Inspection on 24/06/09 for Mayfield

This inspection was carried out on 24th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mayfield 01/03/10

Mayfield 30/01/09

Mayfield 18/01/07

Mayfield 11/10/05

Mayfield 18/04/05

Mayfield 01/11/04

Mayfield 07/06/04

Mayfield 20/05/04

Mayfield 14/04/04

Mayfield 05/06/03

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Fairfields Country Rest Home

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Didsbury Court Rest Home

Belma

Hunters Care Centre

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Random inspection report Care homes for older people Name: Address: Mayfield Mayfield 99 Nursteed Road Devizes Wiltshire SN10 3DU two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Alyson Fairweather Date: 2 4 0 6 2 0 0 9 Information about the care home Name of care home: Address: Mayfield Mayfield 99 Nursteed Road Devizes Wiltshire SN10 3DU 01380723720 Telephone number: Fax number: Email address: Provider web address: mayfieldcarehome@yahoo.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Miss Sharon Anne Cooper care home 20 Number of places (if applicable): Under 65 Over 65 0 17 dementia old age, not falling within any other category Conditions of registration: 1 0 No more than 20 service users to be accommodated at the home at any one time of which 2 service users may fall within the category DE(E). One named female service user, as detailed in the application dated 26th January 2006, may be accommodated at the home falling within the category DE. Date of last inspection Brief description of the care home Mayfield provides personal care and accommodation for up to 20 older people. The service first opened in 1983. It is privately owned and the current owner, Miss Cooper, has been in place since 2000. Miss Cooper employs a manager to run the home. At present, there is an acting manager as the registered manager left in October 2008. Care Homes for Older People Page 2 of 14 Brief description of the care home The home is a short drive from Devizes town centre. It is a detached Victorian residence with many period features. The home has been extended to include additional bedrooms. There is a stair lift to the first floor. One end of the first floor is split level and only accessible by another short flight of steps. Peoples bedrooms are located on the ground and first floor. Two could be shared rooms, but all are currently occupied as singles. Bedrooms have handbasins but no other en-suite facilities. There are bathrooms and toilets on both floors. One ground floor bathroom has an assisted bath. There is a dining room and separate lounge. The home has large gardens surrounding three sides of the property. There are a number of off street parking spaces at the front of the building. Staffing levels are maintained at two carers throughout the waking day. There is also a senior carer and the deputy manager on duty. There is a housekeeper, a cook and an activities organiser. Care Homes for Older People Page 3 of 14 What we found: We made an unannounced visit to Mayfield on 24th June at 10.30 am. We spent over four hours in the home. Before we visited, we knew that the provider, Ms Sharon Cooper, had not paid her annual registration fees when these were due. Non-payment of fees is an offence under the Care Standards Act 2000. We were also aware that there had been a recent issue where the provider had not paid her utilities bill and the home was under threat of having their gas cut off. We had spoken to the provider about this, and she assured us that she had paid the annual registration fees and had made arrangements to pay her utilities bill in instalments. Ms Cooper had told us about financial problems that the home was facing, but said that these were not having an impact on the people who used the service. She also said her financial advisor was drawing up a financial forecast based on her last inspection report and projected bed occupancy. She said he was waiting for a finalised statement of accounts, and agreed to send a copy of the financial forecast when she got it. Unfortunately, she did not do so. We were concerned about the financial difficulties and thought that it was important to visit the home and look at the outcome for the people who used the service. The last inspection was in February 2009. We made a tour of the home, and spoke to various staff members and residents. We also met with a residents visitor. We looked at various records to see if equipment such as hoists and stair lifts had been serviced. We wanted to check that there was enough food for people and that there were enough staff on duty to care for the number of residents in the home. We also looked at two residents care records to see how staff were managing to support them. When we visited, there were only 12 residents, as one respite resident had gone home the previous day. The registered manager left the home last October, and although there is an acting manager, we have not yet received an application to register the person in the post. Ms Cooper came to the home at the latter part of our visit, so we were able to discuss our findings with her. She agreed that she was very anxious about financial viability, and feels that two more residents would help her break even. We saw that one person had poor fluid intake and output, so a fluid chart had been set up. Unfortunately, one entry had not been counted up at night, making it difficult to know if they had been drinking enough. The input and output charts were kept separate, so staff had two charts to complete each day. It might perhaps be easier for them if they only had one chart to complete. We saw another resident with a large dressing on their forehead. Staff explained that this person had fallen, and the paramedics had been called. There were records on file which showed that other grazes and a skin tear had occurred a few days before before that fall. The same person had recently been discharged from hospital following another serious