Inspection on 26/05/10 for Meppershall Nursing Home

This inspection was carried out on 26th May 2010.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meppershall Nursing Home 19/05/10

Meppershall Nursing Home 23/02/10

Meppershall Nursing Home 17/12/09

Meppershall Nursing Home 07/08/09

Meppershall Nursing Home 25/02/09

Meppershall Nursing Home 03/09/08

Meppershall Nursing Home 04/09/07

Meppershall Nursing Home 22/11/06

Meppershall Nursing Home 20/12/05

Meppershall Nursing Home 26/04/05

Meppershall Nursing Home 31/01/05

Meppershall Nursing Home 12/08/04

Meppershall Nursing Home 09/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for older people Name: Address: Meppershall Nursing Home 79 Shefford Road Meppershall Bedfordshire SG17 5LL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Katrina Derbyshire     Date: 2 6 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Meppershall Nursing Home 79 Shefford Road Meppershall Bedfordshire SG17 5LL 01462811224 01462812027 gagroup@btconnect.com gacontracts@btinternet.com G A Projects Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager post vacant Type of registration: Number of places registered: care home 84 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The Maximum number of service users who can be accommodated is 84 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 Date of last inspection Brief description of the care home Meppershall is a purpose built care home with nursing in the 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. The main Care Homes for Older People Page 4 of 31 Over 65 0 49 0 30 0 5 1 7 1 2 2 0 0 9 Brief description of the care home 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. 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. The home is surrounded by large grounds and parking spaces for staff and visitors are provided. The home has links with the local community and shares transport for people with its sister home. Hairdressing, newspapers, toiletries, and staff escorts to medical appointments are not included in the fees. People who have their own telephone are responsible for the bills. Information about this home can be obtained by phoning and visiting the home direct, and there is also an entry for this company on several care home websites. The fees for this service vary between £440 and £530 per week: the exact fees are reflected in individual service contracts for the residents. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection carried out on the 26th May 2010. The care of four people was looked at in detail and this is known as case tracking. Tracking peoples care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. During the visit the communal areas of the home were seen alongside some of the individual rooms. Time was spent with many of the people who live at the home in one of the sitting areas. Care Homes for Older People Page 6 of 31 Observations of care practise and communication between the people living at the home and staff was also made at the inspection. The service was given a 0 star rating at the key inspection undertaken on 25 February 2009. But following significant input and support by health and social care professionals over a six month period, improvements were noted at the key inspection on 7 August 2009. Although there were areas identified for further improvement, none were considered a significant risk to any residents health and well being. The rating changed from 0 star to 1 star service. In October 2009 the local safeguarding team reported concerns about moving and handling practise, nutrition and wound care, and the number of staff who could not communicate with residents in the English language. Also, both the acting manager and deputy resigned on 2nd November 2009. During both our random inspections of the home on 2nd and 13th November 2009, significant shortfalls were identified and immediate requirements were made alongside other requirements. These requirements related to management arrangements, moving and handling equipment and staff competency, staffs insufficient command of the English language and checks required prior to any staff starting work. Our key inspection on 17th December 2009 raised a total of 12 requirements. We also served the owner/responsible individual with a Code B Notice, a procedure in line with the Criminal Procedure and Investigations Act 1996, and allowing inspectors to seize or copy any documents relevant to their investigation. The Notice was in respect of medication not administered for two residents. There had been a change of acting manager for the third time during a five month period. Care and staff management systems had not been implemented to good effect over a number of months. Staff have not received formal recorded supervision regularly and care practise has not been closely monitored and this had impacted on the quality of service delivery for residents. Protection incidents had not been reported immediately to the safeguarding team or Health and Safety Executive and wound management had been poor. The rating again changed to a 0 star service.The owner was then sent a warning letter from us. Given the number of concerns arising, there was a complete embargo placed on this service of any new admissions by the Central Bedfordshire social services. This remains in place. An additional random inspection that we carried out on 23rd February 2010 to check compliance with requirements that we had made showed progress in some areas, but continued non compliance in the management of medications. Further evidence was seized and this resulted in us issuing a Statutory Requirement Notice. We undertook a further random inspection and this was carried out by two pharmacist inspectors on 19th May 2010, this was to check on compliance with the Statutory Requirement Notice. This visit showed that the service had complied with the notice, and noted compliance with the notice. Again at this inspection there are areas that have been noted as needing improving on, however none were considered a significant risk to any residents health and well being. Care Homes for Older People Page 7 of 31 The trend emerging from the history of the service is that improvements were made but not sustained long enough to improve the quality of service delivery. The owner and management of the home must ensure a good standard of care for