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Inspection on 03/09/08 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

One resident said "This is a lovely place really". Another said "I don`t like to complain because it`s such a nice place. Overall they do try very hard". Several people made very nice comments about the staff. People`s needs are assessed before they move in, and the care plans give staff some good guidance on how people want their personal care to be done. Resident`s money is kept safe and records are accurate.

What has improved since the last inspection?

We made five requirements following the last inspection, about things the provider must put right. Two of these had been met, so accidents were being reported to the manager, and records of money we saw were correct. The manager showed us that several new carpets have been fitted and some decorating has been done since our last inspection. The dementia care unit has been built and is now open and almost half full.

CARE HOMES FOR OLDER PEOPLE Meppershall Nursing Home 79 Shefford Road Meppershall Bedfordshire SG17 5LL Lead Inspector Nicky Hone Unannounced Inspection 3rd and 9th September 2008 10:20 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.V371369.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.V371369.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 Mrs Julie Sumner 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.V371369.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 4th September 2007 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 eighty-four people. 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. There is a large day care facility attached to the nursing home, which is not Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 5 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. Residential care, lowest fee:£500 Nursing care, lowest fee: £600 Fees in excess of these figures were determined according to individual assessed need. Uppermost fees were not detailed in the guidance to the service. Fees for residents who fund their own care start at £515 per week for residential care, and £620 for nursing care in the nursing home. Fees start at £550 per week for residential care, and £680 per week for nursing care in the dementia care unit. Fees are determined by individual assessed need: maximum fees were not available. Fees for Social Service’s clients start at £457.06 per week, but a ‘top-up’ of between £5 and £50 per week is needed from people’s families. 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.V371369.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. For this inspection we looked at all the information that we have received, or asked for, since the last inspection of Meppershall Nursing Home . This included: • What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement; Concerns that were raised with us; and Information we asked the home to send us following our visit. • • This inspection of Meppershall Nursing Home included two visits to the home, on 03/09/08 and 09/09/08. Both visits were unannounced, so no one knew we would be visiting on those days. 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. On the first day of this inspection there were forty-four people living in the ‘nursing home’ part of Meppershall, two of whom were in hospital, and there were thirteen people in the dementia care unit. On the second day, another resident had been admitted to hospital, and one more person had been admitted to the dementia care unit (for a respite stay). What the service does well: One resident said “This is a lovely place really”. Another said “I don’t like to complain because it’s such a nice place. Overall they do try very hard”. Several people made very nice comments about the staff. People’s needs are assessed before they move in, and the care plans give staff some good guidance on how people want their personal care to be done. Resident’s money is kept safe and records are accurate. Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: One person said “It was fantastic when I first came [about 2 years ago], I couldn’t fault anything, but it’s not so good now. The food’s not as good, and the girls [from overseas] try very hard but they don’t understand”. There are a lot of things the provider must put right, so we have made 26 requirements. These include: • • • • • • • The management of the home must improve so that people receive the care and support they need; Medication must be administered, recorded and stored correctly so that people living at the home are given their medication safely; People’s healthcare needs must be fully met so people’s health is maintained or improved; Wounds must be dressed according to the care plan, which must be accurate; There must be enough qualified, competent staff on duty to meet people’s needs; Staff recruitment must be done properly so that people are kept safe from staff who should not work with vulnerable people; 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; People must be assisted to move using safe techniques so that the risk of injury to them (and to the staff) is reduced; • Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 8 • Staff’s knowledge of the English language must be sufficient to communicate effectively with residents and with their co-workers, so that people’s dignity is maintained; 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 