Inspection on 07/10/08 for Mayfield House

This inspection was carried out on 7th October 2008.

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

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 30/10/07

Mayfield House 23/05/06

Mayfield House 22/02/06

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 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Mayfield House Mayfield Mews Minshull New Road Crewe Cheshire CW1 3FZ Lead Inspector June Shimmin Unannounced Inspection 7, 8 and 10 October 2008 10:50 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.V372771.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 House DS0000006654.V372771.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mayfield House Address Mayfield Mews Minshull New Road Crewe Cheshire CW1 3FZ 01270 500414 01270 214946 michael@mayfieldcarehome.co.uk 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 Manager post vacant Care Home 51 Category(ies) of Dementia (23), Old age, not falling within any registration, with number other category (51) of places Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 The registered person may provide the following category of service only: Care home only - Code PC to service users 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 Dementia - Code DE (maximum number of places: 23) The maximum number of service users who can be accommodated is: 51 Date of last inspection 18 June 2008 Brief Description of the Service: Mayfield House is a two-storey purpose-built home with 51 places for older people. It is on a modern housing estate, approximately a mile-and-a-half from Crewe town centre, with access to bus links and the railway. The property has been extended and now has two separate units, one for people with personal care needs, and the other for people with dementia. Access to the homes second floor is by a passenger lift and three stairways. There are accessible and well-maintained gardens surrounding the home. Information about the home, including the last inspection report, is available from the home. Current fees range from £367.54 to £537.00 per week depending on the type of care being provided. Further charges apply for toiletries, chiropody, hairdressing, newspapers etc. Mayfield House DS0000006654.V372771.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 1 star. This means the people who use this service experience adequate quality outcomes. We made an unannounced visit to Mayfield House that started on 7 October 2008. The visit was done by one inspector and continued on 8 and 10 October, lasting a total of 10 hours over the three days. This visit was just one part of the inspection. We also looked at other information we had about the home. Before the visit the home manager was asked to complete a questionnaire to provide up to date information about Mayfield House. We sent our questionnaires out to people who live in the home, their families and staff in order to find out their views. Other information we had received since our last major inspection at the home was also reviewed. During our visit, we looked at various records and walked round the home. We spoke with a number of people who live at Mayfield House, relatives who were visiting it whilst we were there and staff. They gave us their views about Mayfield House. We carried out a short inspection at Mayfield House on 18 June 2008. This was to check if the requirements we made at our last major inspection on 30 October 2007 had been met. We also looked at management arrangements for the home and checked on some concerns that had been reported to us since October 2007 and to follow up concerns that had been reported to us since the last key inspection. What the service does well: Relatives gave us positive comments about the staff who work at Mayfield House. One relative said the staff, “seem quite caring, bright and cheerful” and another said, “makes sure she is safe and looked after”. People who are thinking about moving into Mayfield House have their needs assessed by staff from the home before they move in. This is to make sure that they, their family and the staff at the home know the person’s needs can be met there. Each person who lives at the home has a care plan that shows what needs to be done to meet their care needs so they can be confident their needs will be met. Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 6 Staff at Mayfield House make sure that people living there receive advice and treatment for healthcare professionals such as doctors and specialist nurses. This is to make sure their healthcare needs are met. There is a variety of activities available at Mayfield House that people who live there can choose to take part in so they can stay active socially. We were told that the standard of the food provided at the home is good so the people who live there can enjoy nourishing food that they enjoy. The home is clean, pleasant and well-maintained so residents live in comfortable surroundings. Care staff levels appear to be enough so that people’s care needs are met at the home. Staff receive training, including NVQ Level 2 in care, so they can provide better quality care for the people who live at Mayfield House. One staff member told us, “we have lots of training sessions in house and support”. There is a safe system used at the home to manage the small amount of money kept on behalf of residents to make sure that it is kept securely and correctly. What has improved since the last inspection? What they could do better: Staff who have not yet done training on safeguarding adults need to do this training so they know how to recognise possible abuse and what to do if they suspect someone is being abused. Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 7 Staff who have not yet undertaken fire awareness training and have not taken part in a fire drill need to do this training so that all people living and working in the home are protected. Staff should undertake refresher training in safe moving and handling procedures so they and residents are protected from possible injury. 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 House DS0000006654.V372771.R01.S.doc Version 5.2 Page 8 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.V372771.R01.S.doc Version 5.2 Page 9 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): 3 and 6 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People have their needs assessed before they move into Mayfield House so they know their needs can be met there. EVIDENCE: The manager told us that the information about the home, in the service users’ guide, is being revised and showed us a draft of the new version. It was produced in easy to read large print and the layout was good so people could understand the information easily. The manager said he would make sure a copy of the new guide is given to all the people who live at the home so they have up to date information about services there. A relative of person who has recently moved into Mayfield House told us that she had been given information about the home and had been shown round by the manager. This helped her and her relative to make a decision about moving into the home. Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 10 We looked at the assessments done with two people who had recently moved into Mayfield House. The manager had done both assessments and they had been completed to a good standard. They also included assessments on any risks to the person’s health. There was little recorded in the assessments about the social, leisure and spiritual interests of people before they moved in. The manager told us that people’s families are asked to complete a brief life history of their relative for the home. This helps to make sure that staff know people’s individual needs and interests so they can provide care that is centred on the individual person, their preferences, needs and interests. Mayfield House does not currently provide intermediate care. Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 11 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 and 10 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who live at Mayfield House have their needs met and their care is provided in a manner that protects their privacy and dignity. EVIDENCE: We looked at the care plans of three people living at Mayfield House, to check on the care they were receiving there. This included two people who had recently moved into the home. Their care plans had been written within 24 hours of moving in so their care needs were quickly identified and appropriate care provided. The care plans we saw contained relevant risk assessments so any identified risks were well managed. The content of the care plans we saw was good and there were various references to respecting the privacy and dignity of people in the home. There was also reference made to encouraging people to remain as independent as possible. The care plans were kept under review so that people’s changing needs were recorded. Some of the reviews we saw needed to include more Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 12 information about the changes in people’s needs to make sure the care they were getting was evaluated correctly. The daily records made about each person who lives at the home are put on computer. This made it easier for staff to see what had been happening each day and gave them up to date information about people’s care needs. Some of the records were repetitive though and did not show what each person living at the home had been doing during the day. The manager told us he was looking into ways to improve these records so they gave more information to make sure staff could provide good care and support for people. He told us he encouraged staff to look at care plans regularly. These had been moved into the main office so they were easier for staff to access. This would help to make sure that all staff had the right up to date information on what they needed to do to meet people’s care needs. The records we saw showed that staff from the home had referred the people living there to a number of healthcare professionals such as doctors, dieticians, and opticians so all their health care needs were identified and met. The manager told us that nobody living at Mayfield House at the time of our visit has pressure sores. This indicates that the care being provided was good and that people were remaining healthy. We looked at the records kept about medicines in the home. These were of a good standard and showed that people who live at the home receive their medicines as prescribed in most cases. However, we saw that there were several instances where people who live at the home had refused to take medicines they had been prescribed. This should be discussed with the doctor who has prescribed the medicines to explore whether offering them at different time of day might help to make sure that these people continued to receive all their prescribed medicines. Senior care staff at the home have done training on managing medicines. They would benefit from updated training to make sure they have the skills to provide safe care in all aspects of dealing with the health and medication needs of people living at Mayfield House. For example, staff have not received supervision from a competent person to make sure they are checking blood sugar levels of people at the home with diabetes safely. Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 13 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 and 15 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. There are plenty of activities for people who live in the home to take part in if they choose, so they can keep themselves active, and the food is good so that people enjoy a nourishing and varied diet to help to keep them healthy. EVIDENCE: Two staff are employed as activity organisers at Mayfield House to provide activities during weekdays and occasionally at weekends. We met both during our visit to the home. Two-weekly activity programmes are put together and information is put on notice boards throughout the home to let residents know what’s on. We spoke with several people who live at Mayfield House who said they knew what activities were on and were able to take part in them if they wished. As well as activities provided by staff, entertainers visit the home. Whilst we were there, we saw a number of people who live at the home listening to a musician playing. The activity organisers keep records of which people have taken part in social events. This helps them to develop a programme based on people’s preferences and suited to each individual. One of the activity organisers told Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 14 us she had done a course about people with dementia to help her understand how to meet their needs. She said that they also attend residents meetings to find out what people who live in the home would like to do and discuss their preferences. They also provide minutes of the meeting so people can see what was discussed and agreed. During the summer staff take people who live in the home out into the local community, using wheelchairs if needed. Two trips were organised to a nearby garden centre. Staff have also been involved in events to help raise funds to put on activities for people who live in the home to take part in. This helps to provide a wide range of activities so people can take part in sociable occasions as they wish. Information is kept about people’s spiritual needs and representatives of several local churches visit the home to offer communion or hold a service. A mobile library visits the home every other month and a person brings a dog into the home every two weeks for those people who like animals. Friends and families are welcome to visit at any reasonable time but preferably not during mealtimes, as these are busy times for all the people who live at Mayfield House. Meals are served in one of two dining rooms and the tables were laid with tablecloths and napkins. We saw people who live at the home being given help to eat by staff in a discreet and respectful way. The meal appeared nutritious and there was a choice of dishes so people could have the meal they preferred. A person who lives at Mayfield House told us that staff asked him the night before what he would like to eat the following day. Most people we spoke with said they enjoyed the food provided in the home and that much of it was homemade. Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 15 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 and 18 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home’s policies and procedures on complaints and safeguarding are not always followed properly so people living in the home may not be protected from harm and abuse. EVIDENCE: Mayfield House has policies and procedures about complaints and safeguarding adults. On the first day of our visit, the complaints procedure was not displayed in the home and there was no service user guide available that would have given information about the complaints procedure. Several people who live at the home and relatives told us they knew who to raise concerns with but it is possible that some people who live at the home did not know this because of the lack of available information. On the third day of our visit, the manager had put information about the complaints procedure for the home on display with up to date details about how to contact us if people had any concerns about the home. He had also provided a residents’ guide that included information on how to make a complaint about the home. We looked at the records of the complaints received by the home since our last major inspection there. One of these referred to an incident that happened before the current manager started working at the home. It had not been Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 16 handled well so the person concerned may not have been fully protected because correct action had not been taken at the time. Since our last major inspection of Mayfield House, more than half the staff working in the home have undertaken training about safeguarding adults so they know what they must do to protect people if they become aware of possible abuse of anybody who lives at the home. However, a significant number of staff have still not done this training. Concerns were also raised that a former senior staff member at the home had not recognised what abuse meant. As a result, inappropriate behaviours and care practices by some staff had not been acknowledged as being potentially abusive. This will needs to be dealt with to make sure that all staff are aware of good practice and what they must do to protect people living at Mayfield House from harm. Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 17 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 and 26 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Mayfield House is well maintained so people who live there have comfortable, safe and homely surroundings. EVIDENCE: On each of the days of our visit to Mayfield House, the home was clean and tidy with no unpleasant odours. There are enough lounges so that people who live in the home can take part in social activities or go to quiet areas where they can sit undisturbed, if they prefer. There is also a seating area outside for those people who wish to sit out in good weather. The manager gave us information before the inspection about improvements to the home that have been made during the last twelve months, including the purchase of furniture and flooring to make the home more comfortable for the people who live there. Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 18 The manager told us that one of the owners visits the home often to carry out maintenance and repairs. Information we were given before our visit showed that equipment in the home is serviced regularly to make sure it is safe and working properly. During our visit, we walked round the home to see all the shared rooms and we also saw some people’s own rooms. We saw that they had been able to use photographs, pictures, ornaments and small items of furniture to make their rooms more homely. People who live at the home told us their rooms are kept clean and fresh. We saw there are effective measures in place to prevent the spread of infection in the home so that people who live there are protected from possible infections. Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 19 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 and 30 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. There are recruitment procedures and adequate staffing levels to make sure that the people who live at Mayfield House receive the care they need from staff who are suitable to work with them. EVIDENCE: We looked at the recruitment records of three staff who work at Mayfield House to check that thorough processes had been done to make sure they were suitable to work with the people who live there. We had previously found problems with these records. In one file, there was still no reference from one person’s previous employer. The manager acted immediately to obtain a reference to confirm the person’s work history and that they were suitable to work at Mayfield House. In a second file, we found that a member of staff had worked unsupervised in the home, after an initial security check but before their full check had been received from the Criminal Records Bureau. This could have put people who live at the home at risk. The third file we looked at contained all the necessary checks and showed these had been done before the person started working at the home. This thorough checking should be done before any new member of staff starts working in the home to help to make sure that people who live there are protected from possible harm and poor practice and should be done before any new member of staff starts working in the home. Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 20 Staff working at the home are highly regarded by the people who live there and their relatives. One person told us they thought staff were, “courteous and very friendly”. Staffing levels at Mayfield House appeared to be good during our visit. Staff told us that if staffing levels dropped, the management took action to cover shifts by using agency staff. The manager told us that more than half the care staff working at Mayfield House have NVQ 2 or 3 in care and that other staff were working towards this award. The owners of Mayfield House also run a training organisation that provides training for staff who work at the home. Staff told us that management support them to do up to date training. However the manager showed us a training record for all staff that showed some of them had not received up to date training in fire safety and safe moving and handlings. This could put residents, staff and visitors at risk. Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 21 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 and 38 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. The new manager is taking steps to make sure Mayfield House is run in the best interests of the people who live there but a lack of staff training in fire safety has put people in the home at risk. EVIDENCE: The manager of Mayfield House has been in post for just over six months and during this time has made many improvements to how the home is run. He is a nurse specialising in mental health and has management experience in another care home. He told us he had gained experience in managing the needs of people with dementia at the previous home and is hoping to do further training in this area. He is well liked and respected by staff members Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 22 and people living in the home. One staff member said there was a good atmosphere in the home and the manager was described as approachable. One staff member wrote, “he always has an open door policy for all”. The manager said that he likes to be accessible and we saw this during out visit to the home. The manager told us he had started the process of becoming registered with us. This process is required because the Care Standards Act states that anybody who runs or manages a care home must be registered to do so. Becoming registered with us involves a series of checks so people who live at the home know the manager is suitable and has the necessary knowledge, experience and qualifications to run it. There are various methods in place to find out about the quality of the service being provided at the home and the views of the people who live there about it. There are monthly meetings for people who live at Mayfield House so they can say what they think about the way the home is running. There are regular staff meetings so they too can say what they want about how the home is run. The manager has started to carry out checks of various procedures in the home such as medication and is hoping to develop this further to make sure that these are all run well to the benefit of the people who live at Mayfield House. As the owners of the home are not in day to day charge of the running of the home, they make recorded monthly visits to check on how it is being run. This provides the manager with useful information about improvements that might be needed. It also makes sure that the owners know what the people living in the home, their relatives and the staff think about how it is being run. Suitable arrangements are in place to make sure small sums of money held at Mayfield House on behalf of people who live there are safely managed. Although we are notified of some events at the home that we should be told about by law, this is not always the case. This means that we may be unaware of serious issues arising in the home so we can check they are being dealt with correctly and that people living in the home are being protected from any harm. We checked the fire safety records and these showed that not all staff had undertaken training in fire awareness during the twelve months before our visit. We also found it difficult to find out how many staff had taken part in fire drills. This means that people living and working at the home may be at risk if there is a fire. We made an immediate requirement about this and the manager made sure that all staff on duty at the home from 8 to 10 October attended a fire awareness training session and/or a fire drill. He told us that those staff who had not yet done this would do so during the month following our visit. Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 23 The training records we saw showed that only five members of staff had done moving and handling refresher training in the year before our visit. This means they may be putting people who live at the home and themselves at risk of injury through using poor moving techniques. During our visit, the manager confirmed that he had arranged for this training to be done during November 2008. Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 24 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 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 25 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 OP18 Regulation 13(6) Requirement All staff must receive training about safeguarding vulnerable people from abuse to ensure that they know how to act appropriately if they witness or suspect that a resident has been abused. (Timescale of 31/07/08 not yet met in full) All staff must take part in a fire drill at least twice a year, so that people living and working in the home are safe. Records of these fire drills, including the staff members involved, should be kept to show that all staff have taken part in the required number of fire drills. (Timescales of 30/1/08 and 30/06/08 not yet met in full) Staff must undertake annual training updates in moving and handling so that people are protected from unsafe practice. Timescale for action 07/12/08 2 OP38 23(4)(c) 07/10/08 3 OP38 13(5) 07/12/08 Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The refusal of several people who live at the home to take some of their prescribed medicines should be discussed with their GPs to see if changing the time the medicines are given will help to make sure that people take their medicines as prescribed. Care staff should undertake continuing training in the administration of medicines, particularly in checking people’s blood sugars, to ensure they are skilled and competent so that the health of the people who live at the home is maintained. Staff should work under supervision, after a POVA first check has been received for them, until a satisfactory enhanced disclosure has been received about them from the Criminal Records Bureau so that vulnerable people living at the home are protected from possible harm or poor practice. The commission should be informed of any incident that is identified as notifiable under Regulation 37 of the Care Homes Regulations 2001 to make sure that appropriate action is being taken at the home to deal with these incidents. All staff who have not done up to fire awareness training or taken part in a fire drill at the home should do this training so they are aware of what to do in the event of a fire. 2 OP9 3 OP29 4 OP38 5 OP38 Mayfield House DS0000006654.V372771.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection North West Region Unit 1, Level 3 Tustin Court Port Way Preston PR2 2YQ 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 House DS0000006654.V372771.R01.S.doc Version 5.2 Page 28 - 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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