residents, they must continue to make sustained improvements and demonstrate their competency by operating the service safely so residents are not placed at risk.The owner has been advised by us that immediate enforcement action will be taken if shortfalls in care delivery occur again. The focus of this inspection was to look at the key standards Care Homes for Older People Page 8 of 31 What the care home does well: What has improved since the last inspection? There had been several areas that had improved, these included: The management of medication had improved. Since we issued the service with a Statutory Requirement Notice the checking systems that have been introduced as well as the involvement of a local pharmacy have resulted in improvements in this area. People had been receiving their prescribed medication, medication records had been completed and stocks were correct. Documents known as care plans had also improved, the significant improvement was seen to have been within the dementia care unit.These plans detailed any need a person had, and how staff should meet those needs.These care plans are important as they provide the guidance to staff that they have to follow, to make sure there is continuity in care delivery. Information within the documents included for example, what time a person liked to get up in the morning and how they liked to spend their day providing meticulous information about a person. Acknowledgement is given to the very good standard of care planning seen within the dementia care unit. Although we have recommended changes of the care plans within the nursing unit. The training of staff has continued to improve over recent months. A programme of dementia awareness has started, and this has resulted in improving staffs understanding of residents needs who have dementia. Changes that have been made as a result of this increase in their awareness includes, the introduction of fresh fruit and the increase in finger food. Staff have sought alternative ways to ensure residents with dementia, receive the nutrition that they need. Several of the residents are not able to sit and eat a main meal, they will walk away from the table as they feel they have eaten a meal, when in fact they have not.Through introducing more finger food, those residents will eat small amounts throughout the day to supplement their diet. Care Homes for Older People Page 9 of 31 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information available about the services on offer is good, and provides assistance to people when making a choice to move into the home. Evidence: There had been no new admissions to the home since the last key inspection, therefore none of this evidence relates to the previous 6 months. Care files examined included pre-admission assessment. Assessments included information from visiting the person at the hospital, or wherever he or she was living prior to admission and information from any referring social worker or health professional. There were sections covering the social, psychological and physical needs of the person. Assessments seen at this visit were comprehensive and clear, the Acting manager and staff through discussion also demonstrated an awareness of their contents and purpose. Care Homes for Older People Page 12 of 31 Evidence: We spoke with four people about their admission to the home. Everyone confirmed that information was available to them when they moved. One person advised that they had visited the home with a relative prior to moving in. They went on to explain that they had felt apprehensive when they came into the home as they did not know what to expect, however the staff had made sure that everything was explained to them, and for the first few weeks gave them additional support. The statement of purpose was examined. The document provided information on the staffing, accommodation and services available at the home. Alongside the service user guide a range of information was available, including services available. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of medication is has improved so helps to promote peoples health and well being through safer practise by staff. Wound care is not in line with best practise guidelines so places people at risk of increased levels of discomfort. Evidence: At a serious concerns meeting in November 2009 we were informed by a representative of Central Bedfordshire Council that through a review of care plans they had undertaken in November 2009, they believed that care planning for 43 of the 49 care plans they looked at were inadequate. Inconsistencies in the standard of care planning were also seen at the key inspection in December 2009. A random inspector on 23rd February 2010 reported that work had been undertaken to improve in this area. At this visit we examined care plans in both the nursing unit and dementia care unit.Within the nursing unit of the home written entries within the care files evidenced that a care plan was in place for each assessed need. The standard of entries within these plans was mixed. Documents within the care folder for one person showed that Care Homes for Older People Page 14 of 31 Evidence: they were at risk of falls, an assessment of this was in place and had been reviewed monthly, however the outcome of that risk assessment had not been incorporated into the care plan. This would mean staff would not have the most up to date information about that person without looking through numerous care documents. Also the detail of entries were sometimes generic, and not person centred. An example of this was although handwritten many of the care plans contained the same information even though the needs of the people were very different.The care plans examined within the dementia care unit were of a very good standard. Each plan seen gave minute detail on how staff should support that person. Details included if a person liked their curtains opened or closed, the type of soap they liked, if they liked weak tea, whether they preferred a brush or comb and important events in their lives. Concerns had been raised and a requirement made at the February/March 2009 inspection that clear guidance was available to the nursing team on the approach to wound care. Subsequent inspections noted that this had been secured. Care documents for two people receiving wound care were examined at this inspection. A