all staff must be involved in fire drills, so that people who live at the home are as safe as possible if a fire breaks out; Staff must be adequately supervised and supported to do their jobs well; Records must be kept accurately and confidential information must be stored securely; The registered provider or his representative must visit the home at least monthly and write a report of his visit, so that we know he is monitoring the service offered; Meals must improve so that everyone who lives at the home has a nutritious, tasty and healthy diet of their choice; The carpets identified as being stained must be cleaned or replaced, and the home must be kept nicely decorated, so that people have a pleasant place to live; and Good information about the home must be available for people who might want to move in, and new residents must receive confirmation that the home can meet their assessed needs. • • • • • • • • 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.V371369.R01.S.doc Version 5.2 Page 9 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.V371369.R01.S.doc Version 5.2 Page 10 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, 3, 4, 6 People who use this service experience adequate quality outcomes in this area. Some information about the home is available for people thinking about moving in, and people’s needs are assessed before they move in. 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. One relative told us the pack was very useful and gave them a lot of good information. Another said there was no information available about the new dementia care unit. Both the manager and deputy manager told us that one of them always goes to assess people who are thinking about moving into the home before a place is offered to them. We saw evidence of these assessments on people’s files. Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 11 Sometimes the information is quite brief: the deputy manager explained that it is often difficult to get full information if people are in hospital. On one of the files in the dementia care unit we noted that the assessment was dated 2005. We did not see any evidence on people’s files that the provider has confirmed in writing that the home can meet the person’s assessed 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.V371369.R01.S.doc Version 5.2 Page 12 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. People’s personal and healthcare needs are not fully met, and the recording of medication administration is not good enough to be sure people have received the correct medication and are safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at the records the home keeps for several people. The care plans we saw gave staff guidance on the help and support each person needs with their personal care. We saw that some people had signed their care plans to agree that this is the care they want and need. On other plans there was no indication that the plan had been discussed with the person or their relatives. In the dementia care unit staff told us only the nurses look at the care plans. On three of the files we looked at we saw that a risk assessment had been carried out regarding the use of bed-rails. One person had agreed she needs Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 13 bed-rails to stop her falling out of bed at night and her relative had signed the assessment on her behalf. One of the other assessments stated that the person would not be safe if bed rails were used, and the third had not been agreed or signed by the person or their relative. We also saw risk assessments for nutrition, falls, moving and handling and pressure sores. Food and fluid charts had been started for some people where staff had decided they needed to monitor what the person eats and drinks. The records we saw had not been completed fully enough to be an accurate account. We also noted that daily records are not always completed. For example, for one person, who was quite unwell, there was an entry on 10/08/08 at 06:40, and the next entry was 11/08/08 at 06:30. Records of showers and baths, if accurate, show that some people do not get a shower or bath very often. One relative in the dementia care unit said that staff told them they do not have time to bath people more than once a week. The deputy manager told us that a dietician visits regularly, and one person’s file confirmed that they have seen an optician and a chiropodist. We met a TVN (Tissue Viability Nurse) during the inspection. She was from a drugs company and had been working with the home’s staff for several months, doing a trial with a new wound dressing. She was very complimentary about the staff’s work, including their record keeping. She said she had been advised to approach this home about the trial by the TVN from the Primary Care Trust, who had told her the nurses at Meppershall were very good. However, during the inspection we looked at some (not all) residents’ notes and found two examples of wounds that had not been dressed frequently enough. (See Complaints and Protection section of this report). We raised this with the provider in the serious concerns letter we sent him following the inspection. He replied that there had been problems with the surgery and the pharmacy in obtaining the dressings. This is simply not acceptable. In the dementia care unit a relative told us staff had failed to notice and treat