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Inspection on 25/02/09 for Meppershall Nursing Home

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

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

What the care home does well

What has improved since the last inspection?

Overall, the service offered to people who live at Meppershall has improved, especially in the nursing home part. Following our last inspection we made 26 requirements. The pharmacist inspector made a further 6 requirements, making a total of 32. 17 of these had been met. The improvements include: staff are being recruited well; some aspects of the handling of medication have improved; up to date information about the home is available; there is some evidence that other professionals are more involved in people`s care; overseas staff have received training so they are better able to communicate with the residents; activities in the main nursing home have improved; and the registered provider writes a report of his monthly visits to the home. Some people said that the meals have improved.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Meppershall Nursing Home 79 Shefford Road Meppershall Bedfordshire SG17 5LL Lead Inspector Nicky Hone Key Unannounced Inspection 25th February and 10th March 2009 07:00 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 Meppershall Nursing Home DS0000015039.V374716.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. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 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 gagroup@btconnect.com gacontracts@btinternet.com G A Projects Ltd Care Home 84 Category(ies) of Dementia (30), Old age, not falling within any registration, with number other category (49), Physical disability (5) of places Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP Dementia - Code DE Physical Disability - Code PD The Maximum number of service users who can be accommodated is 84 3rd and 9th September 2008 2. Date of last inspection Brief Description of the Service: Meppershall is a purpose built care home with nursing on the outskirts of the village of Meppershall, in Bedfordshire. The service is registered to provide residential and nursing care for 84 people: 54 in the main nursing home and 30 in the dementia care unit. On the second day of this inspection there were 38 people in the main nursing home and 14 in the dementia care unit. The main building (referred to as ‘the nursing home’) is built on two floors, and managed in four units, two on each floor. Each unit consists of a number of bedrooms (which either have ensuite toilet and washbasin facilities, or have a washbasin in the bedroom), a sitting area, bathrooms and a nurses’ station. There is a dining room on each floor, and a large sitting room on the ground floor. There is also a main kitchen, a laundry and offices. There are lifts and staircases to access the upper floor, so the whole building, with its wide corridors and doorways is suitable for people who use wheelchairs. The home was extended in July 2008. A separate, thirty-place unit was built next to the existing home, and attached to it by a glass corridor. This building is known as ‘the dementia care unit’ and accommodation is on two floors accessed by a lift. There are fifteen bedrooms, all with ensuite facilities, a lounge, dining room and bathrooms on each floor. There are also kitchen and laundry facilities, and a small office. On the days we visited, only the ground floor had been opened. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 5 There is a large day care facility attached to the nursing home, which is not included in the registration. This is operated by Social Services who currently open on one day a week for younger people with physical disabilities. The home is surrounded by large grounds and parking spaces for staff and visitors are provided. There is a large, secure garden with a paved patio which is accessed from the dining room of the dementia care unit. The rural setting means that there are views of the countryside from the home. The home has links with the local community and shares transport for service users with its sister home. Information about this home can be obtained by phoning and visiting, and there is also an entry for this company on several care home websites. Hairdressing, newspapers, toiletries/tissues, and staff escorts to medical appointments are not included in the fees. People who have their own telephone are responsible for all the bills. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This is the second inspection where we have judged the outcomes for people living at Meppershall Nursing Home to be poor. Following our inspection in September 2008, the home was also judged to be a poor service. CSCI’s methodology would be to serve statutory enforcement notices when a home is judged to be poor for a second time, as this would mean the home had failed to meet requirements, and people living at the home were still at risk. However, we acknowledge that there has been improvement in some areas of the service offered at Meppershall, and a number of the previous requirements have been met or partially met. We also acknowledge that the current acting manager is new to her post. However, the provider has had almost six months to make the improvements he said he would make, but some key areas are still poor, and outcomes for some of the people who live here are still poor. Any further failure to comply