Inspection on 22/02/06 for Mayfield House

This inspection was carried out on 22nd February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Mayfield House 07/10/08

Mayfield House 30/10/07

Mayfield House 23/05/06

Mayfield House 04/08/05

Mayfield House 06/01/05

Mayfield House 15/06/04

Mayfield House 19/02/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Mayfield House Mayfield Mews Minshull New Road Crewe Cheshire CW1 3FZ Lead Inspector Anthony Cliffe Unannounced Inspection 22nd February 2006 09:00 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 House DS0000006654.V280937.R01.S.doc Version 5.1 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 House DS0000006654.V280937.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Mayfield House Address Mayfield Mews Minshull New Road Crewe Cheshire CW1 3FZ 01270 500414 01270 214946 mayfieldhouse@bt.connect.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) Littleton Homes Limited Lynne Woodroffe Care Home 51 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (23), Old age, not falling within any other of places category (51) Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service is registered for a maximum of 51 service users in the category of OP (Old age, not falling within any other category) Within the overall number of service users to be accommodated a maximum of 23 service users may be accommodated in the category of DE(E) (Dementia over the age of 65 years) Within the overall numbers of service users to be accommodated 1 named service user may be accommodated in the category DE (Dementia under the age of 65 years) until 18/12/2007 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 4th August 2005 3. 4. Date of last inspection Brief Description of the Service: Mayfield House is a two-storey purpose-built property that provides 51 places for older people. The home is located on a modern housing estate, and is within approximately a mile-and-a-half of Crewe town centre with access to bus links and the railway. The property has been extended and now has two separate units - one for residents with general care needs, and the other for residents who have dementia. Access to the homes second floor is provided by a passenger shaft lift, and three stairways. There are accessible and wellmaintained gardens surrounding the home. Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A regulatory inspector conducted this unannounced inspection on 22nd February 2006 over a period of seven and a half hours. Feedback was given to the registered manager. Records were inspected and staff practice was observed. Discussion took place with residents, visitors and staff. Verification of the employment procedures for Mayfield House was discussed with the director responsible on 2nd March 2006. Two requirements remain partly unmet and one outstanding from the previous visit. What the service does well: What has improved since the last inspection? What they could do better: Care plans need further development to ensure that they address all residents’ needs in detail, particularly in relation to providing information to staff. Management and administration of medication must improve to ensure that residents receive their prescribed medication. Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 6 The management and use of physical intervention needs to be clear and in line with the statement of purpose and philosophy of care in the home. More information needs to be provided for residents on activities. The recruitment of staff needs to improve to ensure that residents are protected. A formal system of supervision should be introduced for all grades of staff. Record keeping about staff training and the maintenance and safety of Mayfield House must improve to ensure the health and welfare of residents is promoted. 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. Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This standard was not assessed. Mayfield House does not provide intermediate care facilities and this standard is not applicable. EVIDENCE: Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Residents’ care plans do not ensure that health and social care needs are identified and met. The procedures for managing medication has improved but further improvement is needed to ensure residents are not at risk from not having prescribed medication. EVIDENCE: A resident identified at the previous visit had been reassessed for nursing care and had moved from Mayfield House. There were no residents identified as presenting management problems due to aggressive behaviour. Since the last visit Mayfield House has purchased a new computerised care plans format called the Care Management System. The registered manager had transferred a number of existing residents’ care plans onto this system. The care plan format includes pre admission assessment and risk assessment documents. Four residents’ care plans were looked at using the new format and one care plan using the existing format. The new format uses a template, which identifies the needs’ of residents, action to be taken to meet the needs and outcome. Care plans using the new format contained basic information in them. An example of this being in one resident’s care plan it identified the resident required help with personal care. The action plan stated ‘staff to assist am and pm with washing and dressing, bath X2 weekly’. The action plan was not personalised and did not include how staff were to promote the resident’s independence and choice or identify the level of assistance needed. Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 10 It did not detail if the resident was able to care for herself, assist with her personal care or liked to choose her clothes. The care plans did not have an index that identified specific areas of need. The manager was unaware of the activities of daily living model of care. A care plan using the current format identified two residents as being responsible for the storage and administration of some of their medicines. This was not identified in a care plan for self administration of medicines and no assessment of the resident’s ability to self administer medication or risk assessment about safety in place. The manager stated that training is to be provided to staff on how to use the computerised format. Despite the purchase of a new system and existing care plans being transferred onto this the requirement identified at the previous visit has only been partially met. Staff commented on how information about residents’ health and welfare is shared. A staff member said ‘ I was supervised by Jackie or a senior. Staff gave me lots of verbal information on residents’ needs and likes and dislikes. Staff know the residents very well. The care plans didn’t contain the verbal information. I was used to following very detailed care plans. We could have better written information. Another staff member said‘ ‘we have a lot of information given at handover and care plans in bedrooms’. These were looked at with the carer and contained only basic information on assisting with personal care needs such as if the resident needed assistance with washing and dressing. The carer said ‘the information on these is not in depth. When I worked in care we had to write three reports a day that told you about the resident. We record daily information on residents but it could be better. I worry if people don’t eat enough and should record that information in more detail. That sort of information usually gets passed over at handover’. Examination of resident’s records noted that residents had been referred to the optician and a resident reviewed by a general practitioner due to her agitated behaviour. Medicine administration had improved but errors were found. Signatures had not been recorded for the administration of medicines for five residents. A medicine prescribed four times a day was being administered three times a day. Topical creams prescribed three times a day were only applied twice a day. Two residents had not had medicines administered from the 13th February onwards and no code was used to identify the reason why. Controlled drugs were being stored and administered by staff and there were records of receipt and administration in a controlled drugs register and record of administration of controlled drugs by two staff members on the medication administration sheet. See requirements 1 and 2. Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13. Residents must be offered the opportunity to participate in activities based on their preferences, interests and needs. Visitors are welcomed and can visit at reasonable times. EVIDENCE: An activities organiser is employed for three hours a day Monday to Thursday mornings and Friday afternoon. The social activity at the time of the visit was bingo. There is no planned programme of activities in place and no activities programme displayed. There was information on an external entertainer visiting the home on 1st March 2006. The manager said there is a volunteer who visits Mayfield House on a Monday, Tuesday and Thursday. He plays the piano for residents. The manager said the activities organiser did not keep records of activities she does with residents. The manager said that information about residents’ social preferences and life history is shared with the activity organiser. The manager demonstrated this by showing a family tree completed by a resident’s family. This had important photographs of the resident’s family and significant life events throughout her life. The manager said on Fridays the activity organiser uses information like this to have one to one sessions with residents or organises trips out. The activities organiser is involved in residents’ meetings. The minutes of a meeting held on 8th December 2005 were available. Several residents attended this. They were asked if they were happy with the current activities or had any complaints. No complaints were made other than about the cooking of vegetables. Residents Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 12 said they enjoyed the trips out. The activities organiser keeps details of events happening in the local community and in Crewe. Visitors were seen throughout the day. A visitor spoke about the care of his mother he said ‘ she had a fall at the weekend and staff called her general practitioner. Her breathing deteriorated and she is in pain. My sister lives locally and she was informed about everything. She was told mum slipped and fell on her bottom. There were no injuries. When she sounded chesty they called the doctor. There is good communication from staff. When I visit staff are always up to date about her care. She has Alzheimer’s. She is very well cared for, well fed and looked after. She has been here a year. My sisters chose Mayfield House. It was a good choice. As a family we don’t worry about her. She is healthy and has put on weight. The staff are great very friendly and approachable. We get a good welcome and the place is always warm and welcoming. See recommendation 1. Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The management of physical intervention remains unclear and staff are unsure what constitutes restraint and both residents and staff are at risk of being harmed. EVIDENCE: The policy in place in the home for managing aggressive behaviour guides staff to use a non physical approach, in allowing residents space, summoning assistance, talking calmly and not being confrontational in their approach to residents. The policy guides staff to give support and reassurance to residents, to listen attentively and not making sudden movements. The policy is not clear on what constitutes restraint but does states that restraint ‘should never involve the use of a weapon, locking of doors or any method of withdrawal of a residents’ rights’. Training on ‘dementia care, challenging behaviour’ had been arranged for 28th February and 3rd March 2006 for all staff. Staff members talked about how they manage challenging behaviour. A staff member said ‘ I used to work in EMI care home with very violent and aggressive residents, not like here. The residents here are very quiet you have to repeat things to them and explain things to them but they are usually helpful. l have read the policy on restraint and it’s not clear it doesn’t say what restraint is. I know we have to calm people down and move them to a quiet area. Staff know what works with residents. I’m not sure if I can stop people hitting one another or me’. Another staff member said ‘I’m not sure if I have read the policy on restraint. We try to calm people down and not be confrontational. If a resident digs their nails into me than I have to remove their hand gently. If someone hit out at you, you would automatically defend your self by putting your hand or arm up. I think that restraint is tying a person in a chair and we wouldn’t do that’. See recommendation 2. Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected. EVIDENCE: Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 and 30 The home’s recruitment procedures remain incomplete and do not ensure residents are protected. Training records need to be comprehensive and accessible to senior staff members. EVIDENCE: A training matrix detailing the staff employed and the manager provided the training they had completed. This did not indicate the dates training took place. The matrix noted that fifteen staff had an NVQ level 2 qualification and five staff had commenced an NVQ level 2 training qualification. The matrix gave details on staff training in moving and handling, basic food hygiene, Health and safety and fire training but no dates of training were recorded. The fire logbook recorded fire training as taking place in June 2005. Staff interviewed confirmed they had completed the mandatory training since employment including fire training. Examination of records of employment found recruitment procedures continued to place residents at risk. Four staff members had been recruited and commenced employment without a POVA First check being obtained. The manager stated that she had been advised by the director who was the counter signatory for Criminal Records Bureau (CRB) checks that ‘staff could commence employment without a CRB as long as they are supervised’. This matter was discussed on 2nd March with the director responsible for CRB checks and it was clarified that staff should not have commenced employment without POVA First checks being completed. The director verified that recruitment procedures would change. See requirements 3 and 4. Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36 and 38. Disorganised management results in some practices that do not promote and safeguard the health and safety of people living at Mayfield House. Residents’ monies are dealt with safely. Records of regular maintenance of the building and equipment provided to meet residents’ needs must improve to ensure the safety of residents. EVIDENCE: Mayfield House has employed a fulltime administrator to assist the manager in organising the administration policies, procedures and records. The management of records is disorganised. A training matrix of staff training at Mayfield House did not record dates that training took place. The manager verified that individual staff files would have to be looked at to provide the information and the accuracy of the information depended on whether they had been updated. Four staff had been recruited by the manager and commenced employment without a POVA First check completed. No residents’ money is kept on the units. Residents are usually advised not to keep more than £25. Personal money can be given to the administrator for Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 17 safekeeping and accessed for the resident by request. The administrator said that the majority of resident’s families deal with their finances and that no appointeeship arrangements were in place for residents. Two records were examined and showed appropriate receipts for purchases. The local authority handles some residents’ finances; therefore the administrator makes requests for their personal allowances. Two records were examined and again showed receipts for purchases and invoices. Two recently recruited staff were interviewed and verified they did not have supervision and had not had an appraisal since they were employed. Maintenance records were poor and not all records available. Portable electric appliances were tested in January 2006. Water outlet temperatures were recorded each month. The fire alarm was serviced in February 2006. The portable and fixed hoists and shaft lift had been serviced as required. A waste disposal contract was in place with the local authority. Fire alarms were recorded as tested weekly and emergency lighting as monthly. Fire drills had taken place in August 2005 and January 2006. Records for five year electrical maintenance, water chlorination, legionella and as safety could not be verified as completed as required. See requirements 1 to 5 and recommendation 3. Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 18 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X X X X X X x STAFFING Standard No Score 27 X 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 3 X X 1 Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? yes 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 14 and 15 Requirement The registered person must ensure records that identify residents needs, and staff responsibilities in meeting their health and welfare, are detailed and identify how residents needs are proposed to be met, and include appropriate risk assessments and risk management strategies. (Timescale 1.12.05 not met in full) The registered person must ensure that staff administer medicines as prescribed and record on medication administration record sheets all administrations of medicines, and any reason for nonadministration of medication. (Timescale 1.11.05 not met in full) The registered person must not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. (Timescale 1.11.05 not met) DS0000006654.V280937.R01.S.doc Timescale for action 01/05/06 2. OP9 13(2) 01/05/06 3. OP29 19 22/02/06 Mayfield House Version 5.1 Page 20 4. 5. OP30 OP38 19 Schedule (2)(4) 13(4), 23(2)(4) Records of all staff training including the dates training took place must be kept. The registered person must ensure that all parts of the home to which residents have access are safe any activities free from risks and risks to health and safety eliminated. Including the required testing of electrical safety systems, gas and water supply. 01/05/06 01/05/06 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. Refer to Standard OP12 OP18 OP36 Good Practice Recommendations Information on the variety and choices of activities available based on the preferences of residents should be displayed on each unit. The registered person should ensure that the policy is amended on the use of physical intervention so it is clear to all staff. A formal system of supervision should be commenced for all grades of staff. Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mayfield House DS0000006654.V280937.R01.S.doc Version 5.1 Page 22 - 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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