CARE HOMES FOR OLDER PEOPLE
Meppershall Nursing Home 79 Shefford Road Meppershall Beds SG17 5LL Lead Inspector
Andrea James Unannounced 26th April 2005 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 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 I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Meppershall Nursing Home Address 79 Shefford Road Meppershall Beds SG17 5LL 01462 811224 01462 812027 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) G A Projects Ltd NA Care Home with Nursing 57 Category(ies) of OP Old Age - 47 registration, with number PD Physical disability - 10 of places Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The certificate needed a variation to include 3 service users under 65. the registration certificate is not complete because the manger had recently submitted her application for registration. Date of last inspection 31.01.05 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. c
Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried 4 months after the last inspection. The inspection was carried out over 7 hours which commenced at 10am on the 26/04/05. The manager was present for the duration of the inspection. The inspection process followed a case tracking methodology where one service user from each unit was chosen and their records and care plans were viewed in detail. The inspector was able to speak to relatives, service users, staff, the manager and the police to gain an understanding of the service provided by the home. What the service does well:
Meppershall created a welcoming and clean environment where visitors and service users were made to feel welcome. The home was separated into 4 units and the nurses were only stationed in one unit for a period of time ensuring all staff received the skills and ability to care for all the needs of the service users, by working in all the units. The staff team provided good standards of care for the service users. Relatives and visitors spoke positively of the care provided by the home. The home had various opportunities for staff to receive adequate training in meeting the needs of the service users. The home provided placements for oversee nurses who gained accreditation while working in the home. The service users received a varied amount of meals that appeared balanced and nutritious. The home provided meals for different dietary requirements. The service users were able to access the community resources by the availability of the home’s own transport facility. The home provided a good standard of health professionals to meet the needs of the service users. Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The security of the home needed further improvement to ensure the safety of the service users. The home had suffered three thefts in a short space of time. The individual units were also open to unauthorised personnel entering without the knowledge of the staff team, putting the service users at risk. The home had improved the way disposable gloves were stored but the disposal of used gloves posed a risk to service users. There was evidence that gloves were being disposed in of in communal bins. The unit managers needed to ensure self feeding service users are monitored during feeding to ensure they are able to maintain their dignity at all times, and ancillary staff does not feel they need to assist service users. The home needed to ensure that all care plans detail accurate information about when catheters needs to be changed to ensure good care practice is provided to the service users by all the staff team. Their was also a need for accurate reviewing of care plans that reflect the actual care being provided to the service users. The assessment tools needed further development to ensure they reflect the changing needs of the service users.
Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 7 There was an identified need for more activities for some service users to ensure motivation and stimulation. The need for more accessible call point systems for service users in wheelchairs was identified in the units on the ground floor. The home needed to have a consensual contract for baby monitoring systems used in service users bedrooms. The home needed to improve the Protection of Vulnerable Adults policy to ensure it includes the correct procedure for reporting suspected abuse. 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 I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 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 standard(s) 3,4,5 and 6 Service users appeared happy with the choice of the home but most moved in on the basis on recommendations from their relatives and friends. The admission procedures did not fully meet with the requirements of the standard. EVIDENCE: The home’s admission procedures needed further development to ensure all service users received the appropriate information on admission. The home had one admission recently. The service user was spoken to who said although she was not able to view the home prior to admission her relatives and friends were able to view the home for her. The service user said she was not given a statement of purpose or a service users guide. She was yet to receive her contract but was only in the home for 3 weeks. The home did not have a satisfactory assessment for this service user but some assessments were evident on other files inspected. Some files had basic assessment of needs in the form of a tick chart. The manager said the home was in the process of updating this information and all service users would have satisfactory assessments. The deputy
Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 10 manager worked supernumerary once per week in order to audit all care documentation. These included the new admission assessments. The home had two rehabilitation beds but both were vacant on the day of the inspection. Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 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 standard(s) 7,8,9 and 11 The care plans illustrated service users received good standards of care with a need for further development in some areas. EVIDENCE: The care plans viewed in the home demonstrated that the service users needs were in most cases being met. The district nurses also used the care plans to document their intervention with the service users. The plans had various risk assessments to suggest the safety aspects f the service users were addressed. There were however a need for further development to ensure consistency in recording. There were some care plans that did not identify when catheters or peg feeds were changed and as a result service users health needs could be compromised. The care plans also failed to identify service users death arrangements and consent for burial. The care plans seen suggested that specific areas in the care plans had changed for example the amount of staff needed to transfer service users but these were not recorded in the care plans. The social, cultural and religious needs of the service users were not highlighted in the care plans. One service user said he would like to have the
Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 12 opportunity to attend church because he strongly believed in his faith. This information was not recorded on his care plan. The care home was divided in 4 separate units that had 2 carers per unit one of which was a qualified nurse. The health care needs of the service users were also maintained by the visit of the community district nurses, a weekly visit from a named general practitioner and other therapists that ensured all aspects of the service users health needs were met. The medication procedures were satisfactorily maintained. All units had their own medication trolley and one was inspected by the inspector. The mars sheets were recording accurately. There were no records to suggest the service users wishes at the time of their deaths were recorded. The manager informed the inspector that this matter was identified as a need and would be addressed in the near future. Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 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 standard(s) 12,13,14 and 15 Service users lives had limited social activities but had a satisfactory standard of daily living. EVIDENCE: The home had an activities programme for some service user but the service users social, cultural and religious needs were not highlighted in the care plans and as a result the individual needs of the service users could not be assessed. The home had a large amount of visitors that visited on the day of the inspection. Those spoken to said that the services provided for the service users were satisfactory but felt more could be done in stimulating the service users y providing more activities. One service user spoken to said he was able to exercise his choice in his meals. The meals provided suggested that choices were offered and one service user said choices were offered the day before. There were no menus on display. One service user felt that the meats served needed to be more tender and felt that the glasses they were given were too heavy for them to lift. They commented that the breakfast choices were varied and satisfactory. Service users receiving liquid diets received theses in an attractive manner and staff were seen to be assisting those service users in a sensitive and relaxed manner.
Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 14 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 standard(s) 16, and 18 The home satisfactorily investigated a recent complaint. EVIDENCE: The home received one complaint about the care of a dying service user. The inspector viewed the information gathered and found that the some aspects of the complaint were partially substantiated. The home carried out a thorough investigation. One relative spoken to said she felt able to complain if it was necessary but was not aware of the complaints procedure. The manager said this was displayed in the home. There was evidence to suggest staff were trained in identifying and reporting suspected abuse using the Protection of Vulnerable Adults Policy. The home had two service users who had reported thefts, the police was investigating one but one was not reported to the police and as a result the service user did not receive a satisfactory conclusion. The manager had carried out an in-house investigation. Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19,22,23,24 and 25 The environment was welcoming and satisfactorily decorated but there was a need for better security to protect the service users and their belongings. EVIDENCE: The home had 3 recent thefts that resulted in the police involvement. The home’s entrance was of such that visitors to the home could enter without the knowledge of the staff. The inspector was also informed that one large conference centre at the top of the building was regularly used as a training room by external tutors and students. This facility put the safety of the service users at risk, as the units’ main doors were open to the conference room. The service users bedrooms were also left open during the daytime. There were no risk assessments to protect the service users at these times and as a result service users safety were compromised. On the day of the inspection one service user had a theft from his bedroom and another service user spoke of her financial loss. Previous inspections had highlighted the vulnerability of the service users but this was not actioned.
Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 16 The home provided satisfactory equipment to meet the needs of the service users. Care staff were seen using lifting equipments to aid correct manual handling procedures for service users. There were also other equipment available including pressure relieving mattresses and cushions to ensure service users skin remained in tact. One service user was seen struggling to reach a call bell system that was too high for her because she was wheelchair bound. The home had addressed the issue of lowering the call systems in some units but not in all, as a result the outcome for this service user was not satisfactory and her independence was compromised. The service users bedrooms viewed appeared to be satisfactorily maintained and personal belongings were visible. Their was a need to provide a lockable facility and a bedroom key to those service users who were able to use this facility to prevent future thefts and enable service users to maintain their independence and feel safe in leaving their belongings in their rooms. The home had a core of ancillary staff that maintained satisfactory hygiene within the home and no offensive odours were identified. Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 He home had sufficient staff with the skills to meet the needs of the service users. The recruitment procedures ensured the service users safety was protected. EVIDENCE: The home employed 50 staff which included 12 carers, 2 senior carers,3 prequalified nurses, 14 trained nurses and 19 ancillary staff. The home was divided into 4 units, each was headed by a lead nurse and 1 carer with an additional floating carer. The home provided a 1:5 ratio during the day and 1:10 at nights. The training records show that various training needs were identified and were being met. The home provided courses for staff to include swallowing, nutrition, and strokes catheterization and abuse awareness. 7 care staff had achieved their NVQ level 2 in care. The staff files inspected demonstrated that with the exception of some files not having both references all other aspects of the recruitment procedures were satisfactorily maintained. The staff received regular training and on the day f the inspection some staff had contained their manual handling training. The home had a training matrix that identified courses undertaken and future training needs required for the staff team. Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 35 and 38. The manager was qualified and competent in meeting the needs of the service users. The manager created an open door policy that reduced the need for complaints. Some aspects of the home in regards to health and safety were in need of immediate attention. EVIDENCE: The manager have been managing the home for several years and provided an in-depth knowledge if the needs of the service users. The staff felt she lead the home satisfactorily and visitors found her easy to communicate with. One service user was seen in the office speaking to the manager in a relaxed way. The manager said she regularly visited the service users to ensure they were happy with their care.
Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 19 Some service users finances were held in the manager’s office for safekeeping. Staff said they received regular supervision. There were some aspects of the home that contravened health and safety regulations. These included the usage and disposal of disposable gloves and the cords used for accessing call bells were trailing across some of the units main floor space which could cause a trip hazard to the service users. Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x 3 3 2 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 3 x x x x 2 Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? 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 op03 Regulation Requirement Timescale for action 30.06.05 2. op07 3. op07 4. op07 5. op11 6. op18 7. op19 14(1) ( c ) All service users must have a comprehensive assessment of needs carried out to ensure the home can meet their identified needs. 15 (1) The service users care plans must be developed to ensure all aspects of their needs are identified, including social and cultural needs. 15 (1) The care plans must be developed to show accurate information for changing catheters and pegfeeds. 15 (1) The care plans must record accurate manual handling procedures for the number of staff required to transfer service users. 15 (1) Arrangements must be made for service users death wishes to be recorded on file before their death. 21 (1) The procedure for reporting suspected abuse must include informing social services of any suspected abuse. 13 (4)( c) Arrangements must be made for the homes risk assessment for the security of the home to be reviewed.
I51 S15039 Meppershall V223451 260405 Stage 4.doc 30.06.05 30.06.05 30.06.05 30.06.05 30.06.05 28.02.05 new date 30.06.05
Page 22 Meppershall Nursing Home Version 1.30 8. op24 9. op25 10. op38 11. op38 12. op38 13 (4) ( c) Arrangements must be made to safe guard the service users by making each unit secure from unauthorised personnell. 16 (2) (l) All service users bedrooms must be fitted with a lock and have a lockable facility to store their valuables. A key must be offered to those service users wishing to lock their bedroom doors. 13 (4) ( c) Arrangements must be made for better disposal of all disposable gloves to ensure the safety of vulnerable service users. 13 (4) ( c) Risk assessments must be carried out on the trailing wires that crossess the units main lounges that could cause service users to fall. 13 (4) ( c) All units must have accessible call point systems for service users using wheelchairs. 30.06.05 30.06.05 30.06.05 30.06.05 30.06.05 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 op29 Good Practice Recommendations All staff files should obtain two satisfactory references for all staff employed in the home. Meppershall Nursing Home I51 S15039 Meppershall V223451 260405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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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