a large, bleeding cut on one person’s leg until the relative pointed it out. We were also told about several other issues, such as staff not knowing how to replace hearing aid batteries, relatives having to buy continence aids, and cream for pressure sore prevention not being replaced when it ran out. On the first day we visited we noted numerous errors in the administration and recording of medication, which meant that the recording and administration of medication was not being done safely. We looked at medication records (MAR charts) in the nursing home, for the period 04 to 31 August 2008. Medication was not being administered as prescribed (see Complaints and Protection section of this report). For example, Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 14 • • • • • Movical sachets prescribed as ‘take one daily’. The MAR chart was blank (that is, no signatures to confirm that the medication had been given and no code to explain why the medication had not been given) for the complete period. Paracetamol prescribed as ‘1 or 2 four times a day’. The MAR chart was blank (as above). Tranadol prescribed as ‘1 four times a day’. The MAR chart was blank (as above). Ensure not given twice a day as prescribed. A number of creams listed on the MAR chart had not been administered as prescribed. We looked at MAR charts in the dementia care unit. Medication was not being given as prescribed or instructed. For example: • For one person, Chlorpromazine was prescribed as ‘take 1 three times a day’. The instruction ‘PRN’ had been hand written on the chart. On one day the person had been given the medication four times (see Complaints and Protection section of this report). • Staff were not following instructions for another person’s Furosemide. They were administering from an original packet, and from a blister pack. When we looked at MAR charts in the nursing home and in the dementia care unit we noted that there were numerous gaps on the records (that is, no signatures to confirm that the medication had been given and no code to explain if the medication had not been given, why not). The person administering the medication must confirm, by signing their initials, that the medication has been administered, or they must use a code to explain why the medication was not administered. When we returned on 09/09/08 we checked whether the home had corrected all the mistakes, and complied with the above requirements. The staff had involved the doctor who had done a review of the medication and corrected most of the incorrect entries on the MAR charts. There was still some work to do, so the home had not fully complied with the requirements. The provider responded to our immediate requirement letter: the response was not satisfactory so we have written again. While we were in the dementia care unit, we found a tablet on the floor. The nurse took it to dispose of it: it did not occur to her to try to find out why it was on the floor, and whether the person who should have taken it needed another tablet. The medication trolley was left unattended and unlocked in the lounge in the dementia care unit, with a range of medication open on the top. Staff record the temperature of the medication store cupboards. We noted that in both cupboards the records show that the temperature is always very Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 15 close to, and frequently above, the recommended 250C. Medication can lose its potency if not kept at the correct temperature. People we spoke with had no concerns about the way staff treat them. They told us staff respect their privacy and dignity, and we observed staff knocking on bedroom doors, and making sure doors were closed when any personal care was being done. However, residents and other staff told us that communication is a big issue, because some of the overseas staff do not have a satisfactory knowledge of the English language to be able to communicate easily and effectively with the residents and with their co-workers (see Staffing section of this report). Personal information about people was not always kept locked away. We saw some care plans on the nurses’ station desks, and the filing cabinets, which hold lots of information about people, were open and easily accessible to anyone. Daily records had been left on the desk in the sister’s office and the door was not locked. Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 16 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. Visitors are made very welcome, but the range and amount of activities offered to the people who live at Meppershall Nursing Home is not good enough to make sure everyone leads a full and satisfying life, and people are not happy with the meals. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: An activities coordinator is employed in the nursing home. She keeps a record for each person to show what activities they have been involved in. It was disappointing to see that the only thing recorded between 19th and 26th August was that she had been off sick. She told us that she organises some activities in the lounge, but it is always the same people who attend, as they are the ones who can (and want to) be there. She feels frustrated that she can do very little for the people who have to, or prefer to, stay in their rooms. She told us that the home has a mini-bus and when a driver is available about five people at a time can go out. They have been to garden centres, meals Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 17 out, drinks at the pub, shopping and so on. One gentleman told us how much he has enjoyed the outings he’s been on, but he’s only been out 4 or 5 times in 2 years. One person said “There’s not a lot to do – I’d like more to do during the day”. Recently there was a garden party and barbeque to which family and friends were invited. Residents and their families told us it went really well, and a good sum of money was raised for the activities fund. A lady visits every three weeks to play the guitar and sing, there was ‘sing-along-with-Frank in August, a singer will be booked for the Harvest Supper and ‘sing-along-with-Jim’ has been booked for the Christmas party. Two churches each visit the home twice a month for a service. Staff told us there is a good group of relatives/friends at the moment who are very supportive of the home. Families and friends are invited to all the events held at the home, and are welcomed whenever they visit. Activities are also recorded for people in the dementia care unit. It was clear from the records, from our observations on both days of the inspection, and from discussion with visitors, that very little activity takes place in the dementia care unit. One person said “They need more activities, they just sit and stare in space”. A gentleman from The Alzheimers Disease Society visits once a week to do a music and movement session, and a PAT dog (Pets as Therapy) also visits weekly. Records for one person showed that apart from the weekly music session, the activities consisted of listening to music, watching TV, talking to staff, and sitting in the garden. This person’s assessment stated “Needs stimulating throughout the day otherwise will sleep a lot and not sleep at night”. Daily notes showed that this person had regularly been awake in the early hours of the morning, so had been given sedative medication. Another person’s record showed that the 23 activities recorded were ‘watch TV’, ‘music’ and ‘visitors’. We spoke to the cook and checked the kitchen, which was very clean and tidy, with a reasonable stock of food in the store cupboard and fridges/freezers. The cook said the budget for food is quite generous. She told us that she and the manager had written the menus about 18 months previously. About 40 of the vegetables used are fresh, and the cook makes homemade cakes, including diabetic cakes. Special diets, such as diabetic, are catered for, and the cook meets with new residents and people with problems to work out what they would like to eat. Fresh fruit is offered to the residents twice a day. The cook is hoping that more people will soon be employed, because she would like to help with serving the meals, so she can train the overseas staff. Some dry foods, such as dried fruit and coconut had been removed from their original packaging and were not labelled with the ‘use by’ date, or date of opening. People who live at Meppershall, and the cook, told us that staff ask all the residents, each evening, what they would like for lunch the next day. Staff Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 18 and residents told us that “food is a big issue” in that the quantity, quality and choice are very variable. One person we spoke with said “The food could be better”. Another said “The food’s not as good now – we’ve lost the good cooks”. We sat in the large dining room in the nursing home on the first day of the inspection, just to observe what was going on. On the whole, it was a pleasant, relaxing experience for everyone. Each person was asked what vegetables they would like, and whether they wanted apple sauce with the pork. One person had to wait several minutes after his food was put in front of him for one of the staff to come and cut the food up for him so he could eat it. We sat in the dining room of the dementia care unit on the second day, and it was not a pleasant experience at all. When we arrived, at 12.20, eight people were sitting in the dining room ready for their lunch. The lunch was in the hot trolley in the kitchen, and staff were waiting to serve. One person was getting agitated because he had not been given his food. When we asked about the wait, staff said they are not allowed to start serving lunch until 12.30. Life is confusing enough for people with dementia, without being sat at a dining table and then not given any food. One person was sitting too far from the table to reach her dinner comfortably, so spilt a lot of it in her lap. Another person was in a special reclining chair: his meal was put on a movable table in front of him, but too high up for him to be able to eat comfortably. Staff were standing over people to help them with their food, rather than sitting down next to the person, and one person got very cross when a staff member, on her way past to a resident in bed, picked up a forkful of food and tried to put it in the person’s mouth. Two gentleman were sitting at a table – one was given his dinner but the other was ignored until 12 minutes later when he was given his. One person was given a pudding, but no spoon to eat it with, and another person spilt their drink and was not offered another one. Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 19 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 poor quality outcomes in this area. Not enough staff have received sufficient training in protecting vulnerable people to make sure that the people who live here are kept safe from harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: One person told us “I feel safe here. I would be happy to talk to the deputy manager – she always listens. I don’t like to complain because it’s such a nice place.” The manager keeps a folder with all the information about each complaint, including the responses sent to the complainant from the provider. There were 4 complaints in the file. One was about the food, and the staff’s English; one about the food, care of someone with diabetes, and the person being very dehydrated when they went to hospital; one was about the food; and the fourth one was about staff not responding to the call bell, and the person feeling ‘bullied’ by one member of staff. The registered provider had responded to each complaint. Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 20 Three issues were reported to the Safeguarding of Vulnerable Adults (SOVA) team around the time of this inspection, arising from complaints made by relatives. We made a further three referrals to the SOVA team as a result of this inspection. These referrals were about alleged failure to dress wounds regularly enough, an error in the administration of a sedative drug (see Personal and Healthcare section of this report), alleged general neglect of two people, failure to seek medical help for people when they were not well, failure to offer adequate food and fluid, and failure to administer and record medication correctly. The SOVA team will be investigating all these referrals. The manager keeps a folder with information about SOVA referrals. There were three, however we had also been advised of a fourth which she knew about, but which was not in her file. With the current ones, this is a total of ten referrals since December 2007, most of which were not made by the home, but as the result of complaints. Staff training records showed that not all staff have had SOVA training (see Staffing section of this report). Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 21 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, 20, 21, 22, 24, 26 People who use this service experience adequate quality outcomes in this area. Generally Meppershall Nursing Home offers its residents a homely, comfortable, place to live in, although some areas are in need of decoration or refurbishment. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Meppershall nursing home was purpose built so is very spacious, with wide corridors, and feels light and airy. There is a very pleasant, large lounge on the ground floor which is not often used. The large dining room on the ground Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 22 floor is big enough for far more people than the number who chose to use it on the day we visited and is attractively decorated. When people move into the home they are encouraged to bring in their own possessions, and a number of the bedrooms we saw were very personal. Several bedrooms have been decorated, and have had new carpets or washable flooring. There appear to be some problems with storage, as trolleys with clean and dirty laundry remain in the corridors in the seating areas all day long, and there were items of equipment such as wheelchairs and hoists in corridors and bathrooms. The nursing home smelt fresh throughout, other than outside one bedroom, where there was a strong smell of urine. The carpet in this room was stained, as were several bedroom carpets in the same area: the manager said she was waiting for these carpets to be replaced. The carpet in the upstairs dining room also needs to be replaced as it was seriously faded as well as stained. The home has a very large room on the upper floor which is used as a training room for the home’s staff, and for staff from other homes in the area. The dementia care unit had only been open a couple of months, so is spacious, light and airy, and all the bedrooms have an ensuite toilet and washbasin. We were disappointed that more has not been done to introduce items that are helpful for people with dementia. Staff have put a picture on some of the bedroom doors, but these are in floppy plastic wallets attached with sellotape and already look very tatty. Meppershall Nursing Home DS0000015039.V371369.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 caring and work hard but recruitment is not satisfactory, there are not always enough staff on duty to make sure the needs of the residents are met, and not all staff have received sufficient training to make sure they do their job in they best way possible. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People we spoke with had good things to say about the staff. One relative said “I can only speak highly of the staff when my relative is poorly or upset. They are all very kind, and I can ring or visit anytime”. Another said “The carers are wonderful girls but there’s not enough of them”. And a third said “The staff are brilliant”. There is a high proportion of overseas staff working at the home. The manager told us they come from Latvia, Bulgaria, Rumania, the Philippines, India and Sri Lanka. Residents and other staff told us that communication is a big issue, because some of the overseas staff do not have a satisfactory knowledge of the English language to be able to communicate easily and effectively with the residents and with their co-workers. One resident said “The staff treat me nicely. I get on with them all, but I have a job to Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 24 understand some of them”. Two of the staff were speaking very loudly to each other in their own language in the dining room in the dementia unit. This is very poor practice as it can only add to people’s confusion. We were told that until recently there were two nurses on each floor during the day shifts. At the time of the inspection there was only one. Residents and staff told us that the number of qualified nurses on each floor has been reduced and they said there are not enough nurses. We wrote to the provider about this in the serious concerns letter we sent following the inspection. In his reply he stated “at present the home is adequately staffed in relation to the number of residents and their needs, however residents and staff are taking time to adjust to seeing fewer nurses on the floor”. In our view, the issues that have arisen, for example with medication, wound dressings and record keeping (see Personal and Healthcare section of this report) could well be an indication that there is not a sufficient number of staff. In the dementia care unit there is one nurse and three carers on duty during the day. Three of the staff who spoke with us said there are enough staff for now, although they are very busy and do not have time for activities. The other staff member said there should be at least one more carer on each shift. Some of the relatives we met said there are not enough staff as the nurses always seem to be ‘doing paperwork’ and sometimes there are only two carers. Another relative said “The place is lovely and the people are nice but I don’t think they have enough carers”. The recruitment of staff was not being carried out properly, which puts people using the service at risk. We looked at recruitment files for six staff. None of the files included all the information required by the Regulations. One of the files did not contain a Criminal Record Bureau (CRB) disclosure, nor evidence of a POVA (Protection of Vulnerable Adults) 1st check. Two other files did not contain a CRB disclosure. Some of the files did not have any proof of identity nor a photograph. None of the files had details of criminal offences, a statement of the person’s health, or evidence that gaps in employment had been explored. On 04/09/08 the manager contacted us: she stated she had found a second file for one of these staff, which included a CRB and POVA 1st check. None of the files contained original references written specifically for the person to work at Meppershall Nursing Home, but contained photocopies of letters of recommendation. Some of these were typed and not even signed, and there was no evidence that any of them had been verified. There was no evidence that these staff, all from overseas, are entitled to work in the UK. Most of the files contained no evidence of the person’s training and/or qualifications. Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 25 At the time of the inspection the manager confirmed that she had given us all the information she had about these six staff. However, the following day she rang us to say she had found a second file for one staff member, which contained a CRB and POVA 1st. We raised the issue of poor recruitment practice in the serious concerns letter we sent to the provider. In his reply he said that much of the information was available in the company’s head office, so the failure was in “information sharing”, not poor recruitment practice. He also said all staff had now been asked to complete a health questionnaire, and photographs would be taken. The regulations clearly state that the information must be available in the home. We also noted that the other two staff for whom no CRB was available, but who had a satisfactory POVA 1st check, were working unsupervised in the home. The regulations state that in certain circumstances, staff can work once the POVA check has been received, but must be supervised until the CRB disclosure arrives. This is particularly important in the case of overseas staff, as any offences they might have committed before entering the UK will not be on the UK’s POVA list. Staff training records at the home were not up to date enough for us to know how many staff have been on which training courses. We asked the manager to clarify this, so following the inspection the company sent us a breakdown of staff training. This gave numbers of staff who had received training in the mandatory topics, between April 2007 and 10th September 2008. Out of a total of 48 staff (35 care staff and 13 ancillary staff), only 17 have received Safeguarding Adults (SOVA) training; 22 have received moving and handling; 22 have received fire safety; 18 have been trained in food hygiene and infection control; and 8 have a First Aid certificate. This is not satisfactory. Two of the care staff have been awarded a National Vocational Qualification in care level 2, and five have been awarded an NVQ level 2. Two people are currently undertaking the award. This is far lower than the 50 of staff on duty expected by the National Minimum Standards. The manager said that all new staff are given an induction book to complete, which they keep. They work for 2-3 days as extra staff before going on the rota, and they are able to take up to 3 months to complete the induction. Once completed, the manager signs the last page, and this is kept on the person’s file. During the inspection, the manager could only find one of these back pages, and this was for a member of staff who had left. Other courses have been offered to staff this year, including 12 people have done a 1 day dementia course; 8 have been on a course about the Mental Capacity Act; and 1 person on palliative care. Fifteen staff are having training by the Macmillan Nurses from Bedford Hospital on the Liverpool Care Pathway (LCP). The LCP is about giving excellent care to people who are dying, and their families. Meppershall Nursing Home DS0000015039.V371369.