Inspection on 02/12/05 for Mayfair Residential Home The

This inspection was carried out on 2nd December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Mayfair Residential Home The 26/06/07

Mayfair Residential Home The 07/07/06

Mayfair Residential Home The 19/05/05

Mayfair Residential Home The 19/01/05

Mayfair Residential Home The 02/09/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Mayfair Residential Home The 42 The Esplanade South Cliffe Scarborough North Yorkshire YO11 2AY Lead Inspector Mavis Pickard Unannounced Inspection 11:30a 2 December 2005 nd 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 Residential Home The DS0000033567.V267839.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 Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Mayfair Residential Home The Address 42 The Esplanade South Cliffe Scarborough North Yorkshire YO11 2AY 01723 360053 01723 360053 mayfair@engs.fsnet.co.uk www.mayfaircs.co.uk Mrs Fay E Crawforth 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) Mrs Fay E Crawforth Care Home 22 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (22) of places Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th May 2005 Brief Description of the Service: The Mayfair is a care home providing personal care and accommodation for up to 22 older which may at anytime include up to 4 people with a dementia type illness. Mrs. Fay Crawforth is the registered manager and the proprietor. The home does not provide nursing care. The premises which is situated on Scarboroughs southcliffe has sea front views to the front of the building. Some bedrooms to the rear have views over the Ramshill area of the town. The facilities provide fourteen single bedrooms and 4 shared bedrooms. 18 bedrooms have ensuite facilities. There is a passenger lift available the 5 main floors of the home Some bedrooms situated on mezzanine floors are accessed from the nearest lift stop, by stairs. The home has a small garden area to the front where residents may sit out in the warmer weather and is close to public gardens situated on the promenade. Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. On the day of this unannounced visit the provider/manager was available in the home and along with the deputy manager assisted the process of inspection. The visit was undertaken over a 4.5-hour period and looked at a range of care and health and safety documentation. An accompanied tour of the home was undertaken and residents spoken with on an informal basis. The home was found to be running well. Residents said that they enjoyed living at The Mayfair and that they felt valued and safe in their home. What the service does well: What has improved since the last inspection? What they could do better: They could ensure that the maintenance programme designed to ensure that the home is well maintained and attractively decorated throughout is completed without undue delay. Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 6 A requirement has been made that the provider forwards to the Commission by 1/1/06 an action plan giving timescales for the expected completion of this work. At the date of this report being made public, the Commission has not received this plan. Assessments designed to minimise the risk to individual residents with respect to the use of balconies must be implemented. Staff should ensure that past and/or current resident’s toiletries are not left in communal bathrooms. Extractor fans fitted to all areas must be kept clean in line with current fire safety guidance. The regsitered person should be robust in ensuring that the home meets its responsibilities in respect meeting current standards regarding National Vocational Qualification [NVQ] training. 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 Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 & 5 Prospective residents and/or their representatives are assessed in respect to their need, are provided with appropriate information about where they wish to live and on admission have a contract of residence. EVIDENCE: From pre-admission documentation it is clear that prospective residents and/or their representatives are provided with a range of information about the home and the services that it provides. Following an appropriate written assessment and /or visits to the home residents are advised verbally if the home can meet there needs or not. Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10 Most but not all residents had written care plans. Where appropriate residents are responsible for their own medication. Resident are treated with respect. EVIDENCE: A range of personal records were examined where it was found that most set out in detail the individuals health, personal and social care needs. However the documents of 2 residents whose personal care and/or mental health needs show that they have particular and/or specialised need, did not evidence that care plans are in place to give guidance for staff on the meeting of these needs. The manager said that this situation is unusual and that the issues would be dealt with immediately. Residents spoken with said that they are treated well by the management and staff and did not in anyway indicate that their needs are not being met. Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 10 Residents who are risk assessed as being able to do so take responsibility for their own medication and have a lockable facility in which to store it. The home has a medication policy and follows it. However it was noted that medication normally considered ‘controlled drugs’ were not stored in a controlled drug [CD] facility or signed for in hard backed [CD book] designed for the purpose. Local Pharmacist spoken with advised that good practice recommends such medication should be stored in a double metal cupboard and signed for by 2 people, in a special CD book. The provider/manager said that training has been achieved for people who administer medication and that she as a trained nurse cascade’s her knowledge of medicines to her staff. Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 People accommodated find their lifestyle in the home meets their expectations. EVIDENCE: Not all residents were spoken with during this visit; some were unavailable to meet with. However people spoken with said that they enjoy living at The Mayfair they have the activities and pastimes that they want. Many people said that they go out with their friends and family and /or are able to go out alone into Scarborough town or on to the local shops etc. The registered person showed evidence that regular entertainment and activities are provided in the home and that special events have been arranged for over the Christmas period. People living in the home are encouraged to partake in pastimes they enjoyed before being accommodated such as crosswords, puzzle books, painting and so forth. There was evidence of resident’s artistic prowess throughout the home. Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 12 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): EVIDENCE: None of these standards were inspected at this visit although the registered person said that she has undertaken Adult Protection Training and will cascade this to other staff. Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 13 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): All the above standards were inspected. Residents have access to comfortable facilities, have sufficient toilet and bathing facilities and the specialist equipment they need. The home is clean. Parts of the home are not appropriately maintained. EVIDENCE: A tour of the home was undertaken from the third floor to the lower ground. The dining room and communal lounge has, the registered person said been re-decorated and is comfortable and pleasantly decorated. The bedrooms inspected were in the main pleasant and people had their own belongings around them. One en-suite bathroom to a facility presently unoccupied requires to be completely refurbished. The deputy manager said that where necessary ensuite bathrooms are being refurbished. Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 14 It is noted that a resident who requested when admitted that a shower was provided has been provided with such a facility. It was discussed with the registered person that some parts of the home require to be re-decorated. It is understood this is part of an ongoing programme. Two upper floor bedrooms have ‘patio doors’ leading to a common balcony. This facility is pleasant and the manager said would only be offered to people who she felt would not be at risk. However no written risk assessments were available for inspection in respect to health and safety or privacy issues. [Please refer to standard 38] The home presented as being clean, however in the communal bathroom that the deputy manager said is used by all people who need a mechanical/electric bath seat, there was evidence of what may be communal toiletries. The staff member said that the items, a comb, used disposable razors, soap, talcum powder etc may have belonged to a previous resident and were not used by current residents who always bring their own products with them to the bathroom. If this is the situation these items should be disposed of. Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 15 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): 29, 30 Residents are protected by the home’s recruitment policies and procedures. The home does not presently employ 50 of staff trained to National Vocational Qualification [NVQ] level 2 or above. EVIDENCE: A number of staff recruitment documents were inspected where it was found that the home follows its own policies and meets the current requirements of the Care Standards Act 2000. All Criminal Records Bureau disclosures received for existing staff were examined. All disclosures that had been received to date [02/12/2005] were recorded as having been seen by the Commission. Although the registered person does encourage and support care staff and others to achieve the NVQ qualifications at level 2 or above, to date the numbers having achieved that, do not at 33 meet the current standard. Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 16 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. The registered person is fit to be in charge of the home. The home is run in the best interests of people accommodated. Staff are supervised. EVIDENCE: The provider/registered manager who is qualified to RGN level has achieved a degree in Social Policy and Administration and a Certificate in Management Studies. Therefore the manager meets current National Minimum Standards with respect to the management of a care home. From speaking with residents and staff the home is run in the best interests of people accommodated. The manager said that she ensures that her staff are appropriately supervised and that all receive 1-1 formal supervision regularly, which generates a written record of the topics, covered. Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 17 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 3 X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 X 3 3 3 X X 2 STAFFING Standard No Score 27 X 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 1 Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 18 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 Schedule 3(1)(b) Requirement Timescale for action 02/12/05 2 OP19 3 OP38 All residents must have An individual care plan indicating the care to be provided. All such plans must kept under regular review and amended when necessary. 23(2)(d) The registered person must forward to the Commission in writing, a plan of refurbishment and/or re decoration for the premises. Giving timescales for the expected completion. 13(4)(a-c) The registered provider must ensure that as far as is reasonably practicable all parts of the home to which residents have access are free from avoidable risk. Should a risk be identified, appropriate written risk assessments must be implemented. 01/01/06 02/12/05 Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Medications that are usually referred to, as being ‘controlled drugs’ should be stored in an appropriate, separate metal cupboard and recorded in a controlled drug book witnessed by 2 people. The home should ensure that individual residents toiletries, hair combs and brushes and shaving requisites are stored in their private facilities to minimise the incidence of cross infection. The registered person should ensure that a minimum ratio of 50 trained members of care staff [National Vocational Qualification level 2 or above] is achieved by 2005. 2 OP26 3 OP30 Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mayfair Residential Home The DS0000033567.V267839.R01.S.doc Version 5.0 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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