Inspection on 06/08/08 for Mayfield Care Home

This inspection was carried out on 6th August 2008.

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

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

Mayfield Care Home 05/08/09

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Mayfield Care Home Mayfield Care Home Beaufort Road Sale Manchester M33 3WR Lead Inspector Kath Oldham Unannounced Inspection 07:55 6 & 8th August 2008 th 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 Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 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. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mayfield Care Home Address Mayfield Care Home Beaufort Road Sale Manchester M33 3WR 0161 973 2371 0161 973 2371 gilmours@runbox.com 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) Mr Stephen Reid Gilmour Mrs Janet Kingshott Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP The maximum number of people who can be accommodated is: 24 Date of last inspection Brief Description of the Service: Mayfield is a residential care home providing care and accommodation for 24 older people. New owners Steven and Julia Gilmour in Febraury 2008 purchased Mayfield and have plans to develop the accommodation and improve on the environment and care practice in the home. The home is situated in Sale, in a large Victorian detached property and is located at the end of a long drive and has secluded gardens. The original building has been extended to accommodate bedrooms on the ground and first floor. There is accommodation for three residents in the basement. Access to this accommodation is limited to those able to manage a number of fairly steep stairs. The kitchen is located in the basement and laundry facilities are on the ground floor. There is wheelchair access to the front and rear of the building and provision for parking at the front of the house. The garden was well maintained and gave a pleasant outlook. We were told the gardens are used by the residents to sit out in warmer weather. Fees charged for this service are between £400 and £480 per week. There are additional charges made for hairdressing, newspapers and toiletries. A number of residents pay for their own continence products. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This visit was unannounced, which means the managers and staff were not told we would be visiting, and took place on 6th August 2008, commencing at 7:55am until 5:15pm.A second day was also arranged to conclude the inspection on the manager’s return from holiday. This took place on 8th August 2008 commencing at 8:45am until about 10.40am. Mayfield Care home was sold to new owners who took over the running of the home in February 2008.They have undertaken an audit of the provision and have put in place and action plan to address the areas where the home needs to be improved and the development of the staff team. The inspection of Mayfield included a look at all available information received by the Commission for Social Care Inspection (CSCI) about the service since the new registration in February 2008. We also sent the manager a form before the visit for her to complete and tell us what they thought they did well, and what they need to improve on. The owner and the manager completed this. We considered the responses and information provided and have referred to this in the report. We call this form the Annual Quality Assurance Assessment (AQAA). We are trying to improve the way we engage with people who use services, so we gain a real understanding of their views and experiences of social care services. We used an ‘expert by experience’ on this inspection. An “expert by experience” is a person who has experience of using care services. They help us to get a picture of what it is like to live in or use a social care service. Comments from the Expert by Experience’s report are used in this report. The expert by experience had lunch with the residents and explained that” he was prepared to pay” for himself “but no charge was made”. The expert by experience in their report to the Commission for Social Care Inspection said, “Summing up I felt the home was sufficiently covering the care of the residents but there is a lot of room for improvements. I suppose it was not quite fair to inspect just when the owners were in the middle of a huge programme of improvements and I feel sure that when these are completed it will be a first class residential home. I enjoyed my visit to the home and lovely meeting such nice people both staff and residents.” Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 6 Mayfield was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to staff and posted to specific residents to obtain their views of the service, the views expressed in returned comment cards and those given directly to the inspector and expert by experience are included in this report. We found our information at the visit by observing care practices, talking with people staying at Mayfield; talking with the owner, deputy, and staff. A tour of Mayfield was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how Mayfield was meeting the needs of residents and how well the staff themselves were supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to two residents was looked at in detail to help form an opinion of the quality of the care provided. A brief explanation of the inspection process was provided to the deputy on arrival at the home. Time was spent at the end of the day to provide verbal feedback to one of the owners. Since the registration of the new owners CSCI have not received any complaints about Mayfield. The owner had made contact with the local authority in relation to safeguarding. The policies did not appear to have been followed as indicated. This was ongoing with the local authority at the time of the inspection. What the service does well: The AQAA indicated, “We have owned the home for about 6 months and are currently working through a program of improvements. So far, these physical changes have gone smoothly and both residents and staff are to be commended for their support in this process”. This shows us the new owners understand what they need to do to improve the service, and are willing to do it. The owners have a number of other homes and have experience of improving services. Prospective residents and their families are provided with an information pack which includes the Statement of Purpose, Service Users Guide, resident survey results, complaints information and a standard contract. The owner prints and binds this package so they are able to update it regularly making sure the Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 7 information they provide is accurate. The officer in charge, Mrs Janet Kingshott, has been referred to the commission for consideration as registered manager and has been approved. We were told that, “This is big change symbolically as under the previous management structure of the home, it was sometimes difficult to clearly define responsibilities and to make care based decisions. With this change, Janet is spending more time on management issues and supervision, and less time on hands-on care. This is an on-going process”. The AQAA indicated that 13 out of 14 (93 ) of the care staff have NVQ 2 or above. A review of training has been carried out and a new training provider has been engaged to bring all training up to date. A training file has been established to easily demonstrate what training has been undertaken and what is still required. A resident survey is to be arranged every six months and the results included in the statement of purpose. Staff meetings are now held, and a resident’s forum is to be established to discuss any issues. We were told in the AQAA “we have tried to create an atmosphere of openness with staff, residents and families so that all parties understand what we are trying to achieve”. . What has improved since the last inspection? This is the first inspection since the owners Stephen and Julia Gilmour bought Mayfield in February 2008.Since the purchase, three bedrooms have been refurbished providing improved facilities and a pleasanter place for residents. The plan is (over time) to refurbish all the bedrooms to the same standard as the three bedrooms already completed. Additional work to the building has also been undertaken. The access to bedrooms on the first floor was difficult as residents had to have some degree of mobility to climb stairs after getting off the chair lift. This has now been changed with a new chair lift being installed, which goes up all the stairs, and also additional stairs have been installed and the floors lowered and levelled. This provides people with more independence in moving around the home. Residents were seen using the stair lift independently being able to do this because of their abilities of course but also because of the new layout. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 8 Plans have been submitted to the local authority planning department for a lift to be installed. This will be an additional benefit to residents as they will be able to mobilise around the home a lot easier. Staff have in the last six months received updated and new training which should if transferred into practice benefit the residents at Mayfield and provide additional safeguards. The training has included infection control; moving and handling, medication training and staff have started to learn more about dementia and care of residents who have dementia. The manager who has been employed at Mayfield for over 14 years has recently been nominated for consideration for registration to the Commission. The manager has been in a management role at Mayfield for some time but has now received registration status. We were told that all staff had received supervision with their manager this focuses on their strengths and skills and provides an opportunity to identify training and how staff are progressing in their role. It was anticipated that staff would not receive the necessary six supervisions with their manager this year but that this system will be put in place to ensure all staff received regular supervision. What they could do better: There are a lot of things that still need to be done at Mayfield to improve the accommodation and also in relation to records that need to be in place. The owners have a business plan and this includes the refurbishment and the timescales for completion. From what we have seen so far, we are confident that the business plan in place will vastly improve this service. Currently the care plans are not all completed and records that must be in place to demonstrate that residents get the care they need when they need it in a way they want could not be confirmed. Staff need guidance and direction from management to support them in the changes needed to meet the standards that are required. Some of the staff have been employed at Mayfield for some years and have been used to doing things a particular way, which is not necessary the right way, or current or best practice. Staff need to be aware of the regulations and standards and make sure the residents get the care and support they need in a way, which is right and proper and promotes their skills and abilities and personalities and not because this is how “we have always done it” approach. We accept that this will take time with management support. Training provided to staff should go some way to develop the practice and routines. All grades of Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 9 staff do need to attend the training to make sure that the theory is put into practice. There are six requirements arising from this inspection. The owners have looked at previous inspection reports and have addressed some of the requirements and recommendations of past inspections. 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. The summary of this inspection report can be made available in other formats on request. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 10 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 Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents receive information about the home and have their needs assessed; this enables them to make an informed decision about moving into Mayfield. EVIDENCE: The statement of purpose and service user guide, which are documents that let residents know about the home and the services provided, have been reviewed updated and re-written to reflect the change in ownership of Mayfield and the services provided. We were told that residents who have been admitted since February 2008 have received these documents and anybody making enquiries about the service are given this information. A leaflet telling the reader a little about Mayfield is also placed in reception for visitors to take. