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Inspection on 04/09/07 for Meppershall Nursing Home

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

This inspection was carried out on 4th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

This purpose built home provided spacious and comfortable accommodation. The layout of the building provided a variety of places in which to relax quietly or socialise in the company of others. These arrangements had enabled the home to care for people with diverse needs. The building was well decorated and comfortably furnished. Arrangements to maintain a safe place to live and work in were good. People living in the home who contributed to the inspection were mostly positive about their experiences in the home. Members of staff who worked permanently in the home were described as "Good", "Very Kind", "Marvellous" and "The best". Members of staff were observed to be kind and courteous in their approaches to people. The home had acted in the best interests of a person living in the home by arranging independent advocacy and contact with the Local Authority to ensure their rights were upheld. It was evident that visitors were welcomed into the home.The home`s admission procedures were excellent and ensured that people were informed about the service, and their needs were assessed before they moved into the home. Documents to identify how people`s were to be met were also detailed and well maintained.

What has improved since the last inspection?

A review of menus had been carried out in consultation with people living in the home. Training plans have been expanded to include communication, the care of those with dementia and record keeping. Decorations had been added to some walls through out the home and a window blind had been provided for a bathroom.

What the care home could do better:

Staff must report issues of concern re people`s welfare, accidents and similar to the manager so that she in turn has a view on what action is to be taken next. Incidents were people have received an injury, even if un-witnessed, must be noted as an accident and a corresponding risk assessment must be carried out to remove or minimise any further risks. Feedback from people using the service showed that there were concerns about the time they had to wait for assistance and also about the provision for activities and stimulation. Staffing levels must be sufficient to meet people`s needs and not merely based on a ratio of numbers per given number of people. People living in the home expressed concerns about communication problems with staff employed from overseas. Whilst the home had take steps to improve this situation it must ensure that staff employed for direct care tasks are able to understand people using the service and be able to talk to them. Staff must ensure that beakers and water jugs that have been taken to the kitchen to be washed are returned promptly to people so that they are not solely reliant on the beverages served from the tea trolley and at meal times. Records of monies held on behalf of people must detail the total balance that is held off site by the company. Such monies must not be held in any account in connection with the operation of the home. Staff files must evidence that robust recruitment procedures have been followed to safe guard people living in the home. This must included information about personnel who have transferred from another home operated by the proprietor.The proprietor should consider taking action on a recommendation from the previous report to provide the manager with additional training or support in the areas of human resources and employment law. It had also been suggested previously that the arrangements to monitor staff training records be reviewed to ensure that gaps or updates in mandatory training are not overlooked. The home was without I.T. equipment. This meant that monitoring systems as detailed above and the overall quality assurance for safety and operational systems was done through manual systems. These were seen to be somewhat laborious and did not lend themselves to effective, professional management systems as is to be expected in a home of this size.

CARE HOMES FOR OLDER PEOPLE Meppershall Nursing Home 79 Shefford Road Meppershall Bedfordshire SG17 5LL Lead Inspector Leonorah Milton Key Unannounced Inspection 4 September 2007 10.15 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.V346418.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.V346418.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 G A Projects Ltd Mrs Julie Sumner Care Home with Nursing (N) 57 Category(ies) of Physical Disability (PD) 5 registration, with number Old Age not falling within any other category of places (OP) 57 Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to four (4) service users under the age of 65 years may be admitted to the home. 22nd November 2006 Date of last inspection Brief Description of the Service: Meppershall is a purpose built care home with nursing on the outskirts of Bedfordshire in the village of Meppershall. The service is registered to provide residential and nursing care for fifty-seven service users. Five of these places are for people with physical disabilities and the remainder are for older people. The accommodation is distributed over two floors accessed by shaft lifts. The communal accommodation and facilities are spacious including wide corridors and access routes to the grounds. The building also provides a day care facility not included in the registered facilities used on commission by Social Services. A building is being erected next to the day care facility. It is planned to apply for this building to be used for the care of those with dementia. The building is surrounded by large grounds and parking spaces for staff and visitors are provided. 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 internet website address for the company. 