CARE HOMES FOR OLDER PEOPLE
Mayfield Nursing Home 3 Central Avenue Eccleston Park Prescot Merseyside L34 2QL Lead Inspector
Mrs Joanne Revie Unannounced Inspection 6th February 2006 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.V282660.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mayfield Nursing Home DS0000005464.V282660.R01.S.doc Version 5.1 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.V282660.R01.S.doc Version 5.1 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 21/11/05 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.V282660.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and focused on those core standards which were not assessed during the previous visit in November. This visit lasted two and a half hours. For an overview of the service the reader should refer to both reports. . Discussions were held with the manager and the deputy manager. A variety of records were viewed which will be referred to in the evidence section of this report. Brief discussions were held with three residents. Their comments are included in the summary section of the report. One requirement was made following the last inspection. The timescale for completion was given as the 31st of March 2006. The service had made some progress in addressing this but has not completed, as the timescale had not expired. For this reason this requirement is shown as outstanding on this report and will remain like this until it has been evidenced that it has been addressed. What the service does well:
Medications are managed safely by the service. A named nurse is responsible for overseeing the management of medication, which shows that the service takes the management of medications seriously. Staff are proactive with their care by carrying out random blood sugar tests for those residents who are diabetic. Residents are offered a choice of nutritious meals, which they enjoy. The cook, who visits residents daily, discusses options available. Residents are asked their opinion of the food on a monthly basis. This shows that the service values the resident’s opinion. Comments made by the residents regarding food included” its very tasty”, “ They try very hard to please” and “ they’ll always find something nice for me if I don’t want what’s on offer”. Complaints are managed effectively by the home. All concerns are taken seriously. Mayfield Nursing Home DS0000005464.V282660.R01.S.doc Version 5.1 Page 6 The service has robust recruitment procedures which means new staff are selected carefully. Support is given to them during the three-month probationary period and training is undertaken so that they have a basic knowledge of how to keep residents users safe and meet basic needs. The performance is monitored closely during this period. All of this helps to ensure that the residents are in “ safe hands”. The service develops staff by offering training to all. Much of this training is designed so that staff know how to care for the residents needs. A qualified nurse who is an experienced manager and has achieved a recognised management qualification manages the service. CSCI have agreed that she is “ fit” to manage the home. Every year the provider asks relatives and residents of their opinion of the care offered by the service. Their views are acted on which is further proof that resident’s views are listened to. What has improved since the last inspection? What they could do better: Although medications are managed well this could be further enhanced by recording the temperature of the medication fridge on a daily basis. The yearly survey could be further enhanced by including the opinions of staff that work at the home and health care professionals who visit regularly.
Mayfield Nursing Home DS0000005464.V282660.R01.S.doc Version 5.1 Page 7 Records of personal allowance entitlements are brief and in many cases nonexistent. This must addressed. Clear records must be kept within the home, which show any entitlement, how this is received and how it is spent. 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.V282660.R01.S.doc Version 5.1 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.V282660.R01.S.doc Version 5.1 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): EVIDENCE: No standards were assessed from this section on this occasion Mayfield Nursing Home DS0000005464.V282660.R01.S.doc Version 5.1 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): 9 Medicines are managed safely however some small improvements could be made. EVIDENCE: The medication storage systems, medication fridge and records were viewed. Records showed that nursing staff randomly performs Blood glucose checks for those residents who are diabetic. The Controlled drugs register showed that nursing staff understand the importance of correctly recording and monitoring stock levels. One named nurse is responsible for overseeing the management of medication. Medication administration records wee completed to a good standard. Staff are checking the temperature of the medication fridge is within the safe zone daily but were not recording what the temperature is. This was discussed with the manager. A set of clear guidelines regarding the ordering, receipt and disposal of medication was available and viewed.
