CARE HOMES FOR OLDER PEOPLE
Mayfield Hall 22 Bitton Park Road Teignmouth Devon TQ14 9BX Lead Inspector
Judy Cooper Unannounced Inspection 9:50 9 November 2006
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 Hall DS0000067329.V307012.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 Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Mayfield Hall Address 22 Bitton Park Road Teignmouth Devon TQ14 9BX 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) 01626 772796 Amethyst Care Ltd Mrs Elaine Tanya Sampson Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 20/02/06 Brief Description of the Service: Mayfield Hall is situated off a main road close to the town centre of Teignmouth, and some of the upstairs bedrooms enjoy good views of the Teign Estuary. The home is registered to offer accommodation to male and female residents from the age of sixty-five years with or without dementia. There are eighteen single bedrooms and one double bedroom. All of the bedrooms, except three, have an ensuite facility, which includes a toilet and a bath or a shower unit. There are also three communal toilets throughout the home, with a communal bathroom on the first floor, which has an assisted bathing aid provided. Easy accessibility between the ground and first floor is provided by a passenger lift and there is also the provision of two small chair lifts to further aid accessibility where there are a few additional steps to negotiate to some rooms within the home. There is a large communal lounge, dining area and a pleasant sun lounge. The home has adequate security in place in relation to the client group accommodated. A safe, secure patio area is also available for residents to enjoy and there is a small amount of parking facilities for visitors. The current weekly charge ranges between £306 and £363. The ownership of the home recently changed (June 2006). The new owners will make this, their first inspection report, available within the home’s communal hallway, when received. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This site visit took place on Thursday 9th November between 9.50.m and 3.30 p.m. Opportunity was taken to observe the general overall care given to current residents. The care provided for three residents was also followed in specific detail, from the time they were admitted to the home, which involved checking that all elements of their identified care needs were being met appropriately. A tour the premises, examination of some records and policies, discussions with the new owners, residents (who were able to converse) and staff on duty, as well as three visitors to the home, also formed part of this inspection, whilst staff on duty were observed, in the course of undertaking their daily duties with the residents. Other information about the home, including the receipt of two questionnaires from staff, three from visiting professionals and three from relatives/visitors to the home, has provided further feedback as to how the home performs, and this collated information has been used in the writing of this report. All required core standards were inspected during the course of this inspection. What the service does well:
The new owners have established an “open door” policy, which allow residents, staff and residents’ families/carers the opportunity to be able to speak openly and easily, which helps all concerned, deliver the appropriate care. A relaxed, family atmosphere operates within the home, for which the new owners should be commended. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 6 The new owners and staff are providing very individual care for the residents, some of whom are unable to communicate their needs. The owners are aware of this and try to ensure that the care provided matches the residents’ needs and personal preferences as far as they are able to ascertain. The owners are very much involved in the running of the home, including providing personal care to residents. This has ensured they are both aware of the residents’ needs and therefore aware of how the staff can best meet these needs. The new owners and the staff try to ensure that the residents’ dignity and their rights to make personal choices is upheld and verbal feedback from the relatives of two newly placed residents indicated that they have been successful in this. Due to the category of the resident group that are cared for at Mayfield Hall (i.e. many residents suffer from advanced dementia), it means that carers need to take time and use good observational skills to determine what a resident may be trying to communicate. This skill was noted as being an integral part of the new owners role within the home, whilst existing staff also presented as very caring and concerned for the overall welfare of the residents. It is to the new owners’ credit that previously identified shortfalls, which resulted in several previous requirements being issued, have now been met. Further outstanding shortfalls, which have been identified, are included in the owners action plan to ensure they are met within realistic timescales. What has improved since the last inspection?
The home’s environment has been upgraded to ensure that the accommodation meets the required standards and provides a comfortable and safe environment for the residents living at Mayfield Hall.
Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 7 This has included redecoration of several areas throughout the home including the communal areas and several bedrooms, the replacement of some carpet including the home’s lounge carpet. The home’s medication supply has been resited to a secure storage area on the first floor of the home. Five hospital beds have been purchased which have an easy rise and lower facility, which enables those residents with poor mobility to be able to get in and out of bed more easily. Additional pressure relieving equipment has also been provided. All bedrooms have been clearly named and there is now good use made of pictorial signs to aid those residents that find the written word more difficult to understand. The home’s dining room has been upgraded with the provision of new tablecloths. A new bath hoist has been provided in the first floor bathroom to aid mobility and it is intended a complete new bathing unit, with an assisted lifting facility incorporated into it, is to be provided within the near future. A new shower unit has been provided, within room fourteen, as the previous one was not functioning properly and therefore was not of benefit to the resident in the room. New smart staff uniforms have been provided incorporating the new owners colours of lilac on the tunic top. The new owners have also dealt with other small, yet important issues. Examples of this include the way additional screening has been provided around the communal toilet on the ground floor, sited near the home’s entrance. This has enhanced residents’ privacy and aids staff when helping residents open and close the toilet door. There is a visitors’ book easily available and the home’s statement of purpose and service user guide are prominently displayed in a laminate form to ensure that they remain in good condition. Additional fire notices have been provided throughout the home to ensure staff, visitors and residents are fully aware of the home’s fire precautions and what to do in the event of a fire. Two additional fire extinguishers have also been purchased. Anti bacterial hand gel has been provided within the home’s communal hallway to help prevent the risk of cross infection within the home. Soap dispensers and hand towel dispensers have also been provided in five bedrooms with others to be provided as soon as possible. All showers (bar one) have now been restored to working condition, with the one that is still not operational to be addressed as soon as possible. A new ramp has been provided to the one step that accesses the hallway and the ground floor bedrooms to aid those with mobility problems. A new linen trolley has been provided to aid staff when changing residents’ beds. A new kitchen trolley has also been purchased to allow puddings and afternoon tea etc to be served more easily to the residents. Other kitchen equipment provided includes a new fridge. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 8 New bedding, new towels and face cloths have been provided to ensure residents beds present well and that towels are fresh. Each resident is provided with at least two face cloths, which are changed daily to ensure that there is always a clean one available. The owners have installed an air freshener system throughout the home, which has resulted in a very pleasant smell throughout the home. Pictorial notice boards have been provided within the home’s communal lounge showing the day of the week, weather conditions etc. Menus are now also displayed in the same area. The home’s security has been further enhanced with the exterior door of the home now having being provided with a safe lock. The exterior area of the home has also been upgraded with the owners cutting back hedges and overgrowth to ensure that residents have a pleasant outdoor area to enjoy, when under staff or relative supervision. Locks to a few bedroom doors that were not of a suitable kind have been removed to ensure residents’ safety. Individual baskets have been provided for residents’ laundry once it has been laundered. A system for easy identification of laundered items has also been introduced to aid staff to ensure that laundered items are returned to the correct resident. Closer working links have been created with the local Social Services and specialist Mental Health teams who have been asked for their advice and specialist knowledge regarding the running of the service. This has helped ensure that the care and facilities being provided are as residents require. The owners have audited and reviewed the home’s documentation and the recording of care given and are in the process of enhancing these by introducing more concise and informative systems. This will allow all information to be more easily recorded in a clear and accessible manner, which will allow staff to have a better understanding of each resident’s care needs and therefore further ensure residents receive quality care. A flexible approach as to how residents wish to spend their time has been adopted. Residents can choose such things as what time they get up, where they have breakfast i.e. in the dining room or in their own bedroom, what they want to eat etc. New and varied activities are gradually being introduced into the home, which is allowing residents to have varied lifestyle. New menus, incorporating nutritious ingredients including fresh vegetables and fruit, have been introduced along with increased choice at all mealtimes. The owners have introduced a staff training programme, which is ensuring that all staff receive both basic and nationally recognised training in care and other statutory associated areas.
Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 9 This has already had the effect of giving staff a greater confidence and awareness of the care they deliver and the residents are benefiting from being cared for by a more skilled staff group. What they could do better:
The owners should formalise the information received during the preassessment process to ensure that all the care needs a prospective resident may have are fully documented and available for staff to be able to know what care will be needed on admission. All care given should be recorded including monthly weight checks. This is to ensure that any changes are noted as soon as possible to allow remedial action to be taken as required. The new owners should always liaise with the District Nurse services over any nursing care a resident may need. This is to ensure that the District Nurse services remains aware and involved and that their advice is subsequently followed within the home. There should be suitable storage provided for any medication that requires storage within a cold (fridge) environment. This is to ensure that residents’ medication is at all times protected, administered at the correct temperature and kept free from the risk of contamination when stored in an in a communal domestic fridge. Any form of restraint used (i.e. use of cot sides) must be risk assessed by the home’s management staff, with advice sought from outside professionals, as well as agreement obtained from the resident and/or their family/advocate as to the use of such restraint, These details must be kept in the individual resident’s file at all times. The owners should continue with their identified plan to upgrade the home and thereby continue to provide a good standard of accommodation throughout for all residents. The owners must make arrangements to ensure that the home’s hot water temperature is regulated to a safe temperature (approximately 43degrees Centigrade) where residents have access to the hot water i.e. wash hand basins within residents’ rooms, en-suite showers and baths and communal bathrooms and toilets with sinks. This is to ensure residents will be protected against the risk of sustaining a scald.
Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 10 All window restrictors should be checked to ensure that they conform to the recommended guidelines on the size of openings. This is to ensure that residents are protected from the risk of falling from an open window. The new owners should ensure that the five wall mounted electric heaters, situated within five of the en-suite facilities, conform to the necessary health and safety standards and therefore do not pose any unnecessary risk to the residents. The new owners should ensure that the key pad security system, sited at the front door, complies with the requirements of the fire authority regarding the safe evacuation of the home. The owners should continue with their plans to make nationally recognised staff training available to allow the home to achieve its target of having fifty percent of the staff working at the home to be trained to the required level. All records, maintained in relation to residents, should comply with the Data protection Act 1998 including accident reporting. This is to ensure that residents’ rights to confidentiality are not compromised. A review of the homes past policies and procedures, which were in use with the previous owner, should be undertaken to ensure they are compatible with the new owners way of working/managing the home. A review of the home’s banking systems should be undertaken to ensure that any monies looked after by the home’s owners is undertaken in such a manner that ensures residents receive interest on any monies held. 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 Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 11 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 Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 12 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): Standard 3. Quality in this outcome area is good. The admission process is managed appropriately and new residents and/or their advocates are given clear information regarding the service so that they, and/or their relatives/advocate, can make an informed decision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The new owners have improved the admission process since taking over ownership. They have admitted some new residents and it was noted that the admission process had been thorough, to ensure that residents were placed appropriately at the home. Currently the owners are using existing pre-admission assessment documentation. Discussion took place about expanding and formalising the pre-admission processes further. This would then ensure that all care details are fully
Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 13 recorded in detail so that all staff are aware of the specific needs of the new residents. Two of the new residents were talked with/observed during the inspection, and both had visiting relatives who were also talked with. In both cases confirmation was given that the admission process had been such that the relatives knew the home would provide the required care and the subsequent care given did meet the residents’ needs. The prospective residents and/or their families had been given access to necessary information including the home’s statement of purpose and in both cases it was the family members involved that made the decision to admit their relative. The owners obtained all necessary information prior to the admission from both the family members and, in one case, from a care manager to allow them to be aware of the resident’s needs. The two family members for the residents also confirmed this. The admission process for a previously admitted resident was also discussed, however many care records and contracts for residents admitted prior to the owners taking over the home, including the information for this resident, were not available when the owners took over the home. The new owners, however, are in the process of compiling their own home’s contract, which they will then issue to all residents. The home does not provide an intermediate care service. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 14 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): Standards 7,8,9,10. Quality in this outcome area is good. All residents are looked after well in respect of their health and personal care needs. Residents’ privacy and dignity is upheld and their life style choices respected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans inspected related to the residents whose admission procedure was previously inspected. The care plans were relatively detailed and contained all relevant information appertaining to providing for the individual residents care. This included any medical needs of the resident, as well as any visits made by District Nurses, G.P’s or any other health professionals, such as a specialist nurse who is involved with a resident who has Parkinson’s disease. However the owners are currently in the process of researching another type of care plan that may be better suited to the way they wish to record information.
Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 15 It was also pleasing to note that there is to be a relatives’ meeting held on the 18th November when the owners are to discuss care planning and inform relatives/advocates how they can be involved in this process if the resident and/or they wish to be. The home’s accident recording was inspected and although it was noted that the wrong type of book was being used, (several accidents were being recorded on the same page which therefore contravened the requirements of the Data Protection Act 1998), the actual details of the accidents sustained were noted as being thorough. It was also pleasing to note that the owners had audited the accidents that had occurred so far, with a view to looking at patterns etc and what information they could learn and then build on. This is so that they may be better able to prevent accidents and be more aware of what may cause a resident to fall etc. The owners have now undertaken a full review of all residents’ needs and have also involved the care staff by identifying each one as a key worker with responsibility for ensuring a specific residents’ needs are known and met and that small personal tasks are undertaken for them. They have introduced a record book to be completed by each key worker to allow the owners to conduct a weekly audit of what identified tasks the key workers are undertaking with the resident and to ensure the system continues to meet the residents’ needs. There were basic risk assessments in place including one on moving and handling. Appropriate handling and lifting devices were in evidence including a mobile hoist and handling equipment. The owners have provided an assisted bathing facility as well as five height adjustable beds to help lesser mobile residents be able to get in and out of bed more easily. Manual handling training was recently provided to the staff by an outside trainer. All these measures ensure that residents are moved and handled in the most appropriate manner. The owners liaise well with other professionals, as required, including care managers, the community mental health team etc. One very frail resident was being nursed in bed and was noted as being very comfortable, well presented and had the use of pressure relieving equipment. Discussion took place as to the need to ensure that the owners do contact the District Nurse services regarding any nursing care that may be required to ensure that any such care is overseen and agreed by the District Nurse services. A regular chiropodist visits the home. There were daily records kept for each resident, which documented all the care given to each individual resident. These are written by the member of care staff who has had delegated responsibility for providing care for the resident on their working shift. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 16 This ensures the records are written by a carer who has first hand knowledge of what care has been given. Additionally the owners have introduced a general review sheet which gives basic information such as how a resident most often chooses to spend their time, what they like/dislike, what specific needs they have etc. This will now be available for any new staff member so that they can easily familiarise themselves with the residents at the home. Those residents, able to verbally feedback their feelings, were very positive about the care received, saying that they felt well looked after and that the staff treated them well and were very kind to them. Others were noted as being treated by the staff with kindness and due regard for the maintenance of their dignity and rights to individuality. Such evidence that supported this was noting the gentle way that staff spoke to residents, taking into account their individual levels of ability, all residents being nicely dressed, clean and well presented. A community based psychiatric nurse has provided dementia care training over three training periods to all staff within the home. Verbal feedback from a relative stated the following: “I am happy with the care given. The staff are always available. Very caring and very professional. The food is good and plentiful. I can visit freely and speak openly, the owners are very easy to speak to and the staff are all very pleasant. I am very happy that X is here, I am happy with everything”. Medications were well managed and securely stored. The home uses a recognised administration system. Medication records were inspected and seen to be in order. The administration of medication was witnessed during the inspection and was noted as in order. The owners have provided a drugs trolley to transport the medications to where the residents are i.e. bedrooms at night, communal areas during the day and therefore ensure that the medications are given straight from the package. There are pictures of each resident, his or her name as well as their preferred term of address and their date of birth on their medication record. There is also a list of the staff signatories who are responsible for the administration of the medication. There is a medication policy, which was in operation previously. The owners stated they are in the process of revising this to ensure it is in order and appropriate to the way that the medication is now administered. All these measures help protect vulnerable residents and help ensure any risk in the allocation of medication is minimised. Currently the owners are storing eye drops in the home’s communal fridge in the kitchen. This practice should be reviewed to ensure that there is no risk of cross infection and that storage is secure. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 17 The new owners have provided medication training for the staff at the home and from previous communication with the owners over a medication issue it was evident that the owners regard medication training/awareness to be very important. The home’s supplying pharmacist is booked to provide further medication training to staff on the 29th November to all staff who administer medication. This will ensure that residents are further protected in respect of receiving their medications appropriately. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 18 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): Standards 12,13,14,15. Quality in this outcome area is good. Residents are able to enjoy a peaceful, pleasant yet reasonably varied life at the home, with visitors encouraged. Various informal activities are made available with new activities also tried out to help vary residents’ life at the home. Varied, nutritious meals are provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home operates an open visiting policy and the visitor’s book evidenced that the residents continue to have visitors at varying times throughout the day. Two visitors spoken with confirmed that they were able to visit very regularly throughout the week and was always made welcome. Staff undertake activities with residents both individually and as a group on a daily informal basis. This can involve in house activities, which are changed regularly to meet the residents’ needs/desires each day, and, new ones are being introduced.
Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 19 Recently, flower arranging has proved popular as has indoor skittles and a soft darts game. A record is kept of activities made available and the owners are hoping to compile a fuller activities programme as additional staff are recruited. A Christmas party is planned for December and there are notices up to this effect, inviting residents and their friends/families. There is a two weekly musical afternoon and on the day of the inspection it was one of the resident’s birthday. A lovely cake had been homemade and all gathered to sing “Happy Birthday”. There was appropriate music playing in the lounge area and some residents and staff had a few moments of dancing and singing. It was a happy time for all involved. A regular hairdresser visits for those residents that wish to use this service. The atmosphere in the home is friendly and warm and the mentally frail residents were benefiting from this, being noticeably relaxed and calm within the home’s environment and with the staff. Residents continue to be encouraged to express their individuality and to this end choice is made available whenever possible i.e. at mealtimes, when there is a choice of main course and several sweet choices. These are brought round on a sweet trolley so that residents can see them, which then helps then make their choice. The new owners are currently undertaking the cooking and the meal on the day of inspection was very appetising comprising of savoury mince and three fresh vegetables. All residents enjoyed it. Those residents that needed assistance with feeding were given this in the communal dining room in a sensitive and discreet manner. This was also the case when the cake was provided at tea time. There is a menu board displaying what choices are available. The home caters for specific dietary needs including a vegetarian. The routines within the home are very flexible to ensure that residents can choose how they spend their time. During the inspection residents freely went to their rooms, enjoyed the company of others or their visitors. One resident was noted as having been provided with a safe additional heater as she felt the cold. She was quite free to have this on whenever she wanted, although the temperature within the home was very warm and comfortable generally. Another resident stated: I like living here. They are very nice to me. The food is good. I like most people and I have my friends here”. The same resident wanted to show her room as it was: “lovely” She also stated: “My family visit regularly and I go out sometimes”. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 20 Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 21 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): Standards 16,18. The quality in this outcome area is good. Arrangements for protecting residents and responding to their concerns are satisfactory. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaint policy was centrally displayed and is also contained within the home’s statement of purpose. Returned questionnaires received back from two of the three staff members indicated that they were aware of the adult protection procedures operating within the home. Since the return of the questionnaires vulnerable adult training has been provided for all staff in the home by an outside trainer. The owners dealt appropriately with an anonymous complaint, made through the Commission, shortly after taking over ownership and their investigation established that the complaint was unsubstantiated. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 22 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): Standards 19, 26. Quality in this outcome area is adequate. Upgrading of the home’s environment by the new owners has resulted in Mayfield Hall presenting overall as comfortable, clean and well maintained. The home mostly provides a safe standard of accommodation for the residents, however residents safety is being compromised by the home not yet having regulated the hot water supply to the communal bathrooms, individual showers or residents’ hand wash facilities to a safe temperature. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The tour of the home confirmed that the new owners have commenced a major internal upgrading of the home’s environment.
Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 23 Residents’ bedrooms throughout the home were personalised as desired and residents can bring in personal items with them if they wish to. The owner stated that the home would provide a suitable lock if requested/needed by a resident, but they are not provided as standard on admission. The lounge, dining area and sun lounge provide adequate communal space and all are well appointed. The management was maintaining the day-to-day home’s fire precautions in line with the requirements of the local fire department. Fire awareness training was recently provided for staff from an outside trainer and additional fire notices have been provided throughout the home as well as two additional fire extinguishers having also now been provided. These measures evidence that the residents would be protected, as far as possible, in the event of a fire. The home presented, as very clean with no odours present at all, for which all the staff, but especially the domestic member of staff, should be commended for. The home maintains suitable infection control measures, including the provision of suitable protective clothing as required i.e. aprons and gloves and clean overalls when working in the kitchen as well as anti bacterial gel and adequate hand wash facilities for staff within residents’ rooms, all of which protects residents from the spread of any infections. The security of the home and resident safety is maintained by the use of a keypad lock on the main doors and an enclosed patio to ensure the safety of the residents. The new owner was not completely certain whether the key pad lock would be disabled in the event of a fire and was going to seek clarification on this from the fire department. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 24 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): Standards 27,28,29,30. Quality in this outcome area is adequate. Staff at the home are employed in sufficient numbers to meet the residents’ needs however the required complement of trained staff has not yet been reached. The home’s recruitment programme was in order and protects residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection there were eighteen residents in the home and one in hospital. Staffing rotas inspected evidenced that there is sufficient staff on duty to care for the residents at all times and it was noted that staff had sufficient time to spend with the residents. The owners work each day within the home and are always available. Additionally there are always three carers on throughout the day until 9.00p.m when there is one waking night staff and one sleeping in staff member. There are some overseas staff members, all of whom have worked at the home for several years and are very well thought of by the residents and their relatives. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 25 The owners employ a domestic member of staff who stated that, since the new owners took over, she has been allowed to concentrate solely on the cleaning of the home, rather than having to undertake other duties. She felt this was a good move as it allowed her to ensure the cleanliness of the home was always in order. All residents, that were verbally able to, confirmed that all the staff care for them well. One relative stated that when the resident they were visiting had occasion to call for assistance they noted that help was made available very quickly. Training has been provided by the new owners, including moving and handling, vulnerable adult training, fire awareness traing and there are other training sessions planned to include such things as medication awareness training. The owners are also planning to provide training opportunities to allow staff to obtain the recognised qualification in care (NVQ level 2). Although there have been three new staff appointments made, since the owners took over, these staff did not prove to be suitable. This evidences that the owners are keen to get the right skill mix of staff within the home and to create a good working staff team. The owners have since recruited a trainee member of staff (eighteen years of age) who is wishing to undergo training in care. The recruitment process for this member of staff was inspected and was noted to be in order with two written references having been received and a Protection of Vulnerable Adult check obtained whilst the Criminal Record Bureau check is being waited for. The staff member only works under supervision and is also undergoing induction training which meets the General Social Care Council’s code of practice. The owners should be commended for introducing the staff training already given and for planning to ensure that future training will ensure that at least fifty percent of the staff have a recognised qualification in care. Staff on duty were spoken with and it was evident that they took pride in their role and felt that ensuring residents had a good quality of life, irrespective of need or diversity, was the most important part of their role. The home has maintained a fairly stable staff group with regular staff remaining in post during the change of ownership. This has ensured a continuity of care for the residents. It was pleasing to note the positive comments made by the staff in respect of the new owners, which included such statements as: “The new owners are very nice. They are improving the home. Both are very good nurses and easily approachable and understanding. I think the home will now improve tremendously. All the staff are also pulling together to get it back on track”. “The home is now more organised with better care provided and improving standards. Training is provided and I’ve had fire training, POVA training, manual handling and drug training”.
Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 26 “It is better with the new owners. The food is better, more choices, caring is better and other professionals are called if required. Training has been provided. The new owners are approachable”. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 27 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): Quality in this outcome area is adequate. The home is being managed efficiently and well, with both the new owners being easily available and approachable. They both undertake their role professionally and have an awareness of residents’ needs and the staffs’ abilities to meet them. Their leadership is ensuring that the home runs in the best interests of the residents. Some outstanding aspects of health and safety, is compromising residents’ safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two of the new owners have many years experience in caring for elderly clients and are both qualified, level 1 Registered General nurses.
Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 28 One of the owners has just completed a nationally recognised qualification in management (NVQ level 4) and the second owner, who is the home’s registered manager, is to also commence the same training to allow her to achieve the award in the near future. They are improving the overall management of the home by ensuring all practices are carried out in the residents’ best interests. They provide regular supervision to staff which helps enhance the lines of communication within the home, which ensures that staff are now fully supported in the care of mentally frail and vulnerable residents. This was evidenced in the positive comments received from staff members, (see previous section). This management input has begun to see an effectively run home, which ultimately benefits residents and staff. The owners were well respected by staff, residents and their relatives whilst visiting professionals also spoke well of the improvements they have begun to make within the home. Two examples of written feedback received from visiting professionals was: “The two new managers are working hard to create an excellent home for ladies and gentlemen with illnesses of the mind. I am finding them dependable, truthful, and easy to work with. They have taken some difficult clients and looked after them well and relatives have rung me to say that. Managers are always available on the mobile and they cope well with emergencies”. and: “Mayfield Hall appears to be improving rapidly since they have taken over”. Residents, who were able to, and staff spoke highly of the owners ability to help and support them. They felt confident because they felt they both ran the home efficiently and in the best interests of the residents. The owners are in the process of undertaking a full and continuous quality auditing programme on all aspects of the running of the home and it was clear that they were acting on their findings and improving the quality of care within the home. A staff meeting took place on the day of inspection, which the owners used to discuss the key worker system and what the expectations there would be and how residents can benefit from an effective, well run system. A relatives meeting has been planned for the 18th of November to allow the owners to receive feedback etc as to how they feel the home is operating. The owners are aware of the need to respect diversity issues arising from caring for such a vulnerable group or residents. An example of this is that they employ a male carer who works at night and they were both quite clear that, should any female resident, object to care being given by this carer a female carer would be provided instead.
Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 29 Due to the residents’ mental frailties, the owners, supported by the staff, respect and work with differing behaviour issues ensuring all are treated with respect and equally valued. The residents’ families/advocates mostly deal with any financial matter appertaining to the residents. However the owners manage monies for four residents and financial records were seen in respect of these. One of these resident’s monies had mounted up and a discussion took place as to the best way to manage this situation, taking into account the resident’s right to have a individually named bank account to allow monies to be banked and so allow the resident to benefit from any due interest. The home also holds small amounts of monies for other residents and there were adequate records in respect of this, which protects the residents’ financial affairs. Residents’ health and safety is not being fully protected due to the previously identified shortfall of no hot water regulation within the home. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 30 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x x x x 2 Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No. New owners now have met requirements issued to previous owner, since taking over ownership of home in June 2006. This was the first inspection with new owners. 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 13 Requirement Timescale for action 16/12/06 2 OP25 13 Any use of restraint measures such as cot sides must be risk assessed and advise sought as to the use of such restraint from other relevant professionals. The owners must ensure that all 16/05/07 full body immersion facilities and residents’ hand basins within the home, are provided with hot water regulated to 43 degrees Centigrade. Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 32 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 OP3 OP8 OP8 OP9 Good Practice Recommendations The owners should formalise the information received during the pre-assessment process. A monthly weight check should be undertaken for each resident. The owners should liaise with the District Nurse services over any nursing care a resident may need. There should be suitable storage provided for any medication that requires storage within a cold (fridge) environment. The owners should continue with their identified plan to upgrade the home. All window restrictors should be checked to ensure that they conform to the recommended guidelines on the size of openings. The owners should ensure that the five wall mounted electric heaters, situated within five of the en-suite facilities, conform to the necessary health and safety standards. The new owners should ensure that the key pad security system sited at the front door complies with the requirements of the fire authority regarding safe evacuation. The owners should ensure that 50 of the staff employed have commenced the required training to obtain NVQ level 2 in care within the next twelve months. All records maintained in relation to residents should comply with the Data protection Act 1998. The owners should ensure that all the home’s policies and procedures are reviewed and ammended as required. 5 6 OP19 OP19 7 OP19 8 OP19 9 OP30 10 11 OP33 OP33 Mayfield Hall DS0000067329.V307012.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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
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