fall, in which they sustained a fractured leg. Care Homes for Older People Page 4 of 14 When we looked at our own records, as far back as October 2008 we had a call from the acting manager about this same person. She was concerned about the resident, who was in hospital at that time as a result of a fall. The manager was extremely anxious about the resident returning, although the family was keen for this. The manager said that her worry was that one of these falls may be fatal one day. We advised that the manager should make an assessment of the persons mobility whilst in hospital, and if she felt that the home were not able to support the person, they should be very clear about it and should not have the resident back to stay. We discussed this with the manager, who said that there was no funding for one-to-one care, but staff had set up a system of alarms to warn them if the person left their bed or chair. We have asked the manager to seek an urgent nursing needs assessment for this resident. We found that medication was not always stored correctly. We saw cream prescribed for one resident lying out on the dining room windowsill. One person had several prescribed and non-prescribed medications on their mantlepiece. One of these was ear drops, and another was an artificial saliva spray, with no top on and no date of expiry, so that there was no way of ensuring it was safe to use. When we checked the medication record there was no evidence of ear drops or of artificial saliva being prescribed. The Medication Administration record (MAR) showed that several medications had been signed with an O. The chart indicates that this means other, but there was no recording to say why the medications had not been given. One record said that cream should be applied apply twice a day when required, although there was a hand written note which said Apply 3 times per day. There was no record of this being done, and no record of any medical practitioner changing the application. There was a gap where staff had not signed to say that someones medication had been given. We found that one resident did not have his hearing aid in when we arrived mid morning, and a visitor put it in for him. The same person had a helping hand, or grabber beside his bed, although he was sitting in the chair when we arrived. We discussed the fact that equipment meant to help residents and make their life a bit easier would be more useful if kept nearby. The manager said that the resident now doesnt use the grabber, and sometimes doesnt want the hearing aid in. We advised them to record this in the daily notes. A new cooker had been delivered on the day of our visit, so lunch wasnt cooked. Fish and chips was bought by the manager for all the residents. It was said that this was a regular occurance and was greatly enjoyed by all. The cooker was to be fitted the next next day, but if not, a meal of salad and cold meats was planned. There was a large stock of food in the kitchen, and the visitor and all the residents we spoke to said that the food was very good. We saw one resident with a plate guard, designed for people who have difficulty eating to help the food stay on the plate. The visitor reported that her friend wanted an angled knife and fork, but hadnt got one. The manager said that they were waiting for it to arrive. One area of the home gave us some cause for concern. There is a steep, winding staircase leading from the hall. Staff reported that this is never used by residents. There is a closed door leading to this staircase, but anyone who wished to could access it. We spoke to the manager about this. She said that the home had been aware of the hazard for some time, but had not reached a satisfactory conclusion about how to ensure there Care Homes for Older People Page 5 of 14 was no danger to residents. When asked if there was a risk assessment in place, we were told there wasnt. We have advised her to do this, and to seek advice about how to make it safe. The house was clean and tidy. The visitor we spoke to said that cleanliness has improved recently, although they have, in the past, had to bring in materials to clean the sink in their friends bedroom. We saw that one persons walking frame was extremely dirty and stained, and there was no towel or flannel present in their bedroom. We visited two other bedrooms downstairs. Neither had a towel or flannels. One only had small, used pieces of soap. We discussed this with the manager, who said that all towels had been removed for washing and staff did not have time to replace them with clean ones. The bathroom downstairs had no soap or towels, and we found a jug containing an old razor on the windowsill. The downstairs WC had no soap and the towel dispenser was empty. The situation had not changed by the time we left later in the afternoon. We discussed ways of dealing with this, including the cleaner taking responsibility for this instead of care staff. The staff do not at the moment have the use of an office, so all the care plans etc are kept downstairs in the dining room. This means that the residents are often present while staff are doing their paperwork. The telephone is also situated in the dining room, so that staff can access it easily. Unfortunately, this has the effect that residents are subjected to the phone ringing frequently in their communal space. We discussed the idea of having a staff office where people could work, and Ms Cooper agreed that this might be a good idea. Fire extinguishers had been tested, and the Gas safety record had been completed in October 2008. The stairlift servicing was last done on 24th June 2008, therefore was out of date. The manager said that the service engineers had cancelled their visit, but were due soon. The two hand rests on the stairlift were taped round and round with masking tape of sorts, and this was now becoming loose and dangling off. The remaining tape was extremely dirty. The tape had lots of rough edges, and could easily tear older peoples fragile