care plan was in place that detailed the frequency and type of dressing change. However this approach did not include other factors that have to be considered as part of wound care. One person had significant ulcers to their legs that required dressing changes. No consideration had been given to the increase in discomfort for that person when this treatment was carried out, in turn no pain relief or alternatives had been considered or actioned to address this and a requirement has been made. At the inspections on 19th December 2009 and 23rd February 2010 we had served a code B notice on failings to administer medications correctly. We subsequently issued a Statutory Requirement Notice on this matter. During an inspection on 19th May 2010 to check compliance with this notice, our findings were as follows: We looked at a sample of current medication administration records (period 10th May to 31st May 2010), sampled a number of medicines available for administration and found no numerical discrepancies. We found there to be no medicines remaining in monitored dosage systems that had been signed as administered and we found that where medicines had not been given there were appropriate records indicating why they had not been administered. Codes used to record their non-administration were clearly recorded. We found there to be no omissions in medicine administration records or records for the receipt of medicines. The home has put in place daily records with running balances of medicines that are not supplied in monitored dosage system containers. There are also carried forward figures recorded for the start of new medicine administration records for such medicines. The senior person on duty described to us the auditing systems that have been put in place including daily audit checks. We identified a controlled drug medicine in patch form where there was a surplus of one patch which had not been administered as scheduled on 09/04/10 Care Homes for Older People Page 15 of 31 Evidence: preceding expiry of the statutory requirement notice and which had not been annotated as carried forward on the current medicine administration record. We discussed this with both the senior person on duty and the registered provider at the end of the inspection. We also discussed controlled drugs that we had noted had been recorded as disposed of but where the remaining balances were recorded incorrectly in the controlled drug register when the amount remaining should have been zero. When we discussed the findings of our inspection we asked the registered provider how he intends to sustain improvements made to date. He responded by telling us that the level of auditing currently in place will be sustained and not withdrawn and that the pharmacy suppliers will continue to be involved in ensuring all members of staff authorised to handle and administer medicines are trained. In view of the improvements we found the Commission does not intend to take further action in relation to the statutory requirement notice at this time. The physical appearance of the 9 people we met in both the nursing and dementia care unit appeared satisfactory. Peoples hair looked combed, their clothes were neat and tidy and no remnants of food were noted to be on anyones face or clothes. Observation at this visit showed the 6 staff seen in both areas of the home to approach and engage with people in a courteous manner. Accident forms had been completed following any accident or incident. Documents and staff demonstrated that follow up had taken place and when needed medical attention had been sought in a timely manner. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for social activities are sufficient and meet peoples individual preferences and needs in this area. Evidence: In late October 2009 we were alerted by the Central Bedfordshire safeguarding team of a referral that they had received concerning a person living at the home; a major concern was the lack of nutrition that they had received. Further information was sent to us following their review of this in November 2009 advising that the hospital had stated that on admission to hospital from the home, the person had been severely dehydrated. Subsequent inspections showed inconsistencies in meeting the nutritional needs of some of the people who live in the home and requirements were made in 2009. At the random inspection on 23rd February 2010 we reported: Changes had been made to the menus in the home, with additional hot teas now being offered. Some people expressed needs were catered for, for example one person only likes fish fingers which is what they were given. Fluid charts were in place for people who needed them, although not always added up at the end of the day. We Care Homes for Older People Page 17 of 31 Evidence: also observed other residents in the home, all had drinks provided to them alongside nutritional supplements. At this inspection We spoke to eight residents to ask their views about the food they are offered at the home. All of those eight people spoke positively about the meals the service provided. Four people stated that there had been recent improvements and changes to the menu, this had given them a greater choice.One person said, I eat better here than I did at home, and I ate well at home. The home currently employs 3 activities coordinators who provide a total of 60 hours input per week. we had raised concerns at the key inspection in December 2009 that one of these people could not communicate effectively with the residents on that day. The owner subsequently disputed this and it was minuted following a relatives meeting. However Inspectors were approached by three people at a random inspection on 23rd February 2010, they stated that many of the residents could not understand this person and the reporting made in December 2009 reflected how most residents felt. During the inspection in February 2010 and at this visit we observed staff on duty communication with residents, during that time residents appeared to be able to understand the staff on duty and in turn communicate their wishes to staff. On speaking with six people who live at the home, all reported that there had been an increase in the amount of activities provided. One person was seen to go out into the garden during this visit as he liked to attend to some of the garden, he advised that it occupied his time and he enjoyed it. A significant change was seen within the dementia care unit. During the inspections in November 2009, only one person was seen to be sitting in the lounge on the ground floor, all remaining residents were in their rooms. When we arrived at the unit at this inspection, every resident was up and based in one of the communal areas. Staff were sitting talking with residents, residents appeared to be engaged, and some walked freely around the unit. People questioned said that their visitors are made to feel very welcome indeed, and that they can come to the home at any time. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The response to complaints is inconsistent so people are not always assured their concerns are listened to and acted upon. Evidence: There had been a number of safeguarding incidents, which had occurred since the key inspection on 7 August 2009: several of these incidents had not been reported to the local safeguarding team. The owner told us that part of this was due to the inability of the previous manager to respond to protection matters; however the current Acting manager had also failed to report a person who had sustained multiple skin tears in December 2009. The Central Bedfordshire social services had developed personal protection plans for all 59 people living in the home at that time, reflecting the councils level of concern and its aim to ensure the safety and protection of residents. These have now been removed. We had made requirements relating to safeguarding, we then checked compliance with these requirements at the random inspection on 23/02/2010.We reported at that time: From the key inspection in December 2009 to the date of this inspection, showed no evidence of a safeguarding matter not being referred by the home. Through all records seen at this visit, observations made and discussions with people who use the service, there was no evidence that any further safeguarding matters had not been reported. Care Homes for Older People Page 19 of 31 Evidence: However we were informed by Central Bedfordshire Council of an incident in which the owner had become involved in delaying a move between units for one person, this delay had not been in the best interest of the person. Within the statement of purpose there was information on whom to contact if you wished to make a complaint. The service had received three complaints since the last key inspection. All complaints had been responded too. However one of the responses had been written in a way that was defensive. Even if a complaint is not substantiated, responses must be made in a way that would not deter people from raising concerns in the future. People must feel comfortable to make a complaint and if they do so the response that they receive must be courteous. This area had also been subject to requirements in 2009 and subsequently assessed as met, although it is acknowledged that the complaint was responded too a reverse in practise needs to be acted upon swiftly. Again the matter of sustaining improvements is the issue within this section. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of accommodation is good to provide a comfortable and clean environment for people to live in. Evidence: All bedrooms in the main building have either en-suite toilet and washbasin facilities, or washbasin in the bedroom; all bedrooms in the dementia care unit have en-suite toilet and wash basin facilities. The standard of decoration and furniture and fittings in those areas viewed is good. Residents expressed a great deal of satisfaction with their physical environment. Those spoken with are very happy with their bedrooms and they said that they are able to bring their personal possessions and belongings. Evidence of furniture, mobiles and other personal effect brought by residents was seen in the bedrooms viewed. The home was kept fresh and pleasant and a high standard of cleanliness was evident.One person said, I think the place is lovely I look out of these windows and all I see are fields and open spaces. Parking is available for staff and visitors. The home is surrounded by large grounds with parking facilities. There is a large, Care Homes for Older People Page 21 of 31 Evidence: secure garden with a paved patio area, which is accessed from the dining room of the dementia care unit. Staff reported that the garden is well used by residents during the warmer season. Evidence shows that protective clothing, gloves and hand washing facilities are provided. Cleaning schedules are in place and domestic and clinical waste is disposed of satisfactorily. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Increases being made in staff training and supervision has improved the standards of care in some areas. However varying levels of competency in staff employed means an inconsistent service delievery at times. Evidence: An immediate requirement was made on 13th November 2009 about recruitment. The home had been using an agency to provide nursing cover in the home, this service was unregistered and there was no evidence of checks having been made as listed in schedule 2 of the Care Homes Regulations. A subsequent audit of recruitment practices at the inspection in December 2009 showed complaince with this requirement.We also looked at the recruitment of the current acting manager who took up post in December 2009, at the random inspection on 23rd February 2010. The owner had secured 3 references and undertaken safety checks prior to her starting work at the home. The random inspection report dated 2nd November 2009 reported on incidents where care staff had placed individual residents welfare and safety at risk due to poor verbal communication skills from staff members. An immediate requirement had been made on 2nd November 2009 for staff to have knowledge of the English language so that residents needs are met in a safe and consistent manner. The owner advised that he Care Homes for Older People Page 23 of 31 Evidence: had ended the employment of staff identified at that visit and there were 7 ancillary (Domestics) staff who were receiving weekly lessons (8 week course provided by Skills for Life - UK Learning), in order to improve their numeric and verbal communication skills. The random inspection on 23rd February 2010 and the findings from this visit, showed no concerns in this area. Staff on both visits were observed