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. Items not covered by the fee:Hairdressing (starts at £4, Perm £16); Newspapers; Toiletries/tissues; Staff escorts provided at £6.50 per hour. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 5 Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This report sets out the significant evidence that has been collated by the Commission for Social Care Inspection since the last visit to and public report on, the home’s service provision in November 2006. Reports from the home including its annual quality assurance assessment (AQAA), other statutory agencies, and information gathered at the site visit to the home, which was carried out on 4th September 2006 between 10.15 and 18.30, were taken into account. The visit included a review of the case files for four people living in the home, conversations with nine people, four members of staff and the manager. Much of the time was spent in the communal areas of the building with people living in the home, where the daily lifestyle and the practice of staff was observed. A partial tour of the building was carried out and other records were reviewed. The Commission had received fourteen responses, completed by people living in the home or their representative, to a questionnaire circulated prior to this inspection. These have also been taken into account and reflected in this report. What the service does well: This purpose built home provided spacious and comfortable accommodation. The layout of the building provided a variety of places in which to relax quietly or socialise in the company of others. These arrangements had enabled the home to care for people with diverse needs. The building was well decorated and comfortably furnished. Arrangements to maintain a safe place to live and work in were good. People living in the home who contributed to the inspection were mostly positive about their experiences in the home. Members of staff who worked permanently in the home were described as “Good”, “Very Kind”, “Marvellous” and “The best”. Members of staff were observed to be kind and courteous in their approaches to people. The home had acted in the best interests of a person living in the home by arranging independent advocacy and contact with the Local Authority to ensure their rights were upheld. It was evident that visitors were welcomed into the home. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 7 The home’s admission procedures were excellent and ensured that people were informed about the service, and their needs were assessed before they moved into the home. Documents to identify how people’s were to be met were also detailed and well maintained. What has improved since the last inspection? What they could do better: Staff must report issues of concern re people’s welfare, accidents and similar to the manager so that she in turn has a view on what action is to be taken next. Incidents were people have received an injury, even if un-witnessed, must be noted as an accident and a corresponding risk assessment must be carried out to remove or minimise any further risks. Feedback from people using the service showed that there were concerns about the time they had to wait for assistance and also about the provision for activities and stimulation. Staffing levels must be sufficient to meet people’s needs and not merely based on a ratio of numbers per given number of people. People living in the home expressed concerns about communication problems with staff employed from overseas. Whilst the home had take steps to improve this situation it must ensure that staff employed for direct care tasks are able to understand people using the service and be able to talk to them. Staff must ensure that beakers and water jugs that have been taken to the kitchen to be washed are returned promptly to people so that they are not solely reliant on the beverages served from the tea trolley and at meal times. Records of monies held on behalf of people must detail the total balance that is held off site by the company. Such monies must not be held in any account in connection with the operation of the home. Staff files must evidence that robust recruitment procedures have been followed to safe guard people living in the home. This must included information about personnel who have transferred from another home operated by the proprietor. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 8 The proprietor should consider taking action on a recommendation from the previous report to provide the manager with additional training or support in the areas of human resources and employment law. It had also been suggested previously that the arrangements to monitor staff training records be reviewed to ensure that gaps or updates in mandatory training are not overlooked. The home was without I.T. equipment. This meant that monitoring systems as detailed above and the overall quality assurance for safety and operational systems was done through manual systems. These were seen to be somewhat laborious and did not lend themselves to effective, professional management systems as is to be expected in a home of this size. 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.V346418.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.V346418.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): Standards 3,5,6. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home had carried out detailed assessments of need before people were admitted to the home to ensure that their needs could be properly met. EVIDENCE: Four cases files were assessed at this inspection. Each showed that detailed pre-assessments of need had been carried out before people had been admitted. These had included information from placing authorities, and health care providers where people had been admitted from hospital. The home had an established admissions procedure that included its own written assessment of need that was also used unless people were admitted under an emergency situation. Detailed notes had been taken at the initial referral stage and similarly in relation to pre-admission assessment of need. Records had also been made to chart contacts with the person, their relative and any placing authority and where necessary hospital personnel to ensure that admission to the home was carried out in the person’s best interests. A recent admission to Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 11 the home explained how this process had been most helpful and said that they had visited the home before admission. This visit was also described as “helpful” and had given the person opportunities to find out about the service and daily routines. In most other instances however, people moving into the home had been reliant on their relatives to visit and assess the home on their behalf. The home no longer provided an intermediate care service. Meppershall Nursing Home DS0000015039.V346418.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): Standards 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans were available to staff for them to understand people’s needs and contained sufficient guidance to enable them to properly care for people living in the home. Risk assessments however had not been updated in relation to an incident to ensure that risks to the health of the person living in the home were removed. EVIDENCE: Four case files were assessed. The care plans seen were based on detailed assessments of need. Plans covered people’s personal, physical, health, recreational, social and emotional needs. Details also included guidance for clinical practice in relation to wound care and similar. Observation of practice showed that personnel were familiar with people’s needs and how these were to be met. Risk assessments had been carried out in relation to the risks for each individual. Plans were possible had been agreed by people or their representative and had been reviewed and updated on a regular basis. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 13 There was evidence to show that people had been supported to access health care appointments for routine treatments such as chiropody, optical tests, dental treatment. Specialist services had been consulted in relation to people’s continence needs, tissue viability, speech and language. People could retain their doctor if they remained within the surgery’s catchment area. In practice however, people had opted to transfer to the list for a local doctor who had been appointed to oversee the health of those living in the home. The doctor held a weekly clinic in the home. It was reported that this had enabled the home to build up a good rapport with the doctor and his surgery to the benefit of people living in the home. A report under Procedures for the Protection of Vulnerable Adults made subsequent to the visit to the home raised concerns about an injury that had resulted in the development of a large wound on the leg of a person living in the home. The doctor in the hospital felt that this wound had resulted from a burn. The manager at a later meeting agreed with this opinion. An investigation showed that the original blistering sustained by this person, possibly as a result of the spillage of hot liquid, was not reported initially to the manager or noted as an accident. There was therefore no review of the risk assessment for this person to remove or minimise any further risks. The systems for the storage, administration and recording of medicines were of a good standard. Qualified nursing staff mostly administered medicines. Other senior staff had received training to administer medicines to people admitted to the home for residential rather than nursing care. A nurse was observed as she administered medicines in the late afternoon. Her practice was seen to follow safe guidelines and she was able to demonstrate in conversation that she was aware of other issues in relation to safe practice. Medicines were stored in purpose built, lockable trolleys, which were in turn stored in an inner locked walk in cupboard. Locked wall cupboards in this area housed spare medicines and Controlled Drugs. Records seen for the receipt and administration of medicines and also for the return/disposal of unwanted medicines were satisfactory. Members of staff were seen to treat people living in the home with kindness and respect. Whilst it was evident that they were at times busy responding to calls for assistance, they never-the-less, once with a resident, presented a calm and unhurried approach. One person stated they found the staff to be, “Very respectful” and another said, “Staff knock before entering my bedroom and are good to me”. There had been however instances when people had been less satisfied with the level of assistance because members of staff were busy. Please refer to section 6 for evidence. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 14 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): Standards 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The majority of people living in the home had been supported to achieve a lifestyle that mostly met their expectations. EVIDENCE: Discussions with people on the day of the visits and the results of the survey indicated that the majority were satisfied with the arrangements for day-today routines. People spoken to confirmed that routines were quite relaxed, “You can do what you want”, and “There are no rules for getting up and going to bed and you can stay in your room if you want to”. Feedback from people about activities for recreation and stimulation varied. Three responses to the questionnaire stated they were “Always” activities they could take part in, five “Usually”, five “Sometimes” and one “never”. Written comments included, “Activities are on a weekly basis, more would