Inspection on 19/07/06 for Melford Court Nursing Home

This inspection was carried out on 19th July 2006.

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

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

Other inspections for this house

Melford Court Nursing Home 17/07/07

Melford Court Nursing Home 27/10/05

Melford Court Nursing Home 12/05/05

Melford Court Nursing Home 17/01/05

Melford Court Nursing Home 16/06/04

Similar services:

Henrietta House

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Melford Court Nursing Home Hall Street Long Melford Sudbury Suffolk CO10 9JA Lead Inspector Deborah Seddon Unannounced Inspection 10:00 19th July 2006 and 20th July 2006 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 Melford Court Nursing Home DS0000024445.V304470.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. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Melford Court Nursing Home Address Hall Street Long Melford Sudbury Suffolk CO10 9JA 01787 880545 01787 881845 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) www.bupa.com BUPA Care Homes (BNH) Limited Mrs Susan H Whitney Care Home 52 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (52), of places Physical disability (2) Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 1 The Home is registered to provide care for two (2) service users with physical disability (PD) aged from 45-64. 3 The home may accommodate seven named service users with dementia (DE,E) as detailed in correspondence dated 24/11/04. 27th October 2005 Date of last inspection Brief Description of the Service: Melford Court is situated in the town of Long Melford. The frontage of the Grade II listed building forms part of the main street, enabling service users to have easy access to the local shops, library, church, restaurants and public houses. There is limited parking to both the front and side of the home. The enclosed courtyard and garden area, run along the side of the home. Melford Court was purchased by BUPA from the Community Hospitals Limited in 1997, and has undergone extensive refurbishment. The home is situated on two floors and consists of 45 en-suite bedrooms, 38 of which are singles and 7 doubles. The home provides assisted bath and shower facilities, extra communal toilets, a dining room, three lounge/activity rooms and a hairdressing room. Access to the first floor is via stairs or passenger lift. Mrs Susan Whitney manages the home. She is a Registered General Nurse, with a Bachelor of Science degree in nursing with experience of working in the National Health Service and private sector. The home is registered as a care home with nursing providing care primarily to a maximum of 52 older people, however is also registered to provide care to seven named people with Dementia within this number. The home at the time of writing this report has 41 people residing in the home. The home has a statement of purpose and a BUPA brochure providing detailed information for prospective service users. Residents moving into the home are provided with a welcome gift pack of toiletries and a service user guide providing details to familiarise them with the service provided in the home and the last inspection report from the Commission for Social Care Inspection (CSCI). Each service user has a contract, which specifies their agreed fees and how much they are expected to pay on a weekly basis. Fees are calculated depending on the needs of the resident; they range from £420 – £800 per week. These do not cover resident’s outgoing phone calls and services such as the hairdresser, chiropodist, physiotherapist and receipt of daily newspapers. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over two days, lasting a total of thirteen and a half hours. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from 17 residents ‘Have your say about’ comment cards and 4 relatives/visitors comment cards. Evidence was also obtained reviewing the progress of the requirements made at the last inspection in October 2005 and other documents required under the Care Homes Regulations 2001. Additionally a number of records held at the home were looked at including those relating to residents, staff (which included an audit of all staffs’ Criminal Record Bureau (CRB) checks) training, medication and a selection of policies and procedures. Time was spent talking with the manager, nine residents, five relatives who were visiting, seven members of staff and two people on work experience placements from a local school. What the service does well: The overall service provided at Melford Court is good. The home continues to provide a welcoming and friendly atmosphere for residents to live. There is a range of comfortable communal areas and private accommodation, which are personalised to suit the resident’s tastes. Generally the home is well presented, clean and tidy with no unpleasant odours. Residents spoken with were aware of the existence of their care plan. These provided detailed information about them, which was current and relevant to their individual care needs. Evidence was seen that these were being regularly reviewed. Information in the care plans is supported by detailed risk assessments informing staff of the actions they need to take to support residents to maintain their independence but minimise risks to their health and safety. Comments about the home were mostly positive; these were obtained through feedback from comment cards and conversations with residents and relatives during the inspection. The feedback was complimentary about the service offered and the conduct of the staff. Comments ranged from “It is a lovely clean home, food is ever so good, I have plenty of choice” and “Staff are very kind and competent”,” the home is very well organised and competently run” and “I am very happy here, it is a kind and caring home”. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6, Quality in this outcome area is good. The home has detailed information and processes in place for prospective residents to make a decision to move into the home and for short-term care. Residents can expect to have a needs assessment undertaken prior to admission, which forms the basis of their care plan and whether or not the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose, Service User’s Guide and a BUPA brochure providing information for prospective residents. Residents moving into the home are presented with a welcome pack of the Service User’s Guide and a gift of toiletries. The Service User Guide contains relevant information for the resident moving into the home about the service provided. It contains a copy of the BUPA terms and conditions of residence and a copy of the complaints procedure. Evidence was seen that residents or their nominated representative had signed the terms and condition of residence acceptance form. Residents are informed of the weekly amount they have to pay to live at the home when moving in and are kept informed annually of any increase in fees. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 9 The care plans and personal files of four residents were inspected to track their care and the level of support they require. Evidence was seen in each of the files that pre-admission needs assessment had been completed and the information formed the basis of the resident’s care plan. The care plan of one resident tracked showed they had been introduced to the service for respite through social services. Their spouse was present at the inspection and discussed the gradual transition to move into the home permanently due to the deterioration in their health. Residents are encouraged to visit the home before making a decision to move into residential care. One resident spoken with had moved to the home from hospital and their relative had visited the home on their behalf. Melford Court is registered to provide care for seven named residents with a diagnosis of dementia. During a tour of the premises the inspector spoke with a number of residents whose behaviours suggested varying levels of confusion and memory impairment. A discussion was held with the manager about the number of residents that may have developed dementia whilst living at the home. The manager was advised to assess how many residents have developed dementia. They will also need to demonstrate that they can continue to care for the residents. The numbers of people with dementia must be accurately reflected in the service users guide and statement of purpose. The home does not provide intermediate care, although they do have one respite bed for convalescent care. The room is situated at the front of the house and does not impact on the other residents. Private paying residents use the respite facility regularly. This service is reflected in the home’s statement of purpose and service user guide. The home has four beds that they keep for social services referrals, however they do not have a spot contract. The manager felt due to cut backs they were not getting as many referrals. The home is registered for 52 residents, although current occupancy is 41. The home is in the process of creating two double rooms into deluxe bed-sits, which the home intends to promote as additional private respite accommodation. These rooms are situated at the front of the building on the first floor and will not impact on the permanent residents living in the home. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 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): 7,8,9,10,11, Quality in this outcome area is good. Residents can expect to be treated with dignity and respect. Residents can expect to have their health and personal needs identified, be supported to have access to healthcare services and have their needs reviewed on a regular basis. Residents and their families can expect to be supported with care and sensitivity at the time of their death. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of four residents were sampled. At the front of each care plan there is a resident’s profile sheet with the details of the resident’s next of kin and general practitioner (GP), past medical history and known medical conditions. The care plans were made up of different sections, which included issues around the resident’s social and health and personal care needs. Each of these headings was further explored in detail to form the care plan focusing on the resident’s assessed needs and evaluation of the support required. These are being reviewed on a monthly basis. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 11 Care plans are kept by the resident in their room so that they can be read at any time. Residents spoken with were aware of the existence of their care plan. Each resident is allocated a designated key worker who is responsible for updating the information with the resident and where applicable family members. One of the residents tracked was observed sitting comfortably in their armchair in their room. They have limited communication; therefore it was difficult to obtain the residents views. The inspector observed a chart held discreetly in their room, which showed a detailed record of the resident’s food and fluid intake, continence and pressure area care. Due to their condition the resident required liquidised meals, a record of their food intake was recorded and evidence was seen that they were receiving their nutritional supplement drink as prescribed by the general practitioner (GP). The resident had been provided with pressure-relieving equipment on their bed and a cushion for the armchair. Their care plan showed that they had been assessed for the prevention of pressure sores using the waterlow pressure care scale. The nutritional plan in the care plan of another resident reflected that they had lost weight. Their weight chart showed a loss of 5kg between January and May 2006. To prevent further weight loss the plan stated that the resident is encouraged to eat soft snacks and drinks between meals and have easy chewable and tasty meals. The resident had been prescribed a high-energy nutritional supplement called Calogen. The weight chart reflected that in June 2006 the resident had gained 2kg. Each resident has a separate risk assessment folder. The risk assessment folders for two of the residents being tracked were looked at There was evidence that assessments had been undertaken for moving and handling, safe use of bedrails, pressure relieving equipment and in the case of one resident safe use and working procedure for their wheelchair. Permission for the use of restraint for bed rails and use of lap strap whilst using their wheel chair had been obtained. Evidence was seen that these risk assessments were being reviewed on a regular monthly basis. The care plans contained a section for the record of care involving outside agencies. Regular entries were seen for GP visits, dentist and chiropodist appointments. The seniors have a separate diary, which provided evidence that residents are supported to attend healthcare appointments. For example, entries for the week beginning 17th July, one resident was scheduled to go to the dentist; two residents required urine samples and another had a GP appointment to review their medication. The inspector spent time with the deputy matron observing the administration of the morning medication. The Medication Administration Record (MAR) sheets were examined and seen to have been accurately completed. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 12 The inspector observed the deputy matron take the residents pulse before administering their Digixon, and recorded on the resident’s MAR chart. Whilst administering the medication the inspector observed the deputy matron administer ‘Calogen’ a dietary supplement that contains 200 calories per 20 millilitres. Several of the residents were prescribed Calogen. However it was noted that the deputy dispensed doses for two residents out of the same residents bottle. The deputy informed the inspector the other resident had run out and they had ordered more. The home has a medication room with a separate locked cabinet for controlled drugs. The controlled drugs book was seen reflecting the resident’s name, dates, type of drug and the quantity held. The stock of two service users being tracked was seen, checked and found to be accurate. The home has a safe system in place for the disposal of drugs. All medication, that is unused or soiled is stored separately in a locked cupboard. Two senior staff grinds the unused tablets into a powder using a grinder, which is then added to a container called a doop kit, which contains a gelling agent. The container is then two thirds filled with water. The medication and water turns into a gel, unused liquid medication can also added. The same company that collects all clinical waste from the home collects the doop kits. A risk assessment has been completed providing a safe system of disposing of the medication, which involves staff having the appropriate protective equipment whilst grinding the medication. Evidence was seen throughout the inspection that staff treat residents with respect. Staff were observed speaking to residents showing care and patience. A visitor told the inspector that staff always knock before entering their spouse’s room, they always draw the curtains and ask them to leave whilst attending to their spouse’s personal care. Staff were observed calling residents by their preferred name and were respectful to their level of understanding, especially when speaking with residents who showed signs of confusion. Evidence was seen that residents had their own telephones in their rooms to make private calls. One resident spoken with had a telephone with large numbers enabling them to use their phone unaided. They told the inspector they used their telephone a lot to keep in contact with family and friends. The home has an induction loop system to enable residents with hearing difficulties to access the phone. The home has a policy and procedure for dying, death and bereavement, which gives guidelines to staff to ensure that resident’s wishes are respected at the time of their death. Each care plan has a section where the requirements of the individual in the event of their death are discussed and recorded. Evidence was seen at the inspection that family members were able to stay with their relative who was in the last stages of their life. The resident looked peaceful and comfortable, the family spoken with were very complimentary about the home and the staff in the treatment of their relative. Melford Court Nursing Home DS0000024445.V304470.