with requirements will result in enforcement action being taken. Most of the improvements are in the main nursing home. Our concerns this time are greater in the dementia care unit, where outcomes for the people who live there have improved less. For this inspection we looked at all the information that we have received, or asked for, since the last key inspection. We did not ask for an AQAA (Annual Quality Assurance Assessment), and we did not send out any surveys. As Meppershall was judged to be a poor service after our last inspection, we asked the provider to send us an improvement plan. We also met with the provider to discuss what he was going to do about the 26 requirements we had made. The provider sent us the plan when we asked for it, and it was detailed enough for us to have some confidence that he would address the issues raised. The CSCI pharmacist carried out an inspection of medication at the home on 23/10/08. The home had failed to comply with the immediate requirement we had left them on 03/09/08. The pharmacist found a number of issues around medication which gave him concern, and he made a further 6 requirements. He considered the way the home deals with medication to be poor. This was of even greater concern as we had already made requirements following the inspection in September, and we had discussed medication issues with the provider and the manager. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 7 In October 2008 the provider wrote to tell us that the registered manager had resigned. He wrote to us again in February 2009 to say he had appointed a new manager, Ms Colleen Brothers. Ms Brothers told us she had worked at Meppershall as deputy manager for a few months, and took up her post as manager in early February. We refer to her in this report as ‘the acting manager’. The fire service carried out an inspection on 20/10/08 and served the home with an enforcement notice, which the home had to comply with by the end of January 2009. The fire service said the home’s fire risk assessment was not suitable and sufficient; inadequate staff training was provided when staff were first employed; insufficient competent persons had been nominated to implement fire-fighting measures; and insufficient numbers of competent persons had been appointed to assist in undertaking preventive and protective measures. We understand from the fire service that the home contacted them at the end of March, stating they had complied with the notice, but the fire service had not yet checked this. This key inspection of Meppershall included two visits to the home. On 25/02/09 we arrived at 07:00. Notices on the entrance doors advised us that there had been an outbreak of the winter vomiting virus. We spent an hour looking at some records then spoke to the acting manager when she came on duty. The acting manager confirmed that new cases of the virus were still being reported, amongst residents in both areas of the home and staff. We decided to leave so that the manager and staff could concentrate on looking after the residents, and so that we did not carry the virus to any other services. We returned to Meppershall on 10/03/09 at 09:30, once the home advised us there had been no new cases of the virus. We spent time talking to the people who were living at the home, visitors, the manager and some of the staff. We also looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. A couple of days before the first day of the inspection, we were sent a complaint by an agency member of staff who wished to remain anonymous. The complaint covered a number of areas including the behaviour of one of the permanent staff towards residents and agency staff, and staff rotas. The provider thoroughly investigated the issues and found the complaint against the member of staff was unfounded. We looked at the issue raised about staff rotas and agreed that some staff were working too many hours. What the service does well: Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 8 There were several thank you notes in the entrance hall of the dementia care unit: One person had written “…heartfelt thanks to you all for your excellent care of (name) during the past year…his final months with you were as good as they possibly could be….thanks for all you’ve done – more than mere words can say”. Another wrote “Thank you for all the love and care you gave to our mother….it was lovely to see how happy she was”. And a third wrote “Thank you to all the staff at Meppershall for the almost unbelievable care they gave our mother. It is difficult to find the words needed to express our gratitude for the loving care mother received”. Information about the home is available for people wanting to move here and assessments of people’s needs are carried out to make sure the home can meet those needs. Each person has a detailed care plan and risk assessments are carried out. People are treated with dignity and respect. The service investigated an anonymous complaint (sent to CSCI) well. The environment is clean and comfortable, and staff are recruited well. What has improved since the last inspection? What they could do better: This report contains 17 requirements, 11 of which were made last time and have not been fully met, and there are 2 new requirements. (3 of the requirements from last time were not assessed and 1 had not reached the timescale we set for compliance). Things the home must do better include: Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 