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 12 We were told that where possible the manager would visit prospective residents in their own home or placement to complete the homes own pre assessment procedure. Meeting with residents before they make any decisions about moving in, and introducing themselves and assessing the service user’s needs is best practice and beneficial to the residents and the manager. Where residents cannot be visited, the assessment procedure is completed when the resident is admitted. It would be better if when the local authority arranges the placement that the assessment undertaken by the social services worker is received by the manager before the placement commences so the manager has enough information to make a decision if they have the skills, abilities, equipment and knowledge to look after the prospective resident. We asked staff if they are given information about the needs of the people they support or care for. All staff who responded said, “always” and one added, “Always information about the people in the care plan or when we come on shift”. One added, “We always put info to the next shift”. One of the care files looked at didn’t contain a social work assessment despite being a resident at Mayfield since April 2008. This needs to be chased up by the manager at the referral stage. We asked residents if they were provided with enough information before moving in, residents spoken with told us they were. For those residents whose family members act on their behalf, we were told that theyve received enough information to enable them to inform the resident about the home. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The care plans were not sufficient to demonstrate personal and health care needs of residents. EVIDENCE: We looked some records to evaluate how the care needs of residents were recognised, recorded and met. This included looking in depth at two residents’ care files. The two looked at in detail were for the most recently admitted residents. We were told in the AQAA that, “Each resident has a care plan. Care plans record significant events and daily entries set out care given. We also have regularly updated risk assessments for residents which cover areas such as moving and handling, nutrition, pressure sores, the use of bed rails and falls. The care plans and risk assessments are updated as and when required but at least monthly.The manager and deputy are transferring infornmation from an old care plan format into a new booklet so that all care needs an risk assessments are recorded an evience the care support provided”. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 14 The care plan booklets for the two most recently admitted residents were looked at.These residents had been admitted to Mayfield on 16th April 2008 and 28th May 2008. These residents did not have an old care plan so the new format was being used for them. The booklet is very clear about what should be recorded. The two care plans looked at did not identify the care needs of the residents, how staff supported them or how if risks were identified were managed. It was not clear what care and support these residnets were having. So it wasn’t possible to check if they were receiving the care and support they need. When we looked at other records it was also not possible to check for example if residents were being weighed regularly or when they had a bath or shower. The records looked at recorded showed that for some residents they only had a bath every month. As we know the records keeping needs to be improved we cannot say with any certainty how often residents receive a bath or shower. The owners have bought some new weighing scales so residents can sit down to be weighed. We were told by staff that the previous scales weren’t fit for purpose as some residents couldn’t stand up unaided so they could not in the past be weighed properly. Some residents were being weighed every time they had a bath or shower which for some was weekly. However, this seemed to be a routine rather being based on what residents need. One resident was recorded as losing weight on the weight records. There wasn’t a record of what or if anything had been done about this. This is because there was no information about this resident on a care plan. We were asked if we would look at a couple more care plans that had been fully completed. This we did. They required further information to ensure that they were personalised. For example, a persons preferred time to rising and retiring should be recorded and, where a residents’ needs and/or prefers support, records should reflect the residents’ personal preferences for how that support should be provided. This would ensure that staff have a consistent approach, whilst at the same time making sure residents are receiving support services how they would wish and receive care appropriate to them as an individual. The expert by experience told us “ All the residents I spoke to are very happy with the home and felt that they were well cared for. The appearance of all the residents was clean and tidy and all were well groomed. Those I spoke to said that all their needs were being met”. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 15 One staff member said, “The residents are looked after very well. They are free to go any where around the house or in the garden. They have plenty of meals, cups of tea, drinks, activities, church on Sunday. Relative and friends can visit anytime there are always welcome”. Another member of staff said, “We give good care welcoming all service users, ensuring they are happy and settled also ensuring all their needs are met”. On our arrival at Mayfield in the morning there were no residents in the dining room. We were told that residents all preferred to have breakfast in their room except a couple that “ made a mess in their bedroom”. This detail or request was not recorded on the care files examined. We understand that some residents may prefer to have breakfast in their bedrooms as for some it may mean not having to hurry to get dressed before coming downstairs or they may need time to come round. It is of surprise that all residents choose to do this. We feel that residents have been encouraged to take meals in their bedrooms by staff or by staff practice and choice. One resident said they never had their breakfast in their bedroom before they came to stay at Mayfield but “this is what we do”. We feel that the arrangements for where residents have their meals needs to be reviewed and residents’ needs and preferences taken into account. We have been told that some residents enjoy the social occasion of having a meal together and a chat with other residents at mealtimes. We were also told that all the residents like to have their teatime meal in the lounge as opposed to in the dining room. Again, we are not convinced that this is not a routine of the staff, rather than residents. We were told that, “6.30am for breakfast is a bit early”. We asked staff what time residents had breakfast and we were told that for some who get up early they would have their breakfast possibly at 6.30am.We spoke to one resident who said they were an early riser and got up about 5.45am and had breakfast shortly after 6.00am. The resident said they had a cup of tea with breakfast but waited until about 10.00am for the next drink, which she had in the lounge with other residents. When we read some residents’ records, it could not be confirmed accurately what support they had actually received and/or how often they had received additional support throughout the day to make them comfortable. All residents were receiving two hourly checks throughout the night. It was not clear what staff were looking for, or how they assisted people during the night. There was no detail in the care plan of residents night-time care needs. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 16 Independence and increased life skills should be promoted within a risk management framework. The two care files looked at on this visit did not include up to date risk assessments. There should be documentary evidence that risk assessments had been updated to ensure that the staff team manage newly identified risks appropriately. Daily records should also be individualised to reflect the day-to-day routines of residents and recognise their achievements. Such statements as “no problems”, “slept well”, “pleasant afternoon” and “good lunch” fail to tell the reader sufficient details. Times of rising should be included and the kind of support given should be noted, for example, they should reflect if the resident made their own choice in choosing clothes, supported themselves in washing and received a drink whilst preparing to get dressed. Such personal details indicate how a resident is being individually supported and demonstrates how the staff are meeting the needs of residents and to what standard. We were told by one member of staff, “ residents come first here not just saying that to impress they really do come first”. During one mealtime, it was observed that a resident required support to eat their meal. The resident was asleep at the table. The resident was not spoken to and a spoonful of food was presented to their mouth, which startled them and awoke them from their sleep. The resident was then asked if they wanted their lunch. The staff member stood next to the resident feeding them their meal. No conversation was made with the resident and the staff member continually left the resident to attend to other things. On her return to continue feeding the resident with their meal the resident had returned to sleep. This is not the way residents should be supported in their feeding. All meals were served to all residents in a bowl. We accept that some residents would be able to manage their meal better in a bowl rather than on a plate. The Expert by Experience’ and the Inspectors meal was presented in this way. Some appeared to have difficulty eating there baked potato out of a sweet bowl. The manager needs to make sure that residents are supported at meal times with dignity, and the provision of their meal on a plate, bowl, adapted crockery should be in line with their assessed needs. The medication administration records are printed by the pharmacist detailing the prescribed medication and when and how the medication should be given. The pharmacist provides these monthly. Examination of the medication records identified that there were signatures in place to demonstrate that medication had been administered to residents. There was some medication, which were printed on the medication records, which were not recorded as been administered to the resident. We were told that the residents no longer needed this medication. The records did not indicate this. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 17 Some residents are prescribed controlled drugs medication. The manager has obtained a controlled drugs book. There were no entries within this book. We were told that that some types of controlled drug medication do not have to be entered in the controlled drugs book. But that it sufficient to double sign in the medication administration records. Not all controlled drugs were double signed in the medication records examined. Temazepam doesnt have to be in register, but is recommended as it does need to be in CD cupboard and does need to be witnessed. Another type of controlled drug medication that was recorded in the returned drugs book when it was sent back to the pharmacy was not detailed in the controlled drugs book. It is a legal requirement to document controlled drugs in a controlled drugs book. The storage of controlled drugs needs to be changed, as there is new legislation in place, which indicates the changes in storage requirements. The manager needs to contact their pharmacist for advice, or make sure they ask for a CD cupboard that is compliant with current law (Misuse of Drugs (Safe Custody) Regulations 1973. In the 2007 Amendment includes care homes. A medication that needs to be refrigerated was stored in a domestic type fridge in the kitchen. Its not recommended that foodstuffs and medicines are kept in same fridge together. To restrict access/reduce risk of accidental loss medication should still really be in a lockable container in the domestic fridge. If the manager was regularly holding items that need refrigeration e.g. Insulin then the manager should really have a dedicated medicines fridge. Some instructions on the medication administration records detailed medication to be administered “as directed”. This is not sufficient and needs to be referred back to the doctor for clear instruction how often this medication should be given. This practice safeguards residents and makes sure they receive medication as prescribed by the doctor. We observed part of the medication administration in the morning of the visit. The person administering medication was seen to handle medication and give to a resident. No hand washing was seen to take place before or after this administration. This practice is not good. We were told that staff who administer medication have received training on how to do this. There were records to confirm some staffs’ attendance to medication training quite recently. The home does not have a system in place to evaluate staff practice when administering medication to ensure they are confirmed as continuing to be competent to administer medication. Best practice would be to indicate in the medication records the usual initials of staff who administer medication. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 18 Some medication has limited shelf life and the date the medication is opened needs to be written on it to make sure it is safe. Two such medications did not have the date they were opened, so it could not be confirmed if the medicine was still in date. Three residents were indicated in the medication records to be able to administer some of their medication without the support of staff. To make sure they are safe to do this and to check on occasions if they are able to continue with this the manager should do a risk assessment. We were told that there were no risk assessments in place and that this had been identified as needed and would be completed on return by the manager from holiday. The two residents bedrooms were visited and we were told that the residents had lockable drawer to keep their medication. One of the residents said they had a lockable drawer but didn’t know where the key was. There medication was left on the table in their bedroom. The owner told us that some new lockable furniture had been purchased. We were told that for one of these residents they no longer administered their own medication. This medication was indicated as being administered by the resident on the medication records and did not include any signatures of staff, which should be made on administration. The records looked at were from 14th July 2008 up to 8th August 2008. This information does not evidence if the medication was administered. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The provision of daily activities would add to residents’ stimulation and leads to greater physical, emotional and social well being. EVIDENCE: We were told by the expert by experience that, “Speaking to the residents there was not much mention of activities. They had bingo from time to time and a singer came in now and again to entertain them but very little else. They never had trips out and no mention of the local community becoming involved with the home. I had in mind the local schools that in other areas often came in to entertain the residents. Even showing an old film on a regular basis would have least broke up the routine somewhat. Also there was no evidence of friends and family being involved in the form of a committee to voice their concerns and suggestions to the management. The inspector and I spoke to the owner about my report. Regarding activities he was going to approach the local school to see if they would like to come along and entertain the residents. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 20 Relatives and friends of the residents had held an inaugural meeting to form a committee and he hoped it would develop”. We looked at the records that are kept to record what activities residents take part in. We were told that a member of the staff team had been appointed to the role of activities coordinator but had recently left employment at Mayfield. Some residents were recorded as having taken part in bingo, quizzes, painting and drawing and having manicures. There was no indication in the daily reports how the activities had impacted on the lives of residents and whether it was something they liked doing. There is available in the care records a section that should be completed by staff about residents past or present hobbies and interests but this was not always completed. There was no information about what activities were planned for each day. In order to ensure that activities can be tailored to suit the needs of individuals, social assessments should be in place that identifies past, hobbies and interests, preferences then and now, remaining abilities and skills. We were told by staff, “The residents are well look after. They have got activities, freedom of the house. Any time can go to bedrooms. Have got a lot of meal, tea and biscuits. When is nice weather, they can use the garden”. The AQAA indicated, “Many of our residents are able bodied and capable of attending outside activities such as shopping or shows. We want to encourage these activities by having staff take responsibility on a daily basis”. We asked to see the menus that are in place for the meals. We were told that there was a three week menu and this had been changed recently as previously it was only two weekly. The menu includes the lunch and teatime meal available to residents. We were told that residents could have a cooked breakfast if they wanted one, this was not indicated on the menus seen and no residents had taken up this offer. An option of a cooked breakfast would further enhance residents’ choice at meal times. On further talks with the residents the expert by experience reported, “they did not have cooked breakfast made available to them. I know that people do not always want a cooked breakfast but on occasion I am sure it would be welcome at least say on a Sunday morning”. On the teatime menu fifteen days out of the twenty-one indicated that it was sandwiches and crisps for tea. There were no choice available and no variation to the menu on these days. The expert by experience said, “Both in the dining room and other areas I saw no evidence of fresh fruit being available and when I mentioned this to a couple of the residents they said that there family brought them fruit in. The Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 21 owner said he had put fresh fruit out from time to time but due to the illness of some of the residents it was sometimes half eaten and put back in the bowl. I suggested that some home’s cut up fresh fruit and pass it around in the lounge area from time to time”. A complete record is not maintained of the food served to residents, so a judgement cannot be made as to what individual residents eat each day. This record may also support the care plan and the progress of residents, as it could be used to take into account if, for example, someone was loosing or gaining weight. A recommendation to maintain a record of food served to residents in such detail that anyone examining the record could judge whether the individual diet is sufficient is made in this report. The expert by experience said in their report to the Commission, “I asked could I have a meal with the residents, which I would pay for, payment was declined but the meal I had was very nice and well cooked and presented”. On arrival at Mayfield three residents bedrooms doors were seen to be wedged open as was the lounge doors and other doors in the home. These doors are fire doors and as such should be closed as to safeguard residents and staff. In an emergency situation keeping doors wedged open with a wedge or by furniture could compromise residents and staffs safety. In addition these doors were open when residents were in bed sleeping which does not promote their privacy and dignity. Some bedroom doors were seen to be wedged open when vacated by residents. This practice doesn’t not respect the residents’ personal space or their possessions. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Written complaints procedures ensure residents or their representatives have a means to raise views about the service they receive. Mayfield have policies, procedures and systems in place to protect residents from neglect and/or abuse. EVIDENCE: We were told that residents or their families are able to identify any comments or complaints as they happen. A record is made of the comments raised. This is beneficial to the managers to demonstrate that they take on board all comments and compliments and it also helps them to see at a glance if there are any patterns to the comments that might need further investigation or changes to practice or routines. Records are kept of any comments or complaint received and detail what was done to investigate the complaint was also recorded. The owners and manager use the complaints procedure as a development tool to see how they can improve or develop the service provided at Mayfield. The AQAA indicated, “A new complaints book has been started and discussed with staff. As owners, we expect all complaints, however trivial, to be recorded Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 23 so that we can assess how they have been dealt with. This process is still ongoing as there is not a culture of recording complaints. As owners we have stressed that it is important to deal with matters openly and quickly. We believe that the quality of the home depends to a large extent on how we deal with issues and complaints. Residents’ and family meetings have been set up. This provides residents with a further opportunity to comment on the quality of the service provided. Since the registration of the new owners CSCI have not received any complaints about Mayfield. We asked in comment cards if staff knew what to do if a service user/friend/relative has concerns about the home. All staff who completed a comment card responded, “yes”. With a member of staff adding, “If I have any problems any time I have got to the manager”. Another staff member said, “If they have concerns they will go to the manager to discuss their issues”. We were also informed in the AQAA that, “All care staff are POVA trained and are fully aware of adult protection issues which safeguards the residents from abuse. POVA training was carried out in April and May 2008 for all staff who had not received training before”. Staff have this training to ensure they are able to recognise potential abuse and know what to do if abuse is alleged. Staff spoken with on this visit were aware of what constitutes abuse and what to do if abuse is alleged. Staff spoken to were also aware of the whistle blowing policy. It was suggested that to support the managers’ development that she attend the POVA training for managers, which the local authority provides. This is to ensure that the local authority procedures are known and are followed. We were told that a copy of Trafford’s All Agency Safeguarding Adults Policy and Procedure was available at Mayfield. The manager needs to be familiar with the procedures so that she can respond quickly and efficiently, as required by the local safeguarding adults policy to any suspicions or allegations of abuse. The owner had made contact with the local authority in relation to safeguarding. The policies did not appear to have been followed as indicated within the procedures. This was ongoing with the local authority at the time of the inspection. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 &26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Recent investment has significantly improved the appearance of this home. The improvements, repair and upgrade of the home over the last months go some way to promote the comfort and respect of residents. The planned refurbishment will further enhance the comfort residents should have. EVIDENCE: We were told that since the new owners bought Mayfield in February 2008 they have made some changes to the environment. The AQAA indicated that, “Several bedrooms have been re-decorated as they become vacant”. These are bedrooms 1,4,and 14.These bedrooms have also benefited from having new carpets fitted. Bedroom 6 has had new floor covering installed, which we were told was non-slip flooring. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 25 We were also told and observed that access to the first floor has been improved by removing an internal wall and extending the staircase so that the floor is now level. The chairlift now goes all the way to the top level. A new wet shower room has been installed in the basement. This has now become the bathroom of choice for many residents and the owners are considering installing the same bathroom on the ground floor. The laundry area has been improved by installing a new work surface and purchasing laundry bags that are used to bring soiled and dirty laundry from bedrooms to the laundry area. “New gardeners have been hired and significant improvements made to the lawn and flowerbeds. We have also removed and cut back several trees to improve access down the driveway and to allow more light into the home”. We were also told in the AQAA that, “The previous handyman was retired and a more professional property maintenance service has been used to complete works as necessary”. We were told of additional plans over future months to further improve and enhance the appearance of the house and make more comfortable for residents. Due to the refurbishment described the carpets in the hallways are ill fitting and will be replaced we were told when the major work has been concluded. Staff and residnets need to be careful in certain parts of the house as the carpets could be tripping hazards. The expert by experience told us that, “The lounge was well carpeted and comfortable and I also visited 2 bedrooms along with the occupiers and both bedrooms were clean and tidy and reasonably spacious. At the moment there is a lot of refurbishment work going on in the home which includes laying new carpeting on the stairs and landing also 2 other bedrooms that I visited had no occupants but the rooms had recently been modernised and they were of very high quality, one of them was a double bedroom. However the dining room was in a poor condition, carpets were well worn and at one part were lifted from the floor and were a hazard to anyone using the room. Where I sat the radiator was full on and I almost burnt my arm on it. Tablecloths, which are fairly cheap, would have helped the room to be more inviting. Also there was a lot of what appeared to be office files and stationery in one corner, which did not help with the décor. The inspector and I spoke to the owner about my report. He agreed about my criticisms of the dining area and only that morning he had the plumber in to sort out the radiator”. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 26 A requirement has been made on past inspections to remove the star locks from bedroom doors, as these types of locks posed a potential risk to the welfare and privacy of residents. We were told that the new owners have removed all these star locks and appropriate locks have been fitted to bedroom doors. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 &30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The registered manager has not ensured that robust recruitment and selection procedures have been followed for all staff which means that she cannot be sure that the staff she has recruited are suitable to work at the home. EVIDENCE: Several staff had worked for many years in the home, with the continuity of care benefiting the people living there. Some new staff have been appointed to care positions in the last 6 months. The home completed its own induction, which appeared to be of a good standard. We were told it was to Skills for Care specification, which supports continuing professional development; including helping prepare workers for entry onto the appropriate Health and Social Care National Vocational Qualification (NVQ). Examination of one induction file for a newly appointed staff identified that the induction had not been signed or verified by the manager, as we were told it should be. The induction appeared not to have had any management support as the record was not signed as such but completed solely by the staff member. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 28 All completed staff comment cards responded yes to the question are you given training which is relevant to your role, helps you understand and meet the needs of service users and keeps you up top date with new ways of working. One staff added, “Always I can ask somebody, how to do it”. Another staff member added, “There is always someone to help you”. We looked at the staff duty roster and it detailed the names of staff on duty and their role. However it was apparent from observations that some staff were doing different roles for example one member of staff was the cook and the carer whilst on shift. There was no dedicated cleaning staff employed at Mayfield. We were told that one of the staff carries out cleaning and caring when on duty. We were also told that this wasn’t the case and all care staff undertake the cleaning of the house and no specific or dedicated cleaning staff are employed. This means that staff are taken away from their role as carers to undertake cleaning of the house. Examination of the duty roster identified that the manager and deputy work predominantly the same days with both having the same day off work each week. This means there are times when there are no senior staff on duty. This was identified and reported on during the last inspection in August 2007 prior to the new ownership. We were told, “Usually there is enough staff on but when people go on holidays other have to cover”. We were told, “We are actively recruiting for a senior, 2 carers and a part-time cook. Our goal is to develop a full staff complement that is well trained, well qualified and prepared to work with management to develop and implement best practises”. The expert by experience said, “The staff was very nice and appeared to work well with both the residents and each other. Some of the staff had been at the home for years whereas other had only recently joined the home”. The recruitment and selection procedures are not sufficient to safeguard staff with new staff starting work without the necessary checks in place and working alone before vital checks have been returned. This practice compromises the safety of residents and staff. Training has been provided to staff that should support staff to provide care and support in line with best practice and up to date routines and regulations. A record is maintained of all the training, which makes it easier to arrange for staff to receive updates when they are due and make sure everyone has had the necessary training. When all staff have received this training this should make a difference to how things are done at Mayfield. Staff said they had Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 29 received a lot of training in the last six months, which has helped them to their job. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 30 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36 &38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The owner has a good understanding of the areas in which they need to improve. Planning was in place and sets out how this improvement was going to be resourced and managed. EVIDENCE: Since the new ownership of Mayfield the manager has been successful in obtaining registration with the Commission for Social Care Inspection. This means that she has attended a fit person interview with the registration team at CSCI and has satisfied them that she has the skills and qualifications to be Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 31 registered. The registration team said the manager is currently undertaking the Registered Managers’ Award and expects to complete this by October 2008. The manager and deputy appear to have the same days off as each other every week. At times there is no senior staff member on duty. The owners do attend the home regularly. A quality assurance system is in place that seeks and acts upon the opinions of residents in terms of their day-to-day experiences and improvements that could be made. The owner has compiled a summary report of the findings of the recent questionnaire survey to residents, which includes the findings to accompany the home’s statement of purpose to evidence this consultation process. There is a keypad on the front door for which a code is needed to leave the house. To safeguard residents and staff, the owners need to consult with the fire authority to check that this is appropriate as, in an emergency situation, the code to the door will need to be known to enable people to leave from this exit. Accident records were available and monitoring of accidents had been undertaken. To protect the privacy of residents the collation of these records needs to be changed. All incidents affecting the health and wellbeing of residents should be routinely reported to the Commission. This is being