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is adequate. Residents can expect to live in a home that supports a life style that matches their expectations. Improvements have been made for residents diagnosed with dementia to be involved in activities appropriate to their needs. However there needs to be improvements in the standard and provision of food taking into account the needs of all residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was made at the last inspection for the home to consult with residents on a programme of activities that included local, social and communal activities appropriate to their assessed needs. The activities co-ordinator informed the inspector that they have instigated a small reminisance group where residents are encouraged to discuss old photographs and books. They also hold a coffee morning, which has proved popular with all residents discussing life in the past. Time has been structured so that the activities staff spend time with residents with dementia on a one to one basis. Staff spend time with the residents engaging in activities that involve touch and other senses to engage them in an activity such as flower arranging, giving them a hand massage and manicure. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 14 Other resident’s have enjoyed going for a walk around the village shops including the local supermarket, which promoted a discussion about the variety of foods now available compared to when they were younger. The activities coordinator informed the inspector they had attended an age exchange one-day training workshop for a general introduction and practice of reminisance work. Concerts are held every month. A singer and pianist were seen entertaining a group of residents in the dining room on the first day of the inspection. Several of the residents were observed enjoying the occasion and joining in with the songs. A weekly activities programme was advertised on the residents’ notice board, including movement to music twice a week, a pamper and sensory day, visual art, holy communion, access to the library and visits to the Women’s Institute (WI) on Fridays. The inspector was informed that residents had also enjoyed a trip to Abbey gardens, a mid summer party where strawberries and cream were served and a trip to Felixstowe. Activities that take place on a regular basis are bingo and card games. BUPA have committed to additional funding for staff hours for weekend activities. Residents take part in community-based activities within the village as they occur. They have recently been involved in the Street Fair and attended a garden fete. One resident spoken with informed the inspector they did not choose to join in any of the activities or outings, they were content being in their room, they had lots of friends and visitors and that they never felt lonely. Art link are a group of people supported by the Arts Council promoting arts in the community. The Art Link group has visited the home providing Movement to Music and English sessions. The English group wrote a poem with each resident contributing by writing a line. The Art Link group is returning for another 2 sessions in August. The activities staff are to attend a workshop to learn how to plan and develop future sessions for the residents. A requirement was made at the last inspection about the differing standard of meals served in the upstairs dining room, resident’s rooms and the main dining area. Some improvement has been made, and the provision of meals was discussed with the cook and the manager. A recent complaint remarked about the “over cooked dried up food”. The inspector joined residents for lunch, the presentation of the food varied, the fish was hard and crispy and residents were seen struggling to cut up their fish. The residents’ comments about the food were varied, “not bad, food quite good” and “well cooked but not marvellous”. However, some thought the food be of a very good standard. The fish had been kept warm on the top of the Ban Marie on the hot food trolley and had become baked and crisp. One resident commented when served their lunch “the cauliflower is brown, wouldn’t eat it would you?” The cook explained that they had roasted the cauliflower, however this was not explained to the resident, the cauliflower did not look appetising or fresh. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 15 Consideration needs to be given to residents on how they are supported to maintain their independence but at the same time have the support they require to enjoy their food. Particular thought should be given to residents who are confused or have a diagnosis of dementia where they may be unable to manage the food or cutlery provided with additional support, adapted cutlery and finger foods being provided. Residents were observed having difficulty to open sachets of condiments such as tarter and tomato sauce, which had been placed on the table. The inspector gave the cook a booklet containing useful information produced by the Commission for Social Care Inspection (CSCI) called In Focus - Improving meals for older people in care homes to give them some ideas to improve the service. There has been some improvement in the provision of meals in the upstairs dining area, residents were observed being supported to eat their meal and staff were sitting with individual residents and engaged in conversation. Concerns had been raised before about the number of residents sitting in unsuitable easy chairs with a tray in front of them to eat their meal. Only one resident was seen sitting in an easy chair with a table, however this was their preferred choice and how they liked to eat their meal. The meals for both days of the inspection were seen. Both days had a starter of fresh homemade soup. Residents could make a choice of Spaghetti Bolognaise or breaded plaice with chips and peas, followed by chocolate pudding or fruit cocktail. Steak pie and vegetables or vegetable pasta bake were the choice the following day. One resident had requested a jacket potato and two had chosen salads. Fresh fruit salad and ice cream were available for dessert. There is a four-week rolling menu. The cook was aware of resident’s special diets and provided diabetic alternatives, soft foods and liquidised meals. Liquidised meals were provided in separate portions so that residents could distinguish between the different colours tastes and textures. However whilst observing one resident eating their meal, they commented that they did not know what they were eating. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 16 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): 16,18, Quality in this outcome area is adequate. The service has detailed complaints and adult protection policies and procedures in place, which meet the National Minimum Standard and Regulations. However there was no recognition of the need to make the appropriate referrals to the adult protection team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a detailed complaints procedure. The process is described in a BUPA leaflet, which is issued along side the service users guide. The complaints log was seen and evidence shows that the home has received four complaints since the last inspection in October 2005. The manager had investigated one complainant. Records show that outcome. A complaint was in the manager from another BUPA home a former resident. complaint and an apology was made to the the complainant was satisfied with the process of being investigated by a senior in relation to a complaint from a relative of A complaint had been made to the Commission for Social Care Inspection (CSCI), which was passed to the manager to investigate. The outcome of the investigation will be fed back to the complainant. The most recent complaint was made by a resident about a member of staff who has been suspended pending an investigation. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 17 The home has a BUPA policy called ‘Abuse of a Resident’ dated September 2003. The policy deals with the management of allegations of abuse in line with the Department of Health (DH) guidance ‘NO Secrets’. It directs staff to acquire a copy of the relevant department’s local guidelines, which should be read in conjunction with the homes policy. Evidence was seen that the home has a copy of the Suffolk inter agency policy directing staff to raise any allegations of abuse to the Customer First, Social Services team. The manager has recently informed the Commission for Social Care Inspection (CSCI) that two residents had been subject of theft. They both had substantial amounts of money go missing. The police were notified and the incidents are still being investigated. The manager had not made a protection of vulnerable adults referral. This was discussed at the inspection and they explained they had not made the connection that the thefts were financial abuse, subsequent referrals have now been made to the Customer First team. Copies of the referrals have been forwarded to the Commission for Social Care Inspection (CSCI). To ensure that residents are protected from abuse, additional adult protection training has been arranged to take place in August 2006. All staff are expected to attend as a refresher course to raise their awareness to all types of abuse and their responsibility to report all allegations and incidents of abuse to the appropriate people involved in the protection of vulnerable adults. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 18 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): 19,20,21,22,23,24,25,26, Quality in this outcome area is good. Residents can expect to live in a wellmaintained and welcoming environment, which provides a good range of communal and personal accommodation. Where there are issues about resident’s safety these have been identified and processes are in place to minimise the risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the environment was made. There is a welcoming and friendly atmosphere within the home and it is nicely presented both inside and out. The front of the house has recently been redecorated and the driveway has been resurfaced. All areas of the home are clean and tidy with no unpleasant odours. The gardens are landscaped and well maintained providing a nice environment for residents to walk and sit in the nicer weather. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 19 The home is on two floors and has forty five en-suite bedrooms. Thirty-eight of the rooms are for single occupancy and seven are double rooms. Two of the double rooms are currently being used as singles and there are plans to convert two other double rooms into deluxe private bed-sits. These rooms are intended to offer private accommodation as a single or double room with ensuite showers. Evidence was seen that the three rooms currently being shared have screens available and residents were satisfied that staff are able to maintain their dignity and privacy when assisting them with their personal care needs. Concerns were raised in a relatives and residents comment card prior to the inspection about the process of a resident being moved as a result of shared space becoming vacant. The concerns reflected a room, which is to be made into one of the bed-sits. The process of how rooms are allocated was discussed with the manager. The manager informed the inspector that that situation has been resolved and the resident has been offered a single room, which was agreed at a review meeting with the relatives and social worker. All bedrooms have en suite toilets and sinks. Seven of the bedrooms have ensuite bathrooms fitted with Apollo baths. The manager explained they are in the process