9 • • • • • The home must operate within its registration and statement of purpose so that only people whose needs can be met are admitted (see below); The management of the home must improve so that people receive the care and support they need; Medication must be administered, recorded and handled correctly so that people living at the home are given their medication safely; Wounds must be dressed according to the care plan, which must be accurate; Staff must receive training in a wide range of subjects, including Safeguarding Vulnerable Adults, moving and handling, infection control, fire safety, first aid, food hygiene and specialist topics such as dementia, so that they can do their jobs properly; All the people who live at Meppershall Nursing Home must be provided with social stimulation (activities) so that they have satisfying and fulfilling lives; Fire doors must not be wedged open, and chemicals must be stored safely, so that people who live at the home are as safe as possible; and Staff must be adequately supervised and supported to do their jobs well. • • • 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. The summary of this inspection report can be made available in other formats on request. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 10 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.V374716.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 6 People who use this service experience adequate quality outcomes in this area. Information about the home is available for people thinking about moving here and assessments of people’s needs are carried out so that people know that their needs will be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has an information pack for people who are interested in moving into the home. This contained useful information about what people can expect from the home, and had been updated to include the name of the acting manager. The telephone number of CSCI was not correct, except on Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 12 the complaints procedure. Staff said there were no copies of the pack, which includes the home’s Statement of Purpose, in the dementia care unit. We looked at the paperwork the home has to keep about the people who live there. We saw that pre-admission assessments of people’s needs are on the files. When people move in, the staff assess their level of dependency and this is re-assessed each month. Each person, or their representative, signs a contract with the home. We saw this on one person’s file, signed by the person’s son and by the home. On the improvement plan, the provider told us that a letter is sent to each new resident to say that according to the assessment the home is able to meet their needs. We looked at records about one person because the staff said they were having difficulty meeting the person’s needs. The ‘registration sheet’ stated this person had a mental disorder. Meppershall is not registered to admit people with a mental disorder. The acting manager told us she had given this person notice to leave as the home could not meet their needs. Intermediate care is a service offered by some homes, which gives short-term, intensive rehabilitation for people leaving hospital before returning to their own homes. This service is not offered at Meppershall Nursing Home, therefore standard 6 is not applicable. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People who use this service experience poor quality outcomes in this area. Although there have been some improvements to the overall level of care, wound care is still not done well enough, and medications not administered well enough, to keep people safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: For this inspection we looked at the paperwork the home has to keep, for three residents in the dementia care unit, and four in the nursing home. Each person had a care plan in place. The care plans used at Meppershall include a typed range of options which are then included or deleted depending on what is relevant for each person. In discussion with the acting manager, she said she wanted to change the format of the care plans so that they would be more personal to each individual, and would be more useful to staff. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 14 Generally there was a lot of paperwork on each of the files we looked at, with a lot of information. We looked at the file of a person who is fed through a tube into the stomach (PEG feed). There were several care plans in place referring to the PEG feed with bits of information in each which might be better all together, for example, details of the regime, advice about nutrition, and an assessment of the risk of aspiration. Each plan had been reviewed monthly. The files also contained risk assessments, for example for falls, nutrition, and pressure areas. These had been evaluated monthly and changed when needed. On one person’s file we saw that her family had agreed she needed bed rails to keep her safe at night, and had signed their consent. Several people in the dementia care unit are looked after in bed. We looked at one person’s notes and saw that staff were completing a chart to record what the person eats and drinks, when the person is turned and so on. We noted that almost all of the care plan and risk assessment evaluations in the dementia care unit had been done by one member of staff. She was also the person who had made most of the entries in the activity