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Inspection on 26/11/08 for Mayfield Nursing Home

Also see our care home review for Mayfield Nursing Home for more information

This inspection was carried out on 26th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Care and attention is individualised and there is a warm and cheerful atmosphere so that people who are cared for feel comfortable and at home. An established care team works at Mayfield which means the people who live in the home know the staff well. There are plans of care in place so that staff would know what to do for each person. Menus were varied and there were a number of choices for each meal. Residents spoken with said " The food is lovely" " I enjoy my meals". A good standard of hygeine was seen throughout the home and the standard of decor was good so that people live in a clean and comfortable environment. Residents spoken with said " I like living here" " The staff are really nice " " the food we get is lovely" " my room is always clean". Staff were seen to treat residents with respect and were warm and friendly.

What has improved since the last inspection?

There are more activities on offer each day so that people who live at Mayfield have enough to do.

What the care home could do better:

Pressure wound care records need to be improved to provide a detailed and accurate record of what dressings are currently in use.This will enable accurate evaluation of wounds so that residents with pressure sores are given the right treatment. Improvements are needed in the safe storage of medicine trolleys and the drug fridge should be kept locked to make sure medicines are kept safe. The items stored in the drug fridge with a short shelf life should be dated when opened so that staff know they are not out of date. All staff who work in the home must receive training about safeguarding people from abuse. They must be familiar with how to recognise abuse and what their own responsibilities are fro reporting any observed or suspected abuse to make sure the residents are protected.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mayfield Nursing Home 3 Central Avenue Eccleston Park Prescot Merseyside L34 2QL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joan Adam     Date: 2 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 22 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 22 Information about the care home Name of care home: Address: Mayfield Nursing Home 3 Central Avenue Eccleston Park Prescot Merseyside L34 2QL 01514309503 01514311230 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Maywood Care Limited care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing: Code N, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP. The maximum number of people who can be accommodated is: 31 Date of last inspection Brief description of the care home Mayfield Nursing Home is a 31 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. Fees charged are currently between #365 to #450.00 per week. 0 Over 65 31 Care Homes for Older People Page 4 of 22 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site visit was carried out by an inspector of the Commission for Social care inspection(CSCI) on 26th November 2008 over a period of Five hours. This was to assess if peoples needs were being met at the home. A tour of the premises took place, a majority of bedrooms were looked at and the shared areas such as dining rooms and lounges, shared bathrooms and toilets. The manager, several staff and people cared for were spoken with and their views contributed to the inspection of the home. Care Homes for Older People Page 5 of 22 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 6 of 22 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 7 of 22 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a full assessment of their needs before they go to live at Mayfield so they know their needs can be met there. Evidence: Two people had come to live in the home within the last few months. We looked at their records and this showed that information about their needs had been obtained by the manager before they came to live at Mayfield so she would know if the home could meet their needs. A initial care plan had been written based on this information. Care Homes for Older People Page 8 of 22 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of people living at the home are met, however, some improvement must be made in the recording of residents needs and the management of medicines must improve to make sure that medicines are stored correctly and safely. Evidence: Each resident has a care plan that details their needs and gives information and guidance to staff about how their needs should be met. Four care plans were looked at for people living at Mayfield. Two were detailed and gave good guidance so that staff would know what to do for the residents. However, two others were not as detailed and needed more specific information so that staff would know how to fully care for these residents. One resident had a pressure sore that was almost healed, however the care plan did not state what dressings to put on the wound and referred to see dressing book. On looking in the dressing book the wound had been measured so staff would know how it was progressing but no indication as to what was to be put on the sore and how Care Homes for Older People Page 9 of 22 Evidence: often the dressing would need changing was recorded. Evaluations had been completed monthly but need more information so that staff would know what changes , if any had occurred throughout the month. Medication management was looked at. The door to the clinical room is left open and the trolleys are stored in the main corridor. A wall lock has been provided but was not in use on the day of the visit. The medicine fridge in the room was not locked. The temperatures of the fridge had been record daily. Medicines in the fridge with a short shelf life had not been signed and dated when opened which means that staff would be unaware how long they had been open and could be out of date. All medicine administration sheets had been appropriately signed, medicines had been signed in and any carried forward from the previous month were added to the total so staff would know how many tablets were in the trolley. Care Homes for Older People Page 10 of 22 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Mayfield are able to excercise choices in their daily lives and activities are provided for people who wish to join in to keep them busy and socially active. Evidence: People who live at Mayfield can choose what time they get up and go to bed. There are various lounges at the home and people can choose where they would like to spend their day. The activities programme has improved since the last visit and a staff member is allocated daily to provide activities.A list of what is on offer is written on the notice board in the dining room on a daily basis so that residents know what is to take place. Social