Mayfield Nursing Home DS0000005464.V282660.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Residents receive a choice of food that they enjoy EVIDENCE: Menus were viewed. A discussion was held with the cook. A tour of the environment was undertaken. Brief discussions were held with three residents. A menu board is completed on a daily basis stating what the choice of meals will be for that day. The cook visits all residents in the morning to offer the choice to each resident. Two residents confirmed this to be true. The diet on offer is wholesome and nutritious. Three residents confirmed that they enjoyed the food on offer. The manager and cook agreed that monthly food satisfaction surveys are carried out to ensure that the residents are happy with the standard and choice of food available. The home has two dining rooms. Both were viewed and were set with tablecloths and condiments. Both had a relaxed atmosphere. Staff were observed to support residents appropriately. Mayfield Nursing Home DS0000005464.V282660.R01.S.doc Version 5.1 Page 12 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): 16 Staff understand how to investigate and manage complaints effectively. EVIDENCE: The home has a complaints policy. This was displayed in a prominent area of the home. The complaints book was viewed. No complaints have been made against the service, to the service or CSCI since the last inspection. Viewing this book showed that any complaints made are recorded, dated, along with actions taken and outcomes. Mayfield Nursing Home DS0000005464.V282660.R01.S.doc Version 5.1 Page 13 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): No standards were assessed from this section on this occassion. EVIDENCE: Mayfield Nursing Home DS0000005464.V282660.R01.S.doc Version 5.1 Page 14 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): 29,30 The service has robust recruitment procedures. Staff are trained to meet the residents needs. EVIDENCE: Staff personnel files and training records were viewed. Discussions were held with the manager and the deputy manager. Each staff personal file viewed contained the information required to meet the care home regulations 2000.The files were organised to a high standard so information could be found quickly. The manager stated that all new staff are allocated to a mentor. A qualified nurse oversees this process. Records exist to prove this statement. New staff attend an induction day, which covers the topics that are advised by T.O.P.P.S. The deputy manager confirmed that she acts as training officer for the service. Records showed that training topics are offered on an almost monthly basis and that a great variety is available. The training records showed that the training offered is designed to meet the needs of older people. Other training is also offered to enable qualified staff to maintain their professional status. Mayfield Nursing Home DS0000005464.V282660.R01.S.doc Version 5.1 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 The service is managed by a manager who has the skills and ability to do so. Resident’s opinions on the service are sought and acted on. Little information is available to decide whether residents are receiving their full personal allowance entitlement. EVIDENCE: The managers file was viewed which showed that she maintain her professional status by undertaking further training and that she has achieved Level 5 NVQ in management. The manager is registered as “ fit” to manage with the CSCI. Mayfield Nursing Home DS0000005464.V282660.R01.S.doc Version 5.1 Page 16 Discussions with the manager and reviewing documentation showed that the provider requests the views of residents (where appropriate) and relatives every year to gain their opinion of what the home offers. This is then produced in a report format and made available for viewing. A copy of this was viewed in the Homes Statement Of Purpose. The manager confirmed that staff are not included in the survey nor are health care professionals who visit the home. Little documentary existed in the home to show the amount of personal allowance each resident was entitled to- How this was received and managed or spent on their behalf. The manager stated that the provider oversees such matters. Mayfield Nursing Home DS0000005464.V282660.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 1 X X X Mayfield Nursing Home DS0000005464.V282660.R01.S.doc Version 5.1 Page 18 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 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. The provider must ensure clear records are kept in the home of each residents personal allowance entitlement. How this is received and if appropriate spent on behalf of the residents Timescale for action 31/03/06 2 OP35 17(2) schedule 4-9a 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Staff should record the actual temperature that the medication fridge reaches within a 24-hour period to ensure that the fridge stays within the range of 2- 8 degrees.
DS0000005464.V282660.R01.S.doc Version 5.1 Page 19 Mayfield Nursing Home 2 OP33 The provider should consider surveying Staff and Health care professionals for their view of the service offered. Mayfield Nursing Home DS0000005464.V282660.R01.S.doc Version 5.1 Page 20 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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