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, 37, 38 People who use this service experience poor quality outcomes in this area. This home is not managed well enough to give the people who live here the best possible quality of life, and to make sure they are safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The evidence in the previous sections of this report indicates that the management of this home is not good enough to give the people who live here the quality of life they should have. The manager has been at Meppershall for eight years and is a trained nurse. She has completed her Registered Manager Award (NVQ 4). Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 27 The home has some systems in place for checking that the service they provide is of a good quality, and is what people want. A meeting is held every six months for residents and relatives, so that any issues they have can be discussed. Relatives we spoke with said they find this useful, but they also feel they could come anytime to talk to the manager and deputy. A questionnaire had been sent round about food, as the result of one of the meetings, and the manager had evaluated the responses. Each resident who does not attend the meeting is given a written questionnaire to complete. The manager said she and the deputy used to hold a meeting to audit all the care plans and other paperwork in each of the units but she “hasn’t done this for a while”. She said the activities coordinator talks to all the residents regularly, and so does one of the owners when she collects the newspaper money. The manager told us she does not get round to see the residents as much as she used to nor as much as she would like to. The Regulations (Regulation 26) require the provider to visit the home at least monthly, and to write a report of the visit. This is so that we can be sure the provider knows what is going on in all areas of the running of the home. A copy of the report must be sent to the manager, and be available for inspection. The manager showed us that these reports had been completed (albeit very briefly) every month through 2007, and up to April 2008, but none since. The home keeps a small amount of cash in safe-keeping for some of the residents. We checked the cash balance and the transaction record for one person and it was all correct. The manager said staff do not get formal, recorded supervision sessions. She said she talks to the care staff and the nurses every day to give them guidance and supervision, but it is not recorded. All staff must be appropriately supervised, and the NMS recommend that this should be a minimum of six sessions a year. The current ‘informal’ way of supervising staff is not satisfactory. Records showed that tests of the fire alarms had been done. On our tour of the building we noted that wedges were being used to hold open some of the fire doors. Fire doors must only be held open by a device (approved by the fire authority) which will allow the door to close if the fire alarms are sounded. The door to the smoking room did not close properly, so would not be a smoke barrier in the event of fire. Not all staff have been involved in regular fire drills. One of the staff was using the vacuum cleaner: she was unaware of the danger she was causing by stretching the wire across the corridor. Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 28 Staff training records showed that staff have not received sufficient training in health and safety topics (that is, moving and handling, food hygiene, fire safety, infection control and first aid). When we were in the dementia care unit we saw two staff move one of the residents up in the chair by lifting the person under his armpits. This is a lift that is considered unsafe as it can hurt both the person being lifted and the staff. One of the complaints received from a relative included concerns about this ‘lift’ being used, which they had witnessed. Meppershall Nursing Home DS0000015039.V371369.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 2 X 3 X 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 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 3 3 2 X 3 X 2 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 2 Meppershall Nursing Home DS0000015039.V371369.