needs are recorded in the care plans. A PAT dog visits the home on a regular basis and a resident spoken with said this was lovely, we all love her For the more frail residents one to one time is spent with each person and hand massages can be given. A physio therapist comes in to home to provide gentle chair exercises. Menus are varied with a number of choices for each meal and the food on offer looked good and wholesome. Residents said the food is really nice there is plenty of choice. Care Homes for Older People Page 11 of 22 Care Homes for Older People Page 12 of 22 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure for the home is thorough to make sure peoples concerns are listened to but staff have not had up to date training about safeguarding adults to make sure that they know what to do to protect people from abuse. Evidence: There is a complaints procedure for Mayfield and a record of complaints is kept. There have been no recorded complaints since the last inspection. Staff have not received training about safeguarding vulnerable people from abuse. All staff working at the home have NVQ level two in care and safeguarding is covered in this course, however no specific training has been given so staff are up to date in knowing what to do to protect people. The manager has completed a course so that she can train the staff in this subject and arrangements are being made for all staff to receive the training. Care Homes for Older People Page 13 of 22 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained so that residents live in comfortable, clean and homely surroundings. Evidence: During our visit we walked round the home and saw that all areas had been cleaned to a high standard. All bedrooms looked at were well personalised with photos and ornaments brought in by the residents and their families. The garden was pleasant and accessible for people who need a wheelchair. The corridor lights were dark and the manager stated that these were to be replaced early in December. Care Homes for Older People Page 14 of 22 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Enough experienced nurses and trained care staff are provided to ensure the care needs of people living in the home can be met. All staff must have two written references before they commence work at the home. Evidence: Staff rotas showed that enough nurses and care staff are provided to ensure the needs of the people living in the home are met. All care staff have NVQ level two in care. The home does not use agency staff which means the residents have continuity of care from the homes regular staff. Regular training is provided for staff to ensure that they know how to work safely and make sure residents are safe. Staff records showed that no staff at Mayfield have received up dated training in safeguarding adults so that they know how to recognise if residents are being abused or mistreated and know what to do. The manager has undertaken a course to enable her to provide this training for all staff and dates will be arranged. Staff files for two newly appointed staff were looked at. These contained a Protection of Vulnerable adults check,(POVA 1st) a Criminal Records Bureau check and a full employment history. However only one written reference had been obtained for each staff member before they commenced work at the home. Two verifiable written references must be Care Homes for Older People Page 15 of 22 Evidence: obtained so that management were aware that the person was safe to work with elderly people. The manager agreed to have the staff concerned working supervised until a second reference had been obtained. Care Homes for Older People Page 16 of 22 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new manager must be registered with CSCI and staff training in safeguarding adults needs to be addressed so that staff know what to do in case of residents being mistreated. Evidence: There is a new manager who has been in post since since September 2008. She ihas applied to be registered with CSCI. She is an experienced registered nurse and has been working as deputy manager for some time at the home. She has applied to attend the leadership and management course for registered managers. The home has staff meetings every three months so that staff are kept up to date with all areas of the home and they can share their views. A resident/relatives meeting has not as yet taken place since the manager has been in post. Questionnaires have been sent out to residents and their relatives so that they can give opinions on the running of the home. Care Homes for Older People Page 17 of 22 Evidence: An audit of all areas of the home has been completed by the manager since she came in to post and an action plan has been formulated so she can improve on areas she felt were not up to standard. The home has student nurse placements from John Moores University and a training plan is in place for the students whilst they are at the home. Appraisals are taking place and formal supervision is also taking place on a regular basis so that the staff can feel supported and their training needs discussed. Staff have not received up dates in safeguarding adults so that they know how to recognise if people are being mistreated.The manager has undertaken a course to enable her to provide this training for all staff and dates will be arranged. All new staff must have two written references before they commence work at the home so that people employed are safe to work with elderly people. The home does not deal with any residents monies. The AQAA received from Mayfield states all health and safety checks are in place. Care Homes for Older People Page 18 of 22 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 19 of 22 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medicines with a short shelf life must be dated and signed when opened To make sure that medicines are not out of date. 07/01/2009 2 9 13 The medicine fridge must be 07/01/2009 kept locked. Medicine trolleys must be secured to the wall with locks provided. So that medicines are secured safely. 3 18 13 All staff who work at the home must receive training about safeguarding vulnerable people from abuse. This is to make sure they are fully aware of their responsibilities and know what to do to make sure the pepoel who live at Mayfield are protected. 04/02/2009 Care Homes for Older People Page 20 of 22 4 29 19 All Staff must have two written references in place before they commence working at the home. So that people who are employed are safe to work with vulnerable people. 17/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Clear, full and accurate information about pressure wound care should be recorded in residents care plans so there is up to date information about which prescribed dressings to use on the wound and how often these are to be changed. Care Homes for Older People Page 21 of 22 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 22 of 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!