Inspection on 27/10/05 for Melford Court Nursing Home

This inspection was carried out on 27th October 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Melford Court Nursing Home 17/07/07

Melford Court Nursing Home 19/07/06

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 Announced Inspection 27th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 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) BUPA Care Homes 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.V260553.R01.S.doc Version 5.0 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 sevices users with dementia (DE,E) as detailed in correspondence dated 24/11/04. 12th May 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, runs 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, a Registered Nurse, manages the Home. The Home is registered as a care home with nursing providing care primarily to older people. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and started at 10am. It took place over seven hours during a weekday. Time was spent with the manager and four staff. A tour of the premises was made and a number of records were examined including those relating to the care of residents, staff and a selection of policies and procedures. The inspector spent time talking with 9 residents individually and collectively during lunch, and with 4 relatives visiting the home during the inspection. A total of 3 relatives and 6 residents comment cards were received prior to the inspection. Most had positive feedback with a few exceptions around staffing levels and employment of staff from different nationalities, which highlighted concerns about communication difficulties between residents and staff. What the service does well: Melford Court provides residents with a welcoming friendly atmosphere and a home that is nicely decorated throughout. There is a programme of regular maintenance to ensure the decor of the building is maintained and improved. Resident’s comments about the home included “they were happy living at the home” and “they used to visit friends here, it is a nice civilised place to live” and “staff are very nice and caring”. A relative commented, “it is reassuring to find staff that know what they are doing”. Residents spoken with felt that in their experience staff respected their privacy and dignity especially when dealing with their personal care. The home has detailed care plans, which are reviewed regularly to reflect residents social, health and personal needs. There is a wide range of activities available that meet the expectations of the residents who live in the home with the exception of residents diagnosed with dementia. The home provides a good standard of food; however there appears to be a distinction between the level of service between the two eating areas and support offered to residents choosing to eat in their rooms. However, resident’s comments about the food were that “food is excellent, very, very good” and “food very good, plenty of it” and “food is very nice, good choice”. The activities staff are in the process of introducing an activities profile for each resident. The profile contains a life map and a life story including, where available photographs. The profiles will create a portfolio of activities that the resident chooses to join in, based on their preferences and choices of activities, linked to their hobbies interests and life experiences. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: The manager spoke to the inspector about their responsibility as a nursing home to dispose of controlled drugs. The drugs are disposed of through a clinical waste company, who have instructed the home to grind the tablets into powder form and then mix with water to create a gel. The manager raised their concerns with the inspector about the affects of powders released into the atmosphere whilst being ground and to the health and safety of staff. The manager is currently contacting the environmental health team for advice. Although the issue has arisen through the home carrying out good practice, to ensure the health and safety of staff a requirement has been made for the home to investigate a safer method of disposing of controlled drugs. Residents are supported to follow their own routines, choosing to spend time alone or with other residents or taking part in planned activities. However there was little evidence seen for the provision of activities for residents that are diagnosed with dementia. The home employs a lot of overseas staff. Feedback from comment cards and discussions with residents and relatives during the inspection raised concerns about residents not being able to understand staff due to language differences. The training files need to be summarised to reflect current training and development of staff. This data needs to be kept up to date and reflect current training and future training required for the whole staff team. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 7 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.V260553.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5, 6 The statement of purpose provides prospective residents with information about the home. Residents can expect to have their needs identified prior to moving into the home. EVIDENCE: The manager provided the inspector with a copy of the most recent statement of purpose and the service users guide. These are both well presented and contained detailed information for prospective residents. One resident had recently moved into the home. They told the inspector that the manager of the home had visited them in hospital to make an assessment to see if Melford Court could meet their needs. The resident, due to their condition had not viewed the home but their relative had visited prior to them moving in and found the home to be suitable. The home does not provide intermediate care, however, they do have one respite bed for convalescent care. The manager informed the inspector that the home had created a room for respite as part of their refurbishment six years ago. The room is situated at the front of the house and does not impact Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 10 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. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, Residents can expect to have their health and personal needs identified, and reviewed on a regular basis. Residents can expect to be protected by the home’s policy and procedure for safe administration of medication, however there are health and safety concerns about the disposal of controlled drugs. EVIDENCE: One resident’s care plan was inspected. At the front of the care plan was a residents 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. Evidence was seen that the care plan was being reviewed regularly with the resident. At the last review in October, a relative involved in the review had made a comment that they “were happy with their relatives care” but states that they needed more support with their meals. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 12 Another resident spoken with showed the inspector a chart held in their room, which showed a detailed record of the resident’s continence and pressure area care. They 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 and also had a detailed moving and handling assessment identifying the support required and equipment to be used. This included a falls assessment and preventative action required. The resident had been referred to the GP to review their health and medication. The nursing staff at the home were checking the resident’s blood pressure on a monthly basis. Evidence was seen that these risk assessments were being reviewed on a regular monthly basis. Residents are supported to access other health services. A record of care involving outside agencies was kept in the care plan listing visits from health professionals including the general practitioner (GP). The daily recording sheets seen confirmed the visits and had details of the action to be taken by staff. A relative of one resident who had moved to the home following a stroke informed the inspector that the staff had been brilliant with the resident working with the physiotherapist and that the resident was now able to walk short distances and that their health had much improved. The inspector briefly spent time with a trained nurse observing them administer the lunchtime medication. Each medication administration record (MAR) chart had a photograph of the service user for identification. The MAR sheets were examined and were seen to be completed accurately. At the previous inspection in May 2005, a requirement was made about gaps on the MAR charts being investigated. To monitor this only trained nursing staff administer medication. The home has three portable lockable medication trolleys and staff-administering medication has to sign a sheet to say they are taking the trolley. Any gaps or errors on the MAR chart are easy to identify who was responsible. Some residents in the home are prescribed controlled drugs. The manager spoke to the inspector about the requirement for the disposal of the drugs. They have arranged for the drugs to be disposed of through a clinical waste company but have been instructed to grind the tablets into powder form. The manager told the inspector they would contact environmental health for further advice. Residents spoken with informed the inspector that in their experience staff respected their privacy and dignity especially when dealing with their personal care. Staff were observed knocking on residents doors and waiting to be invited into the room and were observed calling residents by their preferred names. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 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, 15 Residents can expect to live in a home that supports a life style that matches their expectations, however residents diagnosed with dementia have limited local, social and communal activities appropriate to their needs. Residents can expect to receive a good standard of fresh and appealing food with a variety of choice as part of their daily diet. However, residents eating their meals in the upstairs dining room cannot expect to receive the same standard of service as those eating in the main dining area. EVIDENCE: The home offers a range of social activities and leisure interests, which include time, spent on a one to one basis, reading or looking at photographs. There are group activities available and a programme is displayed on the notice board. The inspector observed a music and movement session taking place in the upstairs lounge, which was attended by eight residents. The inspector noticed photographs around the home of people involved in a VE day re-enactment celebrations at nearby Kentwell Hall. They had visited the home in the summer and spent time talking and reminiscing with residents about their wartime experiences. Residents confirmed that they had enjoyed the day. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 14 One resident spoken with told the inspector that they had enjoyed a harvest supper and were looking forward to a Halloween party on the 31st October. Residents also spoke of entertainers that visit the home monthly to sing and play musical instruments. Another resident told the inspector “they were happy living at the home” and “they used to visit friends here, it is a nice civilised place to live”. Group activities available are reminiscing, dominoes and cards, bingo and a video club. A resident showed the inspector a dates for diary sheet they had been given by the activities staff, which included a concert, a friends of Melford Court meeting, an event to join in breast cancer awareness wear it pink day, and a clothing party. Activities staff support residents to access the local shops, pubs and library which is situated across the road from the home. Two residents went to the pub next door for lunch during the inspection. They also assist residents who choose to visit a Women’s Institute (WI) shop on a Friday morning, held in the village hall in Long Melford. The activities rota showed that activities are scheduled to take place Monday to Friday with nothing arranged for the weekends, apart from arranged celebratory events. The manager advised the inspector that this issue was being addressed by BUPA, across the region to review budgets to include staffing for weekend activities. The home offers residents a Christian multi denominational service every Wednesday morning and have close links with other places of worship and ministers. The home has a hairdressing salon and residents have the opportunity to visit the hairdresser employed at the home four times a week, they can also have a manicure. Activities staff showed the inspector an activities profile that they had recently introduced. Each resident is to have a profile containing a life map and story including, where available, photographs. The profiles will create a portfolio of activities they choose to join in based on their preferences and choices of activities, which are linked to their hobbies interests and life experiences. Evidence was seen that residents are supported to follow their own routines, choosing to spend time alone or with other residents in one of the lounges. Residents choosing to spend time in their room told the inspector they were encouraged by staff to join in social activities, however there was little evidence seen for provision of activities for residents diagnosed with dementia. Activities staff told the inspector that these residents were encouraged to join in mainstream activities. Evidence was seen in one service user’s care plan (diagnosed with dementia) of joint activities attended on 8 separate occasions between June and October, however there were no entries of time spent with 1-1 activity or of separate activity specifically for someone with dementia, for example reminiscence work. The activity coordinators did say that a lady visits Melford Court to do some reminiscence work once a week, but there was no record of this particular resident being involved. The care plan also states that the service user will spend most of their day lying on their bed and needs encouragement to be involved in activities. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 15 Comments about the food were varied; mostly comments were that “food is excellent, very, very good” and “food very good, plenty of it” and “food is very nice, good choice”. However, the home has two dining areas, the main dining room is on the ground floor and there is another on the first floor. From observation throughout the day and by talking with residents and visitors there appears to be a distinction between the provision of food between the two eating areas. The main dining room had tables nicely laid out with tablecloths, napkins and wine glasses for residents to have wine with their meal and one resident was seen drinking a beer. Additionally there was a jug of orange juice and squash available on a side table. The upstairs eating area had one table, which was used by three residents using a wheelchair, whereas other residents were sitting in armchairs with either a lap tray, or a small table in front of them. Food in the main dining area was being served from a hot server. The food was plated up and taken to residents upstairs on trays. Comments from residents and relatives were that food was often not very hot by the time they came to eat their meal. They informed the inspector that the home used to have a hot trolley to take the food from the kitchen to the upstairs dining room, which is no longer in use, but thought this was a better system. Concerns were also raised with the inspector about the length of time that residents had to wait for their meal. The inspector was present in the upstairs dining room at 1.20pm and observed some residents being brought their meals, when the inspector returned to the dining room an hour later a relative of a resident commented that two residents had not yet eaten. One resident who chose to stay in their room was observed having their meal sitting in their armchair with a small table in front. The inspector observed that this was not an entirely suitable arrangement for the resident to reach and eat their food unaided. Speaking with the resident and their relative they felt that the resident was not getting the support they needed to enjoy their meal. The nutrition section of their care plan and dependency assessment carried out monthly made reference to the resident needing daily nutritional supplements and prompting with food. The relative informed the inspector that they did not think the resident was receiving the supplements. The manager informed the inspector that the home was looking at the provision of food and the service through the quality assurance monitoring system. Food seen on the day was freshly prepared and looked appetising. Residents had a choice of sausages in gravy or salmon en-crute with a choice of mash or new potatoes, broccoli and mixed vegetables. Carrot and coriander soup was available as a starter. The dessert was a choice of lemon sponge with lemon sauce or ice cream or yogurt. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 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 Residents can expect to have their complaints responded to and be protected form abuse by the homes abuse procedures. EVIDENCE: The home had received eight complaints since the last inspection in May 2005. Three complaints had been substantiated and four complaints were partially substantiated. All had been responded to in accordance with the home’s complaints policy in 28 days. One complaint had been investigated and resolved under the protection of vulnerable adults (POVA). The complaints policy was seen displayed on the wall in reception and had the details of the commission for social care inspection. Residents spoken with told the inspector that they would speak to the matron if they were unhappy with any aspect of their care. The home has a detailed policy that deals with the management of allegations of abuse. A POVA incident had recently occurred in the home and been dealt with in accordance with the policy. An issue about the use of bedrails had been a part of the investigation. The home has on admission a detailed risk assessment tool for the use of bedside rails to ascertain if they are actually required and safety measures to reduce the risk to residents and to obtain their agreement to using this form of restraint. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected 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 Residents can expect to live in a well-maintained and welcoming environment, which provides a good range of communal and personal accommodation, however residents cannot expect to have their safety protected until measurers are taken to ensure fire exits are free from obstruction. Residents must have access to a call bell at all times. EVIDENCE: Melford Court is a Grade II listed building, which forms part of the main street, and has easy access to local shops, the library, the church, restaurants and public houses. There is a welcoming and friendly atmosphere within the home and it is nicely presented both inside and out; all areas of the home were nicely decorated and clean and tidy. The home is on two floors and has fortyfive en-suite bedrooms. Thirty-eight of the rooms are single occupancy and seven are double rooms. All rooms have en suite toilets and sinks. Seven of the bedrooms have en-suite bathrooms fitted with Apollo baths; the manager informed the inspector that there were plans to replace these with showers due to problems of using Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 18 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 consist of a dining room, three lounge and activity rooms and a hairdressing room. Access to the first floor is via stairs or passenger lift. Two part time handy men are employed to maintain the home and the garden. Requirements from the last inspection in May 2005 were to take action to replace a missing grab rail, remove furniture that was blocking a fire extinguisher and to make sure that bathrooms were cleared of unnecessary furniture to make sure that they were fully accessible to residents and staff. During a tour of the building the inspector noted that these issues had been remedied. The manager informed the inspector that they have a planned programme of maintenance for the home and that they were going to be replacing the carpet in the main dining room. Whilst touring the building the inspector was able to visit and speak with several residents in the privacy of the room. Residents rooms seen were nicely decorated and personalised with the resident’s own possessions. One resident told the inspector “they had decided to sell their furniture but had kept bits and pieces, which made it like home from home”. They also spoke of their room being “kept clean and tidy and that staff hoovered every day”. Another resident and their relative spoken with were very happy with the resident’s room; they shared a room with another resident. There was a screen available and the resident was satisfied that staff were able to maintain their dignity and privacy when assisting them with their personal care needs. However, the resident’s bed had been moved to allow staff to have access either side of the bed and the resident told the inspector they were unable to reach their call bell. The inspector also noted that another resident sitting in their armchair in their room was unable to reach a call bell. Whilst talking with one relative and resident they spoke of the resident’s bed not being made sometimes until the early evening. Their relative was concerned that if the resident wanted to have a rest on their bed in the afternoon they would being laying on a bare mattress. The inspector has been informed by the manager that this issue has been discussed with the relative. A fire door to the side of the building had a net curtain draped over blocking a clear exit and the fire exit sign. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Residents can expect to be protected by the home’s recruitment and selection of staff, however cannot expect staff to have the necessary skills to communicate effectively with residents. EVIDENCE: Rotas seen showed that the home operates with 11 staff on an early shift and 8 staff on a late shift with 2 registered nurses on duty within these numbers at all times. The manager informed the inspector that 4-5 staff cover the night shifts, depending on the number of residents in the home. With 45 residents and above the home always has 5 night staff rostered. Two staff files were see. All the necessary paperwork and recruitment checks were in place, including the registration number and a work permit from the home office for an overseas member of staff. The home employs overseas staff sponsored by BUPA personal health service to undertake a conversion course before they can obtain their registration as a nurse in the United Kingdom. Feedback from comment cards and discussions with residents and relatives raised concerns about residents not being able to understand staff due to language differences. This was a particular issue with night staff. The manager explained that the home had experienced difficulties with recruitment and had used a lot of agency. Using the overseas staff has improved the recruitment problems, they are initially employed as care staff and undertake the adaptation course over a period of six months. Part of the course includes an English exam, however the manager did acknowledge that some residents experienced difficulties understanding overseas staff. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 20 Training records were seen, which consisted of two large folders containing all information about training in the home. However, it was very difficult to see from the records who had attended training. The manager told the inspector that the home has a new administrator who has recently attended a course on collecting and storing data and that they would be creating up to date training records. Activities staff spoke of being enrolled on a national vocational qualification (NVQ) level 2 for activities. This is a pilot scheme being run at Otley College; they have the opportunity to follow this up with an NVQ in activities for people with dementia. Domestic staff spoken with confirmed that they had received instruction in control of substances hazardous to health (COSHH) from a representative of the company that supplied the cleaning products. Comments from residents and relatives were very positive about the care delivered by staff. One relative commented that “staff are very nice and caring” and “it is reassuring to find staff that know what they are doing” and another relative commented that staff looked after their relative well and that they always looked clean”. Concerns raised in the comment feedback cards and through discussion with residents and relatives were about staff availability on the late shifts and staff taking their breaks all at the same time. The manager told the inspector that in the evenings staff are busy attending to the personal needs of the residents in their rooms, which could appear that there were no staff available, however the manager suggested to the inspector that they would look into staff taking their breaks in a more visible place. They also have a new pager system being installed and there will be enough pagers for all staff to carry a pager. The system will be able to monitor and print out the call and response times. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 37, 38 Residents can expect to live in a home that is well managed and have their healthy, safety and welfare protected. EVIDENCE: The registered manager is a qualified registered general nurse with a Bachelor of Science degree in nursing. They have ten years experience of working in the National Health Service and private sector and have a variety of certificates in personnel, management, nursing, food hygiene and health and safety. They have obtained an national vocational assessors (NVQ) qualification. They joined the staff team at Melford Court in 1991 and became the matron in 1997. The home has residents 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. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 22 The pre inspection questionnaire shows that the home keeps detailed records of maintenance within the home and has policies and procedures in place to protect the health and welfare and safety of the residents. To meet the requirements from the previous inspection in May 2005, the homes current certificate for registration was correct and on display in the reception hallway. Fire extinguishers were checked and were accessible throughout the building and bathrooms and corridors were clear of furniture and were fully accessible to staff and residents. Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 23 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X 3 3 Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? No 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 (m)(n) Requirement Service users diagnosed with Dementia must be consulted and have a programme of activities that include local, social and communal activities appropriate to their assessed needs. The home must ensure that all service users receive the same standard of service as those eating in the main dining area, including those who eat in the upstairs dining room and those who choose to eat in their room and have staff support to ensure they eat and enjoy their meals and receive their nutritional supplements. Fire doors must not be obscured to ensure that there are adequate arrangements for safe evacuation in the event of a fire or discuss with the local fire authority whether or not to continue using as a fire exit The registered manager must ensure that call bells are DS0000024445.V260553.R01.S.doc Timescale for action 27/12/05 2 OP15 16 (i) 27/11/05 3 OP19 23 (4)(c) (iii) 27/11/05 4 OP22 23 (2) (n) 27/11/05 Melford Court Nursing Home Version 5.0 Page 25 accessible to all service users and that they are shown how to use them in case of an emergency. 5 OP27 19 (5) (b) The registered person must not employ a person to work in the home unless they have the skills with regards to language and communication necessary for the job and measures to be taken to provided training for existing staff to improve communication with the service users. 27/12/05 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 Arrangements for the safe disposal of controlled drugs to be investigated and protocol implemented to ensure the health, welfare and safety of staff disposing of the medicines The home should have a training record that is kept up to date and reflects current training for the whole staff team. 1 OP30 Melford Court Nursing Home DS0000024445.V260553.R01.S.doc Version 5.0 Page 26 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. 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