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 OP1 Regulation 5 Requirement Up to date information about the home must be available for people who are thinking about using the service, and their relatives/friends, so that they can make a choice about whether they want to move in, based on accurate information. Timescale for action 15/10/08 2 OP4 14(1)(d) People must receive confirmation 15/10/08 in writing from the home, that the home can meet their assessed needs. All the personal and healthcare needs of the people who live at Meppershall Nursing Home must be met. Evidence must be available for each resident to show that other healthcare professionals, such as the tissue viability nurse, dietician, dentist, optician, footcare specialist and so on have been involved when needed in the person’s care. 30/09/08 3 OP8 12(1) Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 31 4 OP8 12(1)(b) 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. 12/09/08 5 OP9 13(2) Medication must be administered as prescribed and the recording of the administration of medication must be accurate, so that the residents’ health and welfare is maintained safely. We made an immediate requirement about this. 04/09/08 6 OP9 13(2) Medication must be stored safely at all times. The medication trolley must never be left open and unattended. This is so that the residents are kept safe. Medication must also be stored at the correct temperature so that the drugs work properly. All staff must be able to communicate effectively with the people who live at the home, and with each other, so that satisfactory care and support is offered, and people’s dignity is maintained. People must be provided with stimulation and social and emotional support (activities) to enable them to maintain a satisfactory level of social and emotional wellbeing. The choice and quality of meals DS0000015039.V371369.R01.S.doc 09/09/08 7 OP10 12(4) 31/12/08 8 OP12 16(2)(m) and (n) 15/10/08 9 OP15 16(2)(i) 15/10/08 Page 32 Meppershall Nursing Home Version 5.2 offered to service users must improve so that they are always offered a nutritious, satisfying and healthy diet of their choice. 10 OP18 13(6) All staff must receive training in Safeguarding Vulnerable Adults so that residents are protected from harm and abuse. 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. Adequate storage space must be provided so that corridors, bathrooms and so on are not used for storage. There must be sufficient staff on duty to be able to meet the needs of the people living at the home at all times. This was a previous requirement. The timescale of 31/10/07 was not met. 14 OP28 18(1)(c) A ratio of 50 of the staff on duty (excluding trained nurses) must be qualified to do their job properly. 31/08/09 31/10/08 11 OP19 16(2)(c) 31/10/08 12 OP22 23(2)(l) 31/10/08 13 OP27 18(1)(a) 30/09/08 15 OP29 19, schedule 2 and schedule 4 All the information about new 12/09/08 staff required by the regulations must be acquired before the staff member starts work. This is to protect the people living at the home from receiving care by someone who may not be suitable to work in a care home. We sent a serious concerns letter about this to the provider. In addition the provider must retain records which include the Meppershall Nursing Home DS0000015039.V371369.R01.S.doc Version 5.2 Page 33 start date of the employment, and must ensure the person is eligible to work in the UK. These were requirements following the last inspection and have not been met. 16 OP29 19(9)(10) and (11) New staff who have a satisfactory POVA 1st check but have not received a CRB disclosure must be supervised. We sent a serious concerns letter about this to the provider following the inspection. 17 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. Management of the home must be effective and sufficient to ensure people receive the care and support required to meet their individual needs. The registered provider (or a representative) must visit the home, unannounced, at least monthly, and the written report of this visit must be available for inspection. Following this inspection, these reports must be sent to CSCI. 20 OP36 18(2) Staff must have regular 31/10/08 supervision, so that their training needs/development can be DS0000015039.V371369.R01.S.doc Version 5.2 Page 34 12/09/08 31/10/08 18 OP31 9 30/09/08 19 OP33 26 30/09/08 Meppershall Nursing Home identified and their work practice monitored. All staff must receive one session within the timescale, and regularly thereafter. 21 OP37 17 (1) and (3) All records must be kept accurately. For example, care plans regarding wound dressings, and food and fluid intake charts (if needed). This is so that people’s health and wellbeing is maintained. 09/09/08 22 OP37 17(1)(b) Records containing confidential information about people, for example care plans, must be kept securely so that people’s privacy and confidentiality is respected. 09/09/08 23 OP38 13(5) People must only be assisted to 09/09/08 move by staff using safe moving and handling techniques: the use of underarm lifts must stop. This is to reduce the risk of injury to people living at the home and staff. 24 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. 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 DS0000015039.V371369.R01.S.doc 31/10/08 25 OP38 23(4)(a) 09/09/08 Meppershall Nursing Home Version 5.2 Page 35 home are as safe as possible in the event of a fire. 26 OP38 23(4)(e) All staff must be involved in a 31/12/08 fire drill at least once a year so that staff know how to react, and keep people safe, should a fire break out. 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.V371369.R01.S.doc Version 5.2 Page 36 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.V371369.R01.S.doc Version 5.2 Page 37 - 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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