CARE HOMES FOR OLDER PEOPLE
Mayfield Nursing Home 3 Central Avenue Eccleston Park Prescot Merseyside L34 2QL Lead Inspector
Mrs Joanne Revie Unannounced Inspection 21st November 2005 10:00 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 Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 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 Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Mayfield Nursing Home Address 3 Central Avenue Eccleston Park Prescot Merseyside L34 2QL 0151 430 9503 0151 430 9503 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) Maywood Care Limited Ms Yvonne Tweedle Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service Users to include up to 27 (OP) The service should have a suitably qualified and experienced manager who has been approved by the CSCI Date of last inspection Brief Description of the Service: Mayfield Nursing Home is a 27 bedded home which provides nursing care to older people (i.e. over 65). It is situated in the Eccleston Park Area of Prescott. This is a quiet residential area, which is close to a main road with good connections to the M57 motorway and the near by town of St Helens. Local shops are a short car journey away. The building is a detached Victorian house, which has been converted so that it is accessible for wheelchair users. Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The visit was unannounced. During the visit discussions were held with three service users and two members of staff. Their comments will be included in the summary section of the report. A variety of documentation was viewed which will be referred to in the evidence section of the report. What the service does well:
The home makes sure that it has all the information possible regarding a residents needs before they are admitted to the home. This means that staff can plan the resident’s care and reduce the risk of a resident living somewhere that cannot meet their needs. Nursing needs of residents are well documented in care plans with clear nursing instructions for staff to follow. Plans viewed were updated monthly which means that staff are trying to keep records up to date. This means that staff can access clear, current written instructions about a residents needs. Staff were observed attending to residents needs and it became evident that close relationships had developed. A resident commented” they are good girls” another stated” I never feel embarrassed”. All residents confirmed that the staff are kind and respectful of their wishes. Staff are quick to seek advice from other health care professionals when the need arises. An example of this is contacting a dietician for advice when a resident looses weight. Staff are proactive in monitoring health needs by ensuring all residents are weighed monthly and have vital signs such as blood pressure, pulse, temperature and urinalysis performed. This reflects good practise and shows that staff are trying to identify any changes in health needs at an early stage. Qualified staff have a good understanding of how to manage wound care. Accurate records are kept which clearly detail progress/deterioration and what action to take to promote healing. Techniques, which reflect current good practice, are in use, which shows that staff are keeping themselves up to date. A dedicated staff team consistently staffs the home. Fluctuations occur in staffing levels according to what is going on in the home and whether residents needs have increased. This shows a willingness by the provider to give good care. Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 Page 6 The home is maintained to a good standard and efforts are made to make it a” homely” place to live. In particular residents are offered bedrooms that are individual in size and colour scheme. Residents are encouraged to make these rooms personal to them by furnishing them with personal effects. This helps to promote ownership. Visitors are welcome to visit when they choose and residents are encouraged to undertake activities that they may have done in their own home. An example of this is inviting local clubs which residents are members of to hold meetings within the home. The home has a strong focus on staff training with various training being offered and undertaken on a monthly basis. Clear records are kept so that senior staff can identify which staff need to take further training. Staff are supervised formally which means that the standard of care that they deliver to the residents is assessed. This is also used to identify training needs. The home takes the health and safety of the residents seriously. All necessary checks are undertaken to ensure that the premises are safe. The staff have identified that the surface to a specialised bath has become cracked and have correctly identified that this could possibly cause cross infection. Therefore the bathroom has been taken out of operation and plans to replace the bath are underway. What has improved since the last inspection?
Activities have been further developed with occasional day trips occurring. Each day an activity is offered such as visiting entertainers, birthday celebrations, sport afternoons etc. Recording of dependencies levels has been implemented. This information is used by the home to decide whether there are enough staff to meet the residents needs. An increase has occurred in qualified staff as this exercise showed that there had been an increase in the amount of nursing hours needed. Staff have identified that one resident is prone to falls and that this occurs during the night. The service has responded by purchasing a pressure mat, which sounds an alarm when stepped on. Sensors, which detect movement, have also been fitted in close proximity to the resident’s bedroom. These measures have reduced the risk of falls occurring as staff are now alerted when the resident gets out of bed and leaves the bedroom. Staff Training is ongoing within the home. Staff have undergone training on abuse awareness and on how to protect vulnerable adults. Senior staff have undertaken training on how to instigate adult protection procedures should they suspect an incident of abuse has occurred.
Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 Page 7 All of this means that residents are receiving care from staff who have the skills to protect their rights and keep them safe from abuse. What they could do better: 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 Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 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 Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home gains all available information about a residents needs before they are admitted to the home. EVIDENCE: Two care plans, which contained assessment information, were viewed and a discussion was held with the deputy manager. Assessments were viewed that had been completed prior to admission by a health care professional (social worker, district nurse). The homes own assessment was also viewed, which had been undertaken by the deputy manager (who is a registered general nurse) prior to admission. This provides essential information only. A second long-term assessment was viewed that had been completed by the home within one week of admission taking place. This gave a more in-depth overview of the residents needs. The home does not provide intermediate care therefore standard six is not applicable. Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 Page 10 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): 7,8,10 Staff have clear written instructions available regarding the residents needs but this information is stored in different areas within the home so may not always be accessible. Staff are quick to respond to changes in the residents health needs. Staff treat residents with dignity and maintain their privacy. EVIDENCE: Staff were observed supporting the residents with their needs. Three care plans, Care notes completed by care staff, and the wound documentation file were viewed. Discussions were held with two residents. The care plans viewed were found to be clear and well written. Each resident had a care plan in place, which is regularly reviewed by senior staff. The deputy manager stated that staff are trying to involve residents relatives if they are unable to sign but this was not evident in the plans viewed. The plans are orientated towards nursing needs with personal care records being kept separately by care staff. Activities are provided in the home but social needs had not been addressed on the plans of care viewed. Care staff are keeping records of a very good standard, which evidenced choice.
Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 Page 11 Care staff are also documenting when they have informed the nurse in charge of a change in the residents needs but it was difficult to audit outcomes of these changes as qualified staff record their findings separately in the residents care plan. Records were viewed that showed GPs are in regular attendance and that other health care professionals visit the home (e.g. chiropodist, dietician). Residents have their weight recorded and if necessary referrals are made to the dietician. Staff are monitoring residents weight, blood pressure, pulse and urinalysis on a monthly basis. A wound documentation file was viewed. Staff are managing wound care well and documenting all skin conditions, which reflects good practice. When appropriate, advice is sought from a Tissue viability nurse. Wound mapping is in place and in some cases photographs are taken as evidence. Through observation it was evidenced that all staff of all levels were respectful kind and courteous to the residents. Two residents commented positively on Staffs ability. Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 Page 12 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): 12,13 Ranges of activities are provided within the home. Visitors are welcome to visit when they wish. EVIDENCE: Three care plans and the activities file and the notes kept by care staff were viewed. Discussions were held with a resident. The visitor’s book was also viewed. An activities notice board is available by the entrance of the home, which displays forthcoming events. Activities offered include visiting entertainers, birthday celebrations, manicure/ pampering, sports afternoons and bingo. Themed events are also held according to the time of year. Occasional trips out are organised depending on the requests of the residents e.g a trip has been planned to visit a local operatic societies Christmas production in the near future. Care staff keep clear records using a key system of what activities have been undertaken by a resident. Some residents, who wish, are supported to attend the local church. Another is supported to attend bridge club and has been made aware that she can invite the bridge club to take place at the home as it is” her” home. Viewing the visitor’s book showed that visitors are free to visit as they choose. A resident confirmed this to be true. Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 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 Staff have the skills and knowledge to protect residents from abuse EVIDENCE: Four staff files were viewed. A training programme and certificates were also viewed and a discussion took place with the deputy manager and one resident The resident confirmed that he felt safe in the home. Care staff undertake training on Abuse awareness as part of their induction to their role. Staff have also undertaken training on the Protection of vulnerable adults Senior staff have undertaken further training which gives advice on how and when to instigate these procedures. Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 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): 19,21,24,26 The home is clean, comfortable and well maintained. Residents are encouraged to “ be at home” by personalising their bedrooms. Management identify and replace any areas of the fabric of the building that need renewing. EVIDENCE: A tour of the environment was undertaken. A number of carpets in some bedrooms and some communal areas appeared worn but management had already identified this and a quote had been obtained for their replacement. Other than this all parts of the home viewed appeared comfortable and welcoming. Bedrooms are very personal to the occupant. Each room viewed contained personal effects, which made the rooms appear homely and individual. All areas of the home viewed were clean, tidy and smelt pleasant. The deputy manager stated that staff have received training on the control of cross infection. Sluice areas viewed were found to be clean and tidy also. All bathrooms were viewed and were found to be clean and tidy with good quality fittings. Staff have identified that the surface to the existing parker bath has become cracked and could therefore pose a risk of cross infection. A quote has been obtained for its replacement and the bath has been taken out of use until then.
Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 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): 27 Staff are supplied in sufficient numbers to meet the residents needs. EVIDENCE: Copies of off duties and residents dependency levels were viewed. A discussion was held with the deputy manager. Since the last inspection the deputy manager has implemented monthly dependency levels for the care required by the residents. Staffing levels have recently been increased as the dependency levels showed that there had been an increase in the amount of nursing care required in the home. Viewing the off duties showed that the home is staffed consistently and increases at key times or key days according to what is happening in the home. Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 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): 38 The home is a safe place to live EVIDENCE: The health and Safety file was viewed. This showed that tests had been undertaken and were current for the gas and electrical supply, emergency lighting, and all fire fighting equipment including the fire alarm. Portable appliance tests were carried out in August 05. The passenger lift and all mechanical hoists have been serviced and certification was current. The kitchen was inspected by Environmental health in September 05. Two recommendations were made which have been acted on. The home has a contract for pest control and removal of clinical waste. A maintenance person is available four days a week to carry out minor repairs. Staff record accidents appropriately and eventually theses are filed away in the resident’s personal files. If two accidents occur in close proximity a “ falls diary “ is implemented which reflects good practise. Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 Page 17 The deputy manager stated that all accidents are reviewed by management but recorded evidence of this could not be found. A pressure mat has been purchased and implemented since the last inspection. Sensors to detect movement have been fitted in one area of the home. This has been installed to detect nighttime movements of one resident who is prone to falls. Training records showed that staff have received train9ing on fire prevention, manual handling and food hygiene. Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 Page 19 NO Are there any outstanding requirements from the last inspection? 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 OP12 Regulation 16(2)(m)( n) Requirement The manager must ensure that staff carry out social assessments and that Residents preferences are recorded on the plan of care along with information saying how this need will be met. Timescale for action 31/03/06 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 Refer to Standard OP7 OP7 Good Practice Recommendations The manager should continue her work to involve residents and relatives in the plan of care and to obtain (wherever possible) signatures to evidence this. The manager should consider amalgamating all care records (care plan, care records written by care staff, wound documentation) together so that a clear audit trail exists from the need on the plan to the outcome. This would also encourage all staff to read the plans of care. The provider should carry through his intention to replace the worn carpets within the home 3 OP19 Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 Page 20 4 5 OP21 OP38 The provider should carry through his intention to replace the parker bath The manager should ensure she signs all accident forms to show that they have been reviewed. Mayfield Nursing Home DS0000005464.V267340.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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