interacting with residents, there were no barriers seen to cause any communication difficulties. Residents were observed speaking to staff, and thoes staff responded prompltly and clearly. Within this report are examples and evidence of improved practice, acknowledgement is given. Examples include significant improvements within the dementia care unit, care planning, engagement, activities, atmosphere have all improved in this area. In addition requirements made relating to training were noted to have been met. However consideration has to be given to the enormous amount of time been given to this service by multiple agencies over a sustained period of time. Even with this level of input, some staff have still not been able to demonstrate competency in all areas. Examples include, some nursing staff not understanding the basic principles of wound care treatment, a controlled drugs patch not being documented correctly (we could not act on this as the error was within the Statutory Requirement time period), and examples of inadeqaute care planning within the nursing unit. Monitoring of care practice is essential based upon the history of the service, executive management and day to day management are responsible for this. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Insufficiencies in management systems mean at times the monitoring of care practise is inadequate, and fails to identify shortfalls in care delivery at times. Evidence: The registered manager of Meppershall Nursing Home resigned in October 2008. Since then there have only been acting managers. One acting manager resigned in September 2009, another acting manager was appointed and they resigned in November 2009. At a random inspection on 2nd November 2009 we made an immediate requirement for the owner to make sure that there are management arrangements in place at the home on a day to day basis, as alongside the resignation of the acting manager the deputy manager had also resigned. Including the current acting manager, there had been 3 acting managers in post in the previous 5 months at that time. The current acting manager has been in post since 7th December 2009. She stated that she intended to submit an application to the Care Quality Commission for the Care Homes for Older People Page 25 of 31 Evidence: registered managers post at Meppershall, she made this statement at the key inspection in December 2009. An application was subsequently submitted, however it was incomplete and had to be returned. At the time of this visit it had been over a month since we had returned the application, no re submission had occurred. An in depth conversation took place with both the owner and manager concerning this, this failure to act in a timely manner is surprising based on the history of this service and directions given by us. We expect an application without delay. Acknowledgement is given to the improvements that have been made, these are detailed within this report. However given the spotlight that has been on this service and subsequent support, monitoring, guidance, meetings and inspections by multiple agencies, there remains a concern that shortfalls are not being identified by the services own monitoring systems as evidenced in the health and personal care section of this report. Following a random inspection on 2nd November 2009 an immediate requirement was made, this was to ensure safe and appropriate equipment was in place for moving and handling. An Occupational Therapist-Senior Practitioner subsequently assessed people at the home and gave guidance in terms of make of sling, type, size, loops on the sling that need to be used and how the sling should be fitted. Information received 11th June 2010 indicated that this had not been followed, evidence was then submitted to us by the owner to dispute this. We sought clarification from Central Bedfordshire Council on the information, delaying this report by one week.We have not received a response, however no further delay could be made on sending this report. Consideration must be given that there is the possibility of an outstanding matter. On receipt of this information we will take appropriate action if needed, and this will be used to inform the next key inspection of this service. Therefore we will leave the standard that covers health and safety as not assessed at this point. Moving and handling was observed throughout the inspection, during this time safe practise was seen to be followed by staff. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 Treatment by nursing staff through the provision of wound care must include support to secure required pain relief and nutrition. This will ensure people are free from discomfort and receive supplements to aid healing. 30/06/2010 2 16 22 All complaints received must 09/07/2010 be accepted in a professional manner and then responded to in accordance with the homes own policy. This is to ensure people and their relatives feel confident enough to raise a concern and feel listened to and their concerns are acted upon appropriately. Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 30 18 Staff must have sufficient levels of competency to meet the needs of residents in accordance with best practise. This is to ensure the safety and the protection of people using the service. 30/06/2010 4 31 8 The Acting Manager must re submit her application to apply to be the Registered Manager for this service. This will stop this service being managed on a day to day basis by someone who is not registered. 09/07/2010 5 33 24 The system for quality 30/06/2010 monitoring on standards of care must improve to ensure any shortfalls are identified quickly and action taken to remedy this. This will ensure people receive the care that they require at an acceptable and safe standard. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Consideration should be given to adopt the approach taken in care planning within the dementia care unit and apply Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations this to the nursing unit. 2 18 Management should always base decisions when they have gained the views and assessments of all agencies involved in a case. This will make sure that any action they take will always be carried out in the best interest of the resident. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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