skin. If a resident has any sort of infection, there is a risk that this could be passed on via the dirty tape. When we spoke to Ms Cooper, we told her that this must be looked at. We also told her to put a risk assessment in place for all the residents who use the stairlift while it is in its current condition. The electrical testing and Inspection report was out of date and had expired in March 2008. The safety tests which should have been completed on all the hoists were last done in April 2008, which meant that they too were out of date. People are at risk of their equipment failing or breaking down if it is not serviced regularly, which could be extremely dangerous for them. The fire risk assessment appeared to have been reviewed in September 2008. However, on closer examination, it had been signed and dated but not amended to take account of any changes. There were things recorded for staff members to do, some of whom had left. The format itself did not have any spaces where changes could be recorded. Because of the fact that some of the servicing hadnt been done, and because of our previous concerns about Ms Coopers financial situation, we have asked her to provide us with evidence that the home is financially viable, by sending a copy of the homes Care Homes for Older People Page 6 of 14 accounts to us. What the care home does well: 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 2. Care Homes for Older People Page 7 of 14 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 14 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 All fluid charts must be completely tallied up at the end of each day. So that detailed records can be kept of peoples fluid intake in order to avoid dehydration. 24/07/2009 2 8 13 A nursing needs assessment must be sought urgently for the resident who has had frequent falls. So that the residents needs are known and can be fully met. 24/07/2009 3 9 13 Any medication brought in to 24/07/2009 the home by family must be recorded on the medication record and medical advice sought regarding its appropriate use. So that people are safe when taking medication. 4 9 13 All medication must be recorded on the MAR when given to a resident by staff. 24/07/2009 Care Homes for Older People Page 9 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action If it is not given for some reason, the reason must be recorded. So that people can be sure they have had their prescribed medication. 5 9 13 All medication must be given 24/07/2009 as prescribed until written authorisation is received. So that people can be sure their medical practitioner is aware of any medication changes. 6 9 13 All medication must be stored securely. So that that residents are safe from any risk of having medication which is not intended for them. 7 19 13 A risk assessment must be put in place with regard to the staircase in the ground hallway. So that people can be kept safe. 8 26 13 Bathrooms must not contain 24/07/2009 any toiletries which might be used communally. So as to prevent any potential cross infection. 9 26 13 All bathrooms and WCs must 24/07/2009 have single use towels and soap. 24/07/2009 24/07/2009 Care Homes for Older People Page 10 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So as to prevent any potential cross infection. 10 26 13 All equipment provided for 24/07/2009 the use of residents must be kept clean. To avoid the risk of any infection. 11 26 13 Each bedroom must have a towel for people to dry their hands. To avoid the risk of any infection. 12 31 25 The provider must send an 24/08/2009 up to date statement of the homes accounts to the CQC. So that we can see that thehome is financially viable and that residents are safe. 13 31 8 An application must be sent to the CQC in order to register a manager. So that a fit person is in day to day charge of the home. 14 33 26 The provider must make 24/08/2009 monthly monitoring visits to the home and produce a report of these. Copies of the reports must be sent to the CQC until further notice. So that we know the provider is monitoring progress. 15 38 13 A risk assessment must be put in place for all the 17/07/2009 24/09/2009 24/07/2009 Care Homes for Older People Page 11 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action residents who use the stairlift while the handles remain taped up. So that risks to residents might be minimised. 16 38 13 An up to date fire risk assessment must be put in place. So that risks to people in the event of a fire are minimised. 17 38 13 All equipment such as hoists 24/07/2009 and chairlifts which is used by residents must be serviced on a regular basis. So that people can be moved safely. 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 24/07/2009 1 8 If body maps of pressure sores or bruises are to be kept, they should only be in place when a sore develops. Staff can then monitor their progress. The provider should consider using one fluid chart to record both fluid input and fluid output to make it easier for staff to access and total up. Guidance should be written for staff about what to do if fluid levels fall below a certain level. If prescribed creams are to be kept in residents bedrooms, the provider should consider a safer way of storing them. Staff should make a note in the daily record when a resident doesnt want to use their hearing aid or use equipment such as a grabber so that it is clear that these items are not being kept away from them. Page 12 of 14 2 8 3 4 9 14 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 5 6 19 19 Advice should be sought from the fire department about whether the door to the staircase should be locked. The provider should consider using an empty room as an office where staff can have privacy away from the residents to work on care plans etc. A new fire risk assessment template should be used. This should allow space for any changes to be made in future. 7 38 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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