notebooks. Care plans in the dementia care unit are still not being used by staff as working documents and are kept locked in a cupboard in the office. The acting manager discussed this with us as she was surprised to find this, and wants to involve all staff in using the care plans. We were concerned when we arrived on the first morning that the staff in charge were not clear about how many people had the winter vomiting virus and whether any specimens had been sent for testing. The acting manager told us she had contacted the Health Protection Agency on Monday and they had sent her some advice. She was getting the advice photocopied to put round the building when we left on the first day. On the second day we noticed a contrast between the residents in the main nursing home, who all looked nicely groomed, with their hair done, shaved and so on. In the dementia care unit there were 6 people in the dining room at lunchtime, all of whom looked at though they had not been helped to brush or comb their hair, and one of the ladies had very long facial hair. We did not look for notes that would tell us whether people’s other healthcare needs are met, for example if they see an optician, dentist or have their hearing tested regularly. However, during our visit a dentist came in to visit one of the people who lives here and staff said this would happen for anyone who needed a dentist. One of the people whose records we looked at in the nursing home, had wounds on 2 areas of the body which needed regular dressings. The wounds had not been dressed as often as they should have been. There was a Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 15 separate care plan and notes for each set of wounds. The latest evaluation date on one care plan was 11/02/09, which stated “pressure areas intact”, yet notes showed that there were “superficial skin breaks” from 17/02/09 which had dressings applied up to 06/03/09. On 25/02/09 the diagram showed a greatly increased number of skin breaks and the notes gave a frequency of dressing of 3-5 days with a review date of 28/02/09. There was nothing to indicate that the review had taken place, and the next entry was 06/03/09, indicating a gap of 6 days between dressings. The other care plan was evaluated on 11/02/09 when the GP had said he would refer the person to a tissue viability nurse. This said “dressing changed 3-4 days”. By 17/02/09 notes said frequency of dressing as “alternate days”, which happened until 04/03/09, then not again until 09/03/09 (or possibly 08/03/09 as the date had been changed on one of the records). We spoke with this person who complained of a lot of pain and said that the doctor had been called. In the dementia care unit, records showed that a person whose wound chart stated ‘daily dressing’ had the wounds dressed only 5 times in 12 days. The nurse in charge said the wound had been dressed more often, but staff had forgotten to write it down. There was no pain chart or progress sheet in place in this person’s notes, and no evidence that advice from a tissue viability nurse had been sought. Both these examples about wound dressings show that the home has not met the requirement we made last time, and that some practice is still poor. We looked at the way the home deals with medication. Following our last inspection and the pharmacy inspection, we made a total of 9 requirements about medication. There had been some improvements in the way medication is dealt with in both the nursing home and the dementia care unit, and six of the previous requirements had been met. However, we found some mistakes in both units. For example, in the nursing home, for one person the number of tablets received had been recorded incorrectly, and the number of tablets remaining meant that 7 tablets were unaccounted for. For another person 1 tablet was unaccounted for. In both units, entries on the MAR charts had been altered which had left some administration instructions unclear. The CSCI pharmacist had been surprised by the number of people, especially in the dementia care unit, who had been prescribed psychotropic drugs (14 out of 15 people). The pharmacist made a requirement that medicines of a psychotropic nature prescribed ‘when needed’ must only be given when clinically justified. During this inspection we were also surprised to note that the majority of people in the dementia care unit were being given these drugs. Although we accept that it is the GP who makes the decision about which drugs should be prescribed, this adds to our concerns about the staffs’ knowledge, training and ability to offer good care to people with dementia, other than by using medication. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 16 There were bottles of Fortisip and Ensure in the fridge in the dementia care unit which were not named, and had no date to show when they had been opened. These are food supplements which are prescribed to individuals, so must be named, given to the individual, and a record kept of when the person has taken them. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People who use this service experience adequate quality outcomes in this area. The quality of life for residents in the nursing home has improved and they are offered a range of opportunities for activity and entertainment, but this does not happen so well in the dementia care unit. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: On the first day we visited, in the main lounge of the nursing home we saw a lot of evidence that people have joined in the art and craft sessions. There were models, paintings, mobiles and art work around different themes such as Valentines Day, Chinese New Year, Egyptian art and so on. There were also storage units containing a range of activity equipment such as board games, floor games, videos and music. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 18 Activities are advertised so that people know what is going on. However, people who live here said that sometimes things are advertised which do not happen, such as music and movement. On the second day, we saw a craft session taking place which 7 people were involved in. The hairdresser was also in the home offering a hairdo to people who wanted one. Daily records showed that entertainment had been provided the previous day. In the dementia care unit there were lots of pictures on the walls of the dining room, from the art and craft sessions which take place once a week. The nurse in charge told us the person who leads the activities would soon be coming in twice a week because the residents enjoy her sessions so much. Each person in the dementia care unit has a notebook in which staff write which activities people have been involved in. One person’s notebook had four entries in the 5 weeks between 02/02/09 and 10/03/09. One of the entries recorded that this person did not want to join in the group. The nurse in charge told us that people do activities, but staff do not write them down. She said the staff were starting to do individual activities with people to try to find out what they like doing. She had bought a reminiscence disc which she said one person in particular really enjoys. There were 2 notice boards in the dining room. We were confused by the information on the boards. One was headed “Feburary”, and listed 3 activities, on Saturday, Wednesday, Thursday, but with no clue as to whether this was every week, or on particular dates, and whether this was still going on as it was now March. The second board was headed “February”, and showed lots of photographs – of Halloween. The nurse in charge told us that the home fully involves families in everything that happens, and that families know they can come and go as they want to. Families are invited to some of the activities and entertainments. Part of the complaint we received was that people who live in the dementia care unit were being got out of bed too early, to give the day staff less to do. When we arrived at 07:00 there were only 2 people in the lounge, and no other residents were got out of bed before we left the unit at 08:00. At 07:00 in the nursing home, no-one was up in the lounges: staff said this was because no-one had wanted to get up yet. The menu for the following day is taken to the residents during the evening and staff assist people who live here to decide what they would like to eat. There are always 2 main course dishes on the menu, with a choice of vegetables when the meal arrives, and a choice of 2 deserts. People can also choose a jacket potato or an omelette if they do not like the 2 choices. All the meals are produced in the main kitchen in the nursing home. They are served Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 19 from a heated unit in the main dining room and are sent to the dementia care unit in a heated trolley. We saw that one of the choices for lunch on the second day of our inspection, which most people had chosen, was pork chop, mashed potato, cabbage and cauliflower with gravy. Other than being a rather colourless meal, people said this was quite tasty. Most people we spoke with said the food is okay, one person said it is poor. Staff told us that cooked breakfasts are available, or there is a choice of cereals, toast and so on. On the first day we visited we saw that one person in the dementia care unit had chosen baked beans with bread and butter for her breakfast. We saw that staff were sitting down to assist people with their meal if they needed assistance. In the dementia care unit people were not given a drink with their meal. We did not inspect the main kitchen on this occasion. We saw that there was a certificate on display in the main entrance hall showing that the home had been awarded four out of five stars for a recent food safety inspection. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People who use this service experience adequate quality outcomes in this area. The home deals with complaints well, but not enough staff have received training in safeguarding to make sure people are kept safe from harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a complaints procedure, explaining how and to whom people can complain if they want to. This included correct details for contacting CSCI. We did not ask to look at the complaints folder during this inspection, so do not know whether any more complaints had been received. A couple of days before the inspection, we were sent a complaint from an agency staff member, who wanted to remain anonymous (see Summary of this report.) The complaint included concerns about the way one of the staff behaves towards the residents, and towards agency staff, and about staff working too many hours. We gave the acting manager a copy of the complaint on the first day we visited and asked her to investigate the concerns. We looked at the staff rota and found the complainant was right – some staff were Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 21 working far too many hours before having a break (see Staffing section of this report). The home carried out a thorough investigation of the other matters raised and found no evidence that the complainant’s allegations were correct. In fact they found that it was probably fabricated out of personal maliciousness because of an incident that had taken place. Following our last inspection we reported that 6 referrals had been made to the Safeguarding Adults (SOVA) team. A number of meetings were held and as a result the local authority social work and commissioning teams were involved in a lot of work, including regular monitoring visits, with the home. These referrals have not yet been ‘closed off’. Training records showed that 26 of the 63 staff on the list (41 ) have not had SOVA training. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People who use this service experience good quality outcomes in this area. Meppershall nursing home and dementia care unit provide people with a comfortable, clean place to live. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked round the dementia care unit. This part of the home was newly built and opened in July 2008. It was clean, bright and airy, and well decorated. The dementia care unit smelt fresh throughout, which is commendable, especially in the early morning. We did not do a thorough inspection of the environment in the nursing home on this occasion, but we did note that generally the areas we saw were clean and pleasantly furnished. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People who use this service experience poor quality outcomes in this area. Staff are recruited well but do not yet receive sufficient training or supervision to make sure they do their job as well as possible. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The acting manager told us that recruiting staff was still difficult but that the home had appointed several new staff recently and were still holding interviews. She said that some local staff had recently started and two more would be starting later on the same week. According to the list of staff training that we were given, there were 16 trained nurses, 6 senior carers, 27 carers and 14 ancillary staff employed at the time of the inspection. The home has had to use a lot of agency staff to cover vacant shifts. There were 3 night staff on duty in the dementia care unit when we arrived on the first morning: 1 trained nurse and 2 carers. There were then 4 staff on duty during the day: 1 trained nurse and 3 carers. Staff said there had been an additional carer when there were 17 people in the unit, but the staff number reduced again when one person left. The acting manager confirmed that staff numbers would increase when new residents were admitted. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 24 One part of the complaint was that staff were working a lot of shifts without a break. On the first day we looked at the rota in the dementia care unit. One member of staff was on the rota to work an 8-2 (morning) shift plus night duty the same day, followed by seven more 12-hour night shifts, before having 1 night off. Another member of staff was booked to work 15 x 12-hour day shifts without a break. We discussed this with the acting manager who said she had relied on the deputy manager who had been responsible for the dementia care unit and had recently left, and did not realise this had happened. We wrote to the provider on 25/02/09, expressing our concerns. When we returned on 10/03/09 the rota had been sorted out and staff were not working so many days/nights together and were having more shifts off. The provider explained that staff had done this to help cover the rota. Some of the things we have written about in other sections of this report gave us some concern about staff’s knowledge and understanding about offering people with dementia the best possible care. For example, the notice boards in the dining room with confusing information, cereals in unfamiliar cartons, chemicals left unattended, fire doors wedged open, the number of psychotropic drugs prescribed and so on. We spoke with one new member of staff in the dementia care unit, who told us she had not done this type of work before. She said she had been shown round the home before she started, and had spent the first day working with another member of staff. She was on her fourth day and still shadowing other staff. She had not been shown any care plans. She had been given fire safety instructions to read, and hoped to have some fire safety training that day. She was booked to do moving and handling training the following day. We looked at the personnel files of 3 members of staff. 