of replacing these with showers due to problems of using mobile hoists that do not fit under the bath. Two bedrooms are fitted with en suite showers. The home has three communal assisted baths upstairs and two downstairs and communal shower facilities on each floor. Extra toilets are available. Other communal rooms include a dining room, three lounges, an activity room and a hairdressing room. Access to the first floor is via stairs or passenger lift. The inspector was able to visit and speak with several residents and relatives in the privacy of their rooms. Resident’s rooms seen were nicely decorated and personalised with the resident’s own possessions. However, one relative commented, “my [spouse’s] room begins to look a bit tatty”. The upstairs corridor and landing needs redecorating, especially the paint work around the doors and skirting boards. This was discussed with the manager who acknowledged this and confirmed that there is a programme in place for the redecoration of the home. One resident spoken with told the inspector Melford Court is “a lovely clean home”. All corridors, bathrooms and toilets had grab rails positioned to provide additional support for residents to help them maintain their independence. The home provides accommodation that can meet the needs of residents that are wheelchair users, one resident was observed moving freely around the home in an electric powered wheelchair. The corridors are wide and there are suitable exits for wheelchairs users to access the gardens. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 20 Evidence was seen that the home provides equipment to meet the needs of the residents; beds that are adjustable in height and pressure relieving equipment on beds and armchairs were seen in use throughout the course of the inspection. Hot water temperatures were found to be varied and the maintenance person was monitoring these. They showed the inspector their records, which reflected that some of the water temperatures were too high, in one bathroom the temperature ranged between 33.1 degrees centigrade to 53.2 degrees centigrade. The maintenance person is monitoring the temperatures and resetting the thermostatic valves accordingly. They had discussed the issue with the manager who has allocated a budget to replace the thermostatic valves and the maintenance person is in the process of obtaining quotes. Three fire doors were found to be wedged open, one was to a resident’s bedroom and the other two were to communal areas the lounge and the upstairs dining room. This was discussed with the manager who informed the inspector that these have been assessed as part of the fire risk assessments undertaken for all BUPA homes and have been identified to have fire door guards fitted. Comments about a resident not having access to their call bell had been identified in the relatives and visitors questionnaire, which was received prior to this inspection. Evidence was seen during the inspection that in most cases residents had access to their call bells, however some residents were seen in their bedrooms without a call bell situated within reach. One resident was observed sitting in their armchair and their call bell was on their bedside table. Another issue raised was the length of time a visitor’s friend had to wait to have their call bell responded to, they felt that this was a particular problem at weekends. These issues were raised with the manager who informed the inspector that they have installed a new pager system, which monitors the call and response times. The home has good procedures in place to prevent and control the spread of infection. There is a main laundry room on the ground floor that has a washing machine with a sluice cycle. The home uses red dissolvable bags for soiled laundry these are put directly into the machine for sluicing. Staff have access to hand washing facilities with liquid soap or alcohol and paper hand towel dispensers situated in every bathroom and toilet. All waste is disposed of in yellow bags situated in the sluice rooms around the home and collected on a regular basis by a clinical waste company. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30, Quality in this outcome area is good. The home has an established staff team, available in sufficient numbers that are trained to meet the specific needs of older people. Residents can expect to be protected by the home’s recruitment and selection of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comments had been raised in visitors comment cards about staff shortages. Staffing levels were discussed with the manager. The current staffing ratio is generally 11 staff in the morning and 8 staff on the evening shift with 5 staff on the night shift. The number of staff on duty generally reflects the number of residents, the home currently has 7 vacancies and vacant rooms for respite making the current occupancy of 41 residents, staffing levels have remained the same as for full occupancy. The manager explained there had been occasions where numbers of staff had been lowered due to staff sickness. Attempts are made to cover sickness however this is not always possible at short notice. The staff roster was seen for the first day of the inspection, which reflected 7 care staff with 1 senior and the deputy making 9 on the early shift. Seven care staff and 1 senior made 8 on the late shift. 3 carers and 2 senior staff were on nights. Senior staff are qualified nursing staff. The roster for July and August reflected numbers were set at 11 and 8. Additionally there are 4 catering staff on duty between the hours of 7am –7pm and 4 housekeeping staff with 3 at weekends. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 22 The inspector met two young adults on work experience placements. One had enjoyed working with the staff in the kitchens. The other had been shadowing staff on care. They felt the best part of the placement was being able to spend time talking with the residents. Four staff files were inspected and a selection of 34 staff supervision records. Of the files and supervision records seen evidence showed that eight care staff had completed the National Vocational Qualifications (NVQ) at level 2; with one member of staff due to complete in October 2006. Two had completed level 3. Fifteen staff held a nursing qualification. The inspector spent time with a new member of staff. They have recently been employed to work as a bank member of staff. They had worked at the home previously but had left to pursue a different career. This was their third day of their induction, they spoke well of the home and the support and training they received. They had completed a moving and handling and fire safety course and were looking forward to attending other mandatory training as part of their induction and foundation. The home has good recruitment procedures in place. Evidence was seen that employment policies and procedures are followed and the four staff files seen had evidence of a job application, identification, contract of employment, authorisation for appointment and two written references. In the case of a recent employee evidence was seen that a new work permit from the home office for an overseas staff had been requested and granted. An audit of all staff’s Criminal Records Bureau (CRB) checks was undertaken. In the case of two staff prior convictions were listed. These had been followed up and investigated by the homes manager in line with advice from BUPA human resources department. The majority of the CRB’s were dated between 2004 and 2005, a discussion was held with the manager about the process of renewal of CRB’s to include a Protection of Vulnerable Adults (POVA) check. The manager informed the inspector that BUPA are introducing a programme of renewal every 3-5 years. Training records confirmed that staff do attend training on a regular basis relating to the care of older people. Training covers a wide range of issues most recently administration of medication, health and safety, infection control, nutrition, practical issues in wound care and safe use of wheelchairs and bedrails. Seventeen staff had completed a distance learning course in Dementia Care and eight have enrolled to undertake a Certificate in Dementia Awareness level 2. The course comprises of 4 units covering, understanding dementia, understanding person centred care, understanding and responding to behaviour that is challenging and applying person centred approach to every day care activities. All staff work towards completion of parts 1, 2 and 3 of the BUPA personal best programme. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 23 The home employs staff from overseas who are sponsored by BUPA personal health service to undertake a conversion course before they can obtain their registration as a nurse in the United Kingdom. Relatives and visitors have raised their concerns about residents not being able to understand staff due to language differences. The manager informed the inspector that they are intending to discontinue using conversion as a means of employing staff, but in the mean time the issues of communication are being addressed with individuals at supervision. All staff from overseas have attended an English and report writing course run by the Learning skills Council as part of their on going development. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 24 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): 31,32,33,34,35,36,38, Quality in this outcome area is good. Residents can expect to live in a home that is well managed and have their healthy, safety and welfare protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Susan Whitney is the registered manager. She is a registered general nurse with a Bachelor of Science degree in nursing with experience of working in the National Health Service and the private sector. She has obtained a variety of certificates in personnel, management, nursing, food hygiene and health and safety and National Vocational Qualification (NVQ) Assessors Award. She joined the staff team at Melford Court in 1991 and became the matron in 1997. Evidence was seen in the training file that the manager continues to undertake periodic training to update her skill, knowledge and competence managing the home. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 25 The home has a resident and relatives meeting held on a quarterly basis in the evening. The manager informed the inspector that relatives unable to attend are posted a copy of the minutes so that they are kept informed of decisions made about the home. The minutes for the last meeting held on the 17th November 2005 were seen displayed on the resident’s notice board. The next meeting had been scheduled for 12th April, the manager informed the inspector there had been no attendees therefore the meeting was cancelled. BUPA has quality assurance and monitoring systems in place. The survey covers all areas of the service covering a range of topics, for example, the quality of service provision, friendliness of staff, staff’s knowledge of residents needs, promptness of staff response, meals, administration, laundry services, cleanliness and maintenance of the home and grounds. Following the audit a plan is created to address issues that require action. The area manager regularly checks the