Since the last inspection the dining room has been decorated to make it lighter and new seating has been purchased for the lounge. One end of the dining room is a smoking area for service users and staff when meals are not being served. As previously mentioned this area would benefit from better ventilation to ensure that the room remains fresh when service users are eating. 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 adequately maintained. Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. There is evidence of a thorough recruitment process. On the day of the inspection staff were not deployed in ways that maximised their interaction with, or accessibility to, 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 10am and 2pm. A requirement of the last inspection was that the home kept clear records of all staff training. The home now has written records of the training that staff have undertaken, these include medication administration, fire safety, infection control, first aid and mental health awareness. All staff undertake a full induction when they begin work at the home. One member of staff told the inspector that they felt that training opportunities had improved and the majority of care staff were now enrolled to undertake National Vocational Training at level 2 or 3. At the present time no carers in the home hold an NVQ.
Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 18 The inspector noted that after lunch staff spent much of their time writing and smoking in the dining room and not socialising with service users. The manager should review this practice to ensure that staff appear accessible to service users at all times and that service users receive appropriate social stimulation. This is particularly important for those people who are unable to go out unsupervised and who can not easily occupy themselves. No new staff have been employed since the last inspection but a selection of staff files viewed showed that the recruitment process is good with written references, Protection Of Vulnerable Adults and Criminal Records Bureau checks in place. Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 37 & 38. The manager of the home is competent and demonstrates a good knowledge of staff and service users. Staff would benefit from regular formal supervision. There are no effective quality assurance systems in place. 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 has recently completed the Registered Manager Award (NVQ Level 4) and has begun to put some of this learning into practice.
Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 20 All spoken to described the management as open and approachable, all service users appeared relaxed and happy to talk with the inspector in communal areas and in private. The inspector was given unrestricted access to all areas of the home and all records requested were made available. The manager has carried out appraisals with all staff but there are no formal recorded supervision sessions in place. Although it was evident through discussion with the manager that she has a development plan for the home there is no evidence that any quality assurance measures are in place. There appears to be no formal routes for service users, or interested parties outside the home, to express their opinions about the quality of the service. Steps have been taken to ensure the health and safety of service users and staff. A fire log is maintained that shows that alarms, extinguishers and emergency lighting is tested in house on a regular basis and serviced by outside contractors on a half yearly basis. The lift is regularly serviced and visual checks are carried out monthly on all areas of the home. Portable appliances were tested in May of this year. All accidents in the home are recorded. The inspector viewed these records and noted that some were poorly written, one was not dated and another was incorrectly dated. There has been an improvement in the record keeping in the home and all records requested were easily obtainable. The home is currently still reviewing their policies and procedures and currently have more than one policy on some aspects of care. The home needs to ensure that staff are clear about the correct policy and procedure to be followed. Up to date certificates of registration and insurance are displayed in the home. Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X X 1 2 3 Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) Requirement Care plans must be further developed in consultation with service users and/or their representatives. Risk assessments must be incorporated into care plans. The manager must review the smoking area in the home to ensure that it well ventilated and does not offend service users. The manager must ensure that all areas of the home are adequately heated. The manager must ensure that staff are appropriately deployed to ensure that they appear accessible to service users and provide appropriate social stimulation. The manager must introduce effective quality assurance systems to encompass the views of service users and interested parties outside the home. The manager must ensure that records of accidents are clearly written, comprehensive and dated. Timescale for action 28/02/06 2 OP15OP20 23 (2)[h] 31/12/05 3 4 OP25 OP27 23 (2) [p] 18 (1) [a] 31/12/05 31/12/05 5 OP33 24 (1) 31/03/06 6 OP38 17 (2) Sch 4 (12) 31/12/05 Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 23 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 Refer to Standard OP28 OP36 Good Practice Recommendations 50 of care staff should have an NVQ in care at level 2 or above. It is strongly recommended that all staff receive formal recorded supervision sessions at least 6 times a year. Mayfair Care Home DS0000046793.V258191.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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