CARE HOMES FOR OLDER PEOPLE
Meppershall Nursing Home 79 Shefford Road Meppershall Bedfordshire SG17 5LL Lead Inspector
Ms Louise Trainor Unannounced Inspection 20th December 2005 10:45 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 Meppershall Nursing Home DS0000015039.V269055.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. Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Meppershall Nursing Home Address 79 Shefford Road Meppershall Bedfordshire SG17 5LL 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) 01462 811224 01462 812027 G A Projects Ltd Mrs Julie Sumner Care Home 57 Category(ies) of Old age, not falling within any other category registration, with number (47), Physical disability (10) of places Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Up to four (4) service users under the age of 65 years may be admitted to the home. 26th April 2005 Date of last inspection Brief Description of the Service: Meppershall is a purpose built care home with nursing on the outskirts of the Bedfordshire in the village of Meppershall. The service was registered to provide residential and nursing care for fifty-seven service users. Ten of these places were for younger adults with physical disabilities and the remainder were for older people.The accommodation was distributed over two floors accessed by shaft lifts. The communal accommodation and facilities were spacious including wide corridors and access routes to the grounds. The building also provided a day care facility that was not included in the registered facilities and which was used on commission to the Social Services Department. The building was surrounded by large grounds and included adequate parking space for staff and visitors. The rural setting allowed good views of the countryside from the Home.The home had evident links with the community and shared transport with its sister home to support service users to access the community. Those aspects of the service assessed at this inspection demonstrated that satisfactory arrangements were in place to meet current service users needs. Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on the 20th of December 2005.The inspection commenced at 10.45 hrs and was completed at 15.00hrs. Unfortunately the manager was not present, but the deputy manager was on duty and assisted throughout the inspection. This was the second inspection of the year and the main focal points were: to follow up on activities, some health and safety issues, care plans, and the privacy and dignity of service users. In addition, service users finances were looked at as was quality assurance, complaints, and hygiene / infection control. During the inspection, two service users were case tracked and interviewed. One relative and four staff were interviewed. Observation of care practice and communication was observed throughout the midday meal. This report should be read in conjunction with the previous report for this year, dated 26/04/05. The inspector would like to thank all staff, visitors and service users who assisted during this inspection. What the service does well:
Meppershall provides a clean, safe environment with a homely atmosphere which makes visitors and service users feel welcome. The home functions on two floors, accessible by stairs and shaft lifts. It is separated into 4 units each with between ten and fourteen beds. Each unit is staffed separately, and the nurses are allocated to each unit for a period of time, ensuring all staff gain the skills and abilities to care for the varied needs of the service users. The interaction between staff and service users was seen to be of a high standard, particularly during mealtimes, when staff and service users from all four units dine together in the main dining area. Service users do however have a choice, and some choose to eat in their rooms, although this is only a minority. The home promotes an open visiting policy and relatives spoke positively of the care provided by the home. The home provides varied training for staff. This includes access to training from local Trusts and services such as The County Continence Service, ensuring practices are nationally recognised and up to date. Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 6 The home provides placements with accommodation facilities for overseas nurses who wish to undertake adaptation training. The service users receive a varied menu with choices. The meals appeared balanced, nutritious and well presented, meeting different dietary requirements. 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.
Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 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 Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 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, 3, 4,5 All service users are fully assessed prior to moving into the home, assuring them that all their needs will be met. EVIDENCE: The matron and deputy matron visit and assess all prospective service users prior to admission and complete a detailed assessment of needs. One service user who had been admitted during the afternoon on the day before the inspection had a full needs assessment completed. She was also admitted with a single assessment file that included documentation from all the health professionals she had received care from prior to admission. One service user stated that although she did not visit the home prior to moving in, her daughter had and was very happy with the outcome. The home issue a colour brochure to all it s service users or their representatives. This includes information about the company, a Statement of Purpose for the home, a contract of care, details of fees including extra costs
Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 9 such as the hairdresser, a copy of the complaints procedure and details of social activities available in the home. The deputy matron works mainly with the staff in the clinical areas, ensuring that the standard of care remains high. The matron and deputy matron carryout an audit of care plans once a month. Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The home has detailed care plans in place for each service user, ensuring that their health, personal and social needs are met. EVIDENCE: Two case files that were examined had detailed care plans in place, identifying the service user needs and giving instructions as to how these needs should be met. One service user was not sure what a care plan was, but he was able to say what the staff do for him, and when his case notes were examined he had signed all the care plans present in his file. One set off care plans examined, had the ‘needs’ for Activities and medication on one sheet. This should be avoided to minimise the risk of confusion when evaluations and reviews are taking place. Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The home has an open visiting policy so that service users maintain good contact with families, friends and the local community. The home has systems in place to ensure that service users have choice and control over their lives. The homes activities programme is not varies enough to ensure all service users are sufficiently stimulated. EVIDENCE: One resident talked at length about his weekly visits from family members, and also his weekly visits to another nursing home where his wife is presently residing. He also spoke of his enjoyment with the singing groups, although felt activities for him were somewhat limited. He did however use the mobile library regularly, and staff stated that he spends a lot of time with the activity staff. This gentleman also has regular visits from local council members whom he used to be involved with prior to his illness. Another service user talked enthusiastically about her weekly hair appointment. Her room was very personally furnished and she also had her own phone line in her room.
Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 12 During the inspection many of the service users in Cook Wing sat with no stimulation, accept the television that they were not watching. One visitor stated that his wife, who has no speech , stated ‘there s no activities for her’. Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The homes system for the training and promotion of the Protection of Vulnerable Adults (POVA) is good so that service users are protected from abuse. EVIDENCE: Three members of staff were interviewed and all were able to give a clear description of action they would take if they suspected abuse was apparent in the home. One member of staff, who had only been in post for three months, spoke in depth of her understanding of abuse. This included the approach and attitude of staff towards service users as well as the more obvious physical abuse. Two of the staff had undergone training in POVA, this had been incorporated into their NVQ training and not part of a core training plan for all staff. A copy of the complaints procedure is issued to all service users, and two service users who were interviewed were able to describe the process they would follow should they need to complain. Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25, 26 The environment was clean, comfortable and homely so that the service users feel safe and their belongings are protected. EVIDENCE: The homes security has been reviewed. The front door can only be opened by authorised personnel from the inside. This ensures that staff are always aware of all visitors entering or leaving the building. There is a maintenance book in place. This shows when repairs are required/ reported and when they are carried out. The home is clean and homely and free from offensive odours. The deputy manager stated that all service users have been asked if they would like to keep the key to their rooms, but only one gentleman stated that he would. Extra call points have been installed since the last inspection. These are activated by ‘chord buzzers’ thus giving ease of access to wheelchair users. No chords were seen trailing on the floor or unsafe.
Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The home is well staffed who have a good skill mix so that service users needs are met. EVIDENCE: The home have access to training from specialist services such as the continence service, ensuring up to date training on catheterisation and continence assessment. Two of the three staff interviewed are presently undergoing NVQ training. Training on Peg feeds, wound care and other specialist needs are included in the homes training plan. Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32,33, 35, 38 The staff have a good understanding of the service users needs ensuring that their health, safety and welfare are protected and promoted. EVIDENCE: Both the matron and the deputy matron have been in post for more than five years and are clearly well supported and respected by other staff of all grades in the home. One service user stated ‘the staff are good and they do their best for me’. Interactions between staff and service users were observed throughout the midday meal. The atmosphere was very relaxed and friendly. The meal did not appear rushed, and focused on the service user needs. Service users were offered assistance in a respectful and dignified manner. Staff sat amongst the service users and made the mealtime a sociable event.
Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X 3 3 3 3 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 X 3 X X 3 Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 18 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 OP18 Regulation 13(6) Requirement The manager must ensure all staff undertake training in the Protection of Vulnerable Adults. Timescale for action 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The activities programme should be reviewed to include sensory stimulation for those who have more profound disabilities and are unable to participate in the present regime. Service user plans should be written with one ‘need’ per sheet in order to promote clarity and minimise confusion when reviewing and evaluating. 2 OP7 Meppershall Nursing Home DS0000015039.V269055.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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