undertaken as required by the regulations. To ensure the Commission is aware of these events the manager needs to arrange for this information to be sent to us routinely. We asked to see the fire records. These records should demonstrate that the fire safety procedures are followed and the necessary checks are undertaken to safeguard residents and comply with fire safety legislation. When we looked at these records a number of the entries of checks being done had been crossed out. When we asked what this meant we were told by the manager that the checks had been done but crossed out. It could not be confirmed if or when these weekly checks had been undertaken. The records kept for the purpose of regulation must be maintained accurately. Changing records could potentially put residents at risk and also compromise the integrity of the manager. Not all staff were recorded as having taken part in fire drill practice training. It is essential that staff know what to do in an emergency situation. Failure to be unaware of these procedures could compromise the health and safety of residents. Staff need to sign next to their printed name to confirm they have undertaken this training. Two staff told us they had not taken part in fire drill training. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 32 We looked at the records, which are kept to detail residents purchases. We saw that residents were paying for continence products as opposed to having these provided free of charge from the health service. The owner said he would look into this matter. Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 33 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? New service 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 Requirement To ensure that residents receive the care and support they need make sure that all have a care plan in place which details this care and support. For the protection of vulnerable residents, robust recruitment and selection procedures must be followed at all times. To safeguard residents and staff fire doors within the home must not be wedged open To safeguard residents and staff, fire safety checks must be carried out and recorded as such at the regularity prescribed by the fire authority. To make sure staff know what to do in an emergency situation ensure that staff on their next duty take part in a fire drill training practice and sign to say they have received this training Timescale for action 06/09/08 2 OP29 8,19 & Schedule 2 23 23 30/08/08 4 5 OP38 OP38 30/08/08 30/08/08 6 OP38 23 30/08/08 Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 OP7 OP9 OP9 Good Practice Recommendations Daily care plans should be in sufficient detail to identify care support and the service users’ routines and achievements. Ensure that risk assessments are in place for all residents that are up to date and reflect the needs and support of the individual. To promote best practice, staff that are trained and are competent to administer medication should detail their initials, which should accompany the medication records. Refer back all medication, which is indicated on the medication records “use as directed” to the residents doctor for clear instruction on how often this medication is administered. This needs to be printed on the medication administration records routinely. Obtain a CD cupboard that is compliant with current law (Misuse of Drugs (Safe Custody) Regulations 1973. Introduce a system to evaluate staff practice when administering medication to ensure they are confirmed as continuing to be competent to administer medication. Temazepam is not a controlled drug, however good practice with this drug is that it is recorded as such and is stored in the Controlled drugs cupboard. To promote residents safety, privacy and respect for private space cease the routine and practice of staff wedging open residents bedroom doors or if this is a preference of the resident, ensure that such practice is undertaken in a safe manner, in consultation with the local fire service. In order to ensure that activities can be tailored to suit the needs of individuals, social assessments should be in place that identifies past, hobbies and interests, preferences then and now, remaining abilities and skills. Review the arrangements for residents having their meals ensuring that they have their meals where they want and are not influenced by staff routines to have meals somewhere else. Maintain a record of food served to residents in such detail DS0000071340.V368983.R01.S.doc Version 5.2 Page 36 5 6 OP9 OP9 7 8 OP9 OP10 9 OP12 10 OP15 11 OP15 Mayfield Care Home 12 OP15 13 OP27 14 OP31 that anyone examining the record could judge whether the individual diet is sufficient. Ensure that there are menus in place so residents receive varied and their preferred meals at mealtimes and that resident are aware of the planned meals. To further promote choice of meals to residents, routinely provide the option of a cooked breakfast throughout each week. Ensure that there are sufficient numbers of senior, care and domestic staff employed at Mayfield at the right time to maintain and enhance the care of residents. There needs to be a better system of identifying who is on cleaning duty and who is on caring duty so that the provision of care to the residents is not diluted, but also that the manager can be confident that the cleanliness of the home is not reduced. The manager must ensure that she keeps the CSCI informed of any event within the home, which affects the wellbeing of residents. The manager needs to attend training specific for managers in relation to adult protection procedures and protocol to make sure if there is an allegation of abuse made the procedures are known and are followed to promote the safety of residents. All records maintained for the purpose of regulation must be maintained accurately and not changed to suit the circumstances. To ensure that the safety of residents, staff and visitors is not compromised in an emergency situation by the placement of a keypad on the back door, the manager needs to consult with the fire authority to check that this practice satisfies fire regulations. To protect the privacy of residents the accident book must be used correctly in accordance with the Data Protection legislation. 15 16 OP31 OP38 17 OP38 Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: 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 © 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 Mayfield Care Home DS0000071340.V368983.R01.S.doc Version 5.2 Page 38 - 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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