action plan when they visit to complete their monthly check of the home. The home has a system in place that supports residents to manage their personal allowances. The administrator manages a personal allowance account for 75 percent of the residents. Other residents choose to have their family support them to manage their finances and two residents have the support of a Power of Attorney. Resident’s monies are paid into a central bank account held at BUPA head office. The administrator has access to the personal allowance accounts via the computer and they monitor the accounts on a monthly basis and adds the individual interest for each resident. They liaise with family members to ensure that the resident has sufficient funds in their account. The accounts are used for sundries such as hairdressing, trolley shop and other personal items they may require. Residents are able to withdraw funds from the office safe, which are deducted from their accounts. Withdrawals are made with the resident’s agreement and signature, if they are unable to sign two staff sign to witness the withdrawal of the money. Residents are provided with a bedside cabinet with a lockable draw to keep small amounts of money. The administrator demonstrated that home’s finances and accounting procedures are effectively managed in line with BUPA policy. The home has a business plan and financial manual that the administrator uses to ensure their paperwork is correct and up to date. All invoices received by the home are checked and sent to head office for payment. BUPA carries out an internal financial audit annually; the last audit was undertaken in September 2005 all records were found to be correct. The home’s public and liability insurance certificate was seen and is valid until June 2007. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 26 Staff supervision records were seen. The home has introduced a new format. Each member of staff is scheduled to receive bi monthly supervision sessions. Evidence was seen that supervisions were taking place which covered practice issues about care and philosophy, communication skills, key work duties, team work, customers service including progress of the individuals achievements of the personal best, training, areas of improvement or concern and review of previous objectives. Evidence was seen during the inspection that the health, safety and welfare of residents is protected. Detailed risk assessments and regular staff training is in place ensuring the safe working practices for moving and handling, fire safety, use and storage of wheelchairs, bedrails and infection control. The home has a policy and procedure in place for dealing with infection control, however the inspector was advised this is in the process of being updated. Staff spoken with were very clear about the procedure for dealing with clinical waste and dealing with personal hygiene of residents who had contracted Methicillin Resistant Staphylococcus Aureus (MRSA) and in the case of one resident recently discharged from hospital, Clostridium Defficule. Time was spent with the cook who showed the inspector records of how the home managed the receipt, storage, preparation and cooking of food. The food stores seen held a wide range of dry, fresh and frozen foods. All were being stored appropriately and in line with food safety regulations. The accident folder provided evidence that all accidents, injuries and incidents were being recorded and reported. Detailed records of maintenance around the home are kept; evidence was seen that regular checks were being carried out by the maintenance person to monitor the regulation of water temperatures and the risk of legionella. Fire extinguishers are accessible throughout the building; these had been checked buy UK Fire international in March 2006. Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 27 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 2 3 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 X 3 Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 28 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 OP15 Regulation 16 (g)(i) Requirement The provision of food needs to looked at with regards to: 1. The consistency of the standard of food being served. 2. Assessments need to reflect resident’s individual needs and the level of support required to eat their meal. 3. Residents who have poor dexterity must be provided with additional support, suitable crockery, cutlery and utensils. 4. Take into account the specific nutritional needs of people who are confused or have dementia. This is a repeat requirement from 27/10/06 All allegations or incidents of abuse must be reported to the Customer first team, social services in line with the Suffolk inter agency policy. CSCI must be informed of the timescales for fitting fire Dorgards to prevent doors being wedged open as identified in the risk assessment undertaken by BUPA. DS0000024445.V304470.R01.S.doc Timescale for action 01/09/06 2. OP18 13 (6) 27/07/06 3. OP19 23 (4)(c) (i) 18/08/06 Melford Court Nursing Home Version 5.2 Page 29 4. OP22 23 (2) (n) The registered manager must ensure that call bells are accessible to all service users and that they are shown how to use them in case of an emergency. This is a repeat requirement from 27/10/05 CSCI must be informed of a timescale for replacing the thermostatic valves to taps in bathrooms and toilets. 18/08/06 5. OP25 13 (4) (a)(b)(c) 18/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Melford Court Nursing Home DS0000024445.V304470.R01.S.doc Version 5.2 Page 31 - 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. 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