2 staff were very new, and one had worked at Meppershall for 8 years. All the required information was on each file, other than a photograph of the 2 new staff. This included details of a Criminal Records Bureau (CRB) check, 2 references, a full employment history and a declaration that the staff member is physically and mentally fit to work. We looked at staff training records. The acting manager said that when she started in her role as manager the training records were not accurate or up to date so she had been trying to get the records sorted. She had been aware that a number of staff had not had all the training they should have had, so she had arranged several courses to take place. The dates for these were advertised on the notice board in the office. It is disappointing that the provider has not got this issue sorted, as he has had almost 6 months since our previous inspection, when we found a similar situation, to do so. The acting manager said that a number of the overseas staff had completed a basic English course, arranged by the provider following our last inspection, Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 25 and held at Meppershall. All of them had now been accepted to do a National Vocational Qualification (NVQ) in care level 2. From the record the acting manager gave us there are, as she said, a lot of gaps. For example, 29 of the 63 staff have not done moving and handling training; 28 have not done food hygiene and infection control; and 26 have not done training in safeguarding vulnerable adults. We were not given any information about which, if any, staff have done any training in dementia other than the nurse in charge of the dementia care unit on the day we visited told us she had done a course on dementia. We did not look at any training certificates so we do not know what any of the courses staff have done included, who the trainers were, or anything about their competence to train. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 People who use this service experience poor quality outcomes in this area. Management of Meppershall is not yet good enough to make sure people who live here have the best possible quality of life. Health and safety in the dementia care unit is not given sufficient priority. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The registered manager of Meppershall Nursing Home resigned in October 2008, following our inspection when so many failures and breaches of regulations were brought to the attention of the provider. The provider had Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 27 brought in a manager from another service, who had been trying to support the manager. This person then took over as acting manager. In October 2008 Ms Colleen Brothers was appointed as deputy manager, then in February 2009 she was promoted to acting manager. Ms Brothers was on duty on both days we visited and assisted us with the inspection. This inspection showed some improvement in a number of areas, and some of the requirements we made following the last inspection had been met, or partly met. However, the management of the service has not been good enough to fully comply and a number of the requirements have been repeated. We acknowledge that Ms Brothers had only been in post for a couple of weeks when we carried out our inspection. She seemed to be aware of the improvements that are needed, and realistic that these would not happen overnight. It is not a reflection on Ms Brother’s competence that we have judged the management of this home to still be poor, as she has not had time to show what she is able to do. Ms Brothers told us that staff had probably not received the supervision they should have done, under the previous management. She said she had met with most of the staff in January, and supervision would now be cascaded down, with deputy managers and senior staff supervising other staff. Since our last inspection the provider has carried out visits as he is required to do, and left a written report in the home. The most recent one was in much greater depth and included what actions need to be taken for any areas where a good enough standard has not been reached. We did not check money held on behalf of residents this time, but this was handled well at our last inspection. When we arrived in the dementia care unit on the first morning, one of the residents had slipped from his chair and was on the floor in the lounge. Although the staff fetched the hoist, they were clearly not well-practiced in using the hoist to pick people up off the floor. The manager wrote to us following the inspection telling us that this had raised some issues about the training which staff receive, and whether the hoist is suitable for this purpose, which she is looking into. While looking round the dementia care unit we found that health and safety were not dealt with well. For example, the bathroom door was open and in the bathroom we found a 5litre container labelled ‘thick bleach’ on the floor; the cleaning trolley, with several bottles of various cleaning chemicals on it, was left unattended in the corridor; and the fire doors between the kitchen and the dining room, and the dining room and lounge were both held open with chairs. There were various items of food in the fridge, for example, sandwiches, cake, a bowl of something which looked like marmalade, and so on which had not Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 28 had a date put on them to show when they were put in the fridge. There were two open cans of evaporated milk in the fridge door: the milk had congealed in yellow lumps around the openings of the cans and they were not dated to show when they were opened. And there were a number of jars, for example, of peanut butter, pickle, jams and so on which had no date showing when they were opened. Plastic containers with breakfast cereal in them had no dates to show when they had been topped up. There were bottles of Fortisip and Ensure in the fridge which were not named, and again had no date to show when they had been opened (see Health and Personal Care section of this report). The fire service had inspected the home in October 2008 and served an enforcement notice (see Summary of this report). The acting manager told us that the fire risk assessment had been updated, but was not yet in the file, so we did not see it. Records showed that tests of the fire alarm and emergency lighting systems have been done as required. A fire drill was planned for the day after our inspection. Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 29 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 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 X 2 Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 30 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 OP4 Regulation 4 Requirement The home must operate within its registration, and within its statement of purpose. People whose needs cannot be met must not be admitted to the home. There must be clear guidelines for staff about wound dressings from a person qualified to give this guidance, and these guidelines must be followed. This is so that the person receives the care they need and wounds are dealt with properly. We sent a serious concerns letter about this to the provider following the inspection on 03/09/08. This requirement was not fully met: the timescale has been extended. 3 OP9 13(2) Full and accurate records of medicines received into the home on behalf of people and disposed of or leaving the home must be kept at all times. DS0000015039.V374716.R01.S.doc Timescale for action 10/03/09 2 OP8 12(1)(b) 10/03/09 30/04/09 Meppershall Nursing Home Version 5.2 Page 31 This requirement was not fully met: the timescale has been extended. 4 OP9 13(2) Medicines must be administered to people in line with prescribed instructions at all times. This must be demonstrated by record-keeping practices enabling medicines to be accounted for. We made an immediate requirement about this on 04/09/08 which was not met by 23/10/08. This requirement was not fully met again: the timescale has been extended. 5 OP9 13(2) Medicines of a psychotropic nature prescribed on a discretionary administration basis (PRN) must only be given to people when clinically justified. This must be demonstrated by record-keeping practices. This requirement was not fully met: the timescale has been extended. 6 OP12 16(2)(m) and (n) People in all parts of the home must be provided with stimulation and social and emotional support (activities) to enable them to maintain a satisfactory level of social and emotional wellbeing. This requirement was not fully met: the timescale has been extended. 7 OP18 13(6) All staff must receive training in Safeguarding Vulnerable Adults DS0000015039.V374716.R01.S.doc 30/04/09 30/04/09 30/04/09 30/04/09 Meppershall Nursing Home Version 5.2 Page 32 so that residents are protected from harm and abuse. This requirement was not met: the timescale has been extended. 8 OP19 16(2)(c) The carpets identified as being stained and/or worn must be cleaned or replaced so that residents always have a pleasant home to live in. This requirement was not assessed: the timescale has been extended. 9 OP22 23(2)(l) Adequate storage space must be provided so that corridors, bathrooms and so on are not used for storage. This requirement was not assessed: the timescale has been extended. 10 OP28 18(1)(c) A ratio of 50 of the staff on duty (excluding trained nurses) must be qualified to do their job properly. The timescale for this requirement had not been reached by the time of this inspection. 11 OP30 18(1)(a) All staff must receive sufficient training so that they are competent to meet the needs of the people admitted to the home. For example, in care of people with specific conditions such as dementia. This requirement was not met: the timescale has been extended. 31/05/09 31/10/09 30/04/09 30/04/09 Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 33 12 OP31 9 Management of the home must be effective and sufficient to ensure people receive the care and support required to meet their individual needs. This requirement was not fully met: the timescale has been extended. 31/05/09 13 OP36 18(2) Staff must have regular 30/04/09 supervision, so that their training needs/development can be identified and their work practice monitored. All staff must receive one session within the timescale, and regularly thereafter. This requirement was not fully met: the timescale has been extended. 14 OP38 13(3),(4) and (5) Staff must receive training in all topics relating to health and safety, for example moving and handling; food hygiene; infection control; fire safety; and first aid. This is so that people living at the home are kept safe. This requirement was not fully met: the timescale has been extended. 31/05/09 15 OP38 23(4)(a) Fire doors must not be held open by anything other than a means approved by the fire authority, so that people who live at the home are as safe as possible in the event of a fire. This requirement was not met: the timescale has been extended. 10/03/09 16 OP38 23(4)(e) All staff must be involved in a fire drill at least once a year so DS0000015039.V374716.R01.S.doc 31/05/09 Meppershall Nursing Home Version 5.2 Page 34 that staff know how to react, and keep people safe, should a fire break out. This requirement was not assessed: the timescale has been extended. 17 OP38 13(4) Chemicals must be stored securely. So that people are kept safe. 10/03/09 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 Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Meppershall Nursing Home DS0000015039.V374716.R01.S.doc Version 5.2 Page 36 - 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. 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