be welcome”, “I’ve not taken part so far but I can if I want to, I am always asked. People who contributed to the inspection at the visit said, “There is not much to do” and “We do quite well”. People confirmed that activity organisers provided opportunities for group recreational activities or arts and crafts events Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 15 each weekday and there were occasional group events such as a recent barbeque. There were fewer opportunities for stimulation for those who were less able. A person who had been admitted following a Cerebral Vascular Accident stated there were “Never “ any suitable stimulating exercises. Care staff confirmed that they were not available to take part in activities on a regular basis but would talk to people if they had time. The overriding comments in relation to care, support and activities were in relation to the lack of availability of staff, which is detailed in Section 6 Staffing, of this report. People had been able to bring items of a personal nature into the home and to handle their personal finances where they had the capacity to do so. Lockable facilities were available in each bedroom for the secure storage of personal valuables. The home had continued to provide for a person living in the home even though their representatives had ceased to pay fees for the accommodation for several months. The conduct of the organisation in relation to this situation and also in relation to the access for this person to private savings had been extremely supportive of the resident. Advice and support for this person had been arranged through contact with the Local Authority and also with an independent advocate. Care plans seen contained nutritional assessments of need. Menus showed a nutritious and varied choice. A temporary menu was in operation on the day of the inspection because the cook was on leave and an assistant covered their role. Two main meals and a salad were available and a choice of two puddings. Sandwiches and soup, cake and fruit were available for the teatime meal. It was reported that a hot, light meal was available twice each week at this time. The mid-day meal was served with a choice of squashes or fruit juice. Tea was offered after the meal. Documents in the dining room showed that dietary needs such as soft diet, and liquidised meals had been noted. Diabetic needs were not noted. Given that some people were using insulin and one person’s diabetes was not fully controlled by this treatment, a controlled diet must be available even if the resident chooses an alternative. People living in the home were mostly satisfied with their meals and beverages. The survey showed that two of fourteen people, “always” liked the meals, ten “usually” and two, “ sometimes”. Comments, verbal and written, included, “Well served and usually hot”, “Not always good choice or alternatives to meal presented if not liked. Often food very salty”, “XXX seems to enjoy the meals on offer. There could be more variety on the menu but other than that the meals seem nourishing and appetising”, “ I don’t feel there are enough staff on at any time. My xxx chooses to eat in their room and by the time there is someone available to feed xxx it is often cold.” The inspector sat with people as they took their mid-day meal. The atmosphere in the dining area was congenial. The meal took place at an unhurried pace and was an enjoyable social experience. A member of staff Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 16 was observed to provide sensitive assistance to a person who was unable to feed them self. Later in the day it was noted that no fluids were available on the upper floor other than the mid afternoon tea trolley. There were no drinking utensils of any sort or jugs in the kitchenette facilities on the upper floor. It was subsequently explained that their return from the kitchen had been an oversight. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 17 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): Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s complaints and protection procedures had enabled people to voice their opinions about the service and to safeguard them from abuse, EVIDENCE: Previous inspections had established that the home had satisfactory written complaints and protection procedures. Records indicated that the few complaints raised and been properly investigated and responded to. People confirmed that they felt able to raise concerns, “The manager will always listen and sort things out”, “We can say if we are not happy”, “ I can but there has been no need”, “I can talk to a senior member of staff”. Seven responses to the survey stated that they, “Always” knew who to speak to if they were not happy”, five responded “Usually”. Two responses did not complete this section. One response detailed that the relative could speak to the manager but “never went beyond that as my xxx thinks id carers get to hear we are moaning they will hold it against xxx and not speak to xxx”. There was no evidence in the home that any formal complaint had been made to the home about this issue. None had been raised with the Commission. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 18 Two personnel files were assessed. Each contained records to show that recruitment practice had included the checking of employment history through references and checks via the Criminal Records Bureau and the Protection of Vulnerable Adults Register. Records indicted that staff had received training in safeguarding procedures. Conversations showed that they were aware of these procedures and the home’s whistle blowing policy. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 19 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): Standards 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The building had been purpose built and provided a comfortable, well-adapted environment that was suitable to people’s needs. EVIDENCE: People confirmed that they were satisfied with the comfort of the environment. “ My room is nice and they keep it very clean”, “My room is comfortable. The bed is good and I sleep well”, “Its nice here, we can sit here or in the lounge and I can see the garden”. “ They work hard to keep it clean here”. The layout of the building, its adaptations, décor and furnishings provided a suitable environment in which to care for those living in the home. Communal and private accommodation was spacious as were toilet and bathroom facilities and could accommodate wheelchair users. The building was well decorated and furnished. Suitable equipment had been provided to meet people’s Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 20 assessed needs such as fixed and mobile hoists, specialist beds and pressure reliving equipment. Procedures were in place to ensure that the safety of the building and its equipment through regular maintenance checks and servicing by qualified contractors. Visual checks at the visit confirmed that equipment had been regularly serviced. A maintenance programme had ensured the upkeep of the building and its décor. A maintenance book was kept to ensure that day-to-day maintenance issues were dealt with promptly. Similarly, daily cleaning routines had ensured a clean and hygienic environment. Areas of the building seen at the visit to the home were clean and orderly. Responses to the survey had remarked on occasional unpleasant odours in the home. This is to be expected on occasions when people are using commodes and such like in bedrooms. No unpleasant odours were detected at the visit to the home. Procedures were in place to prevent the spread of infection. Protective clothing and disposable gloves were provided. Sluice rooms contained equipment for the hygienic cleaning of bedpans and commodes. Information provided pre-inspection showed that fourteen staff had received training in infection control measures. Peoples’ bedrooms, whilst quite uniform in layout, décor and furnishings, had been individualised by personal possessions. Many rooms had achieved a homely appearance. People had televisions, audio equipment, books, pictures, ornaments and other possessions of a personal nature. One person spoken with in their room had a private telephone and described how they liked to keep in touch with their family. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 21 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): Standards 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements had been determined by a ratio of numbers rather than on assessments of need. This had lead to a lack of personnel to respond to people’s requests promptly at some times of the day and a lack of resources to provide stimulation for some people. EVIDENCE: Members of staff on duty presented as caring and competent. Conversations with some personnel and observation of practice showed that they were aware of people’s needs and how these were to be met. As detailed previously, people using the service passed many positive comments about the conduct of staff and the service overall. “ Perfect”, “ They can’t do enough for you”, “Staff treat me well”. Other comments were less positive, “Other responses commented, “They are often very busy”, “ I’ve heard staff talk to patients and its not nice…One particular carer shouts all the time and I’ve heard her discussing a patient in the corridor with other members of staff which is unprofessional”. The respondent to the survey explained that staff were often rushed and, “They do answer bells but always say they will come back as they are on their own…My xxx is often made to feel that they are an inconvenience”. The survey detailed that staffing arrangements have been raised with the manager but that the response received has been about staffing ratios not dependency levels. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 22 On the day of the inspection visit there were thirty-eight people in residence. There were sufficient ancillary personnel on duty to carry out catering, domestic, laundry and maintenance tasks. An activity organiser had provided an arts and crafts session in the main lounge. There were no other organised activities elsewhere in the home. In the afternoon staffing on the upper floor was a qualified nurse and three care staff. On the ground floor were two other nurses and two carers. On the upper floor the inspector saw that a resident had slid down in their chair and was in danger of falling out. This had happened on two other occasions previously that day. Staff had attended to assist the resident. On the final occasion were no members of staff available in the vicinity. The inspector had to summon help by knocking on a bedroom door where the nurse and a carer were engaged in helping another resident. Discussions with staff and assessment of the central training record showed that staff had received statutory training and updates usually as required. One lapse in revisiting manual handling training was seen. The central training record was somewhat laborious to assess and would have benefited from an electronic monitoring system. Information supplied on the AQAA indicated that more than 50 of the staff had achieved National Vocational Qualifications in care. The home was currently reviewing its induction procedures to update its practice in line with “Common Induction Standards”. Two personnel files were assessed. One as detailed previously contained insufficient evidence about recruitment practice but it was reported that these documents because the carer had only been appointed recently were still held at head quarters. The other file was in relation to a carer/nurse who had worked for the organisation for April 2004 and had undertaken conversion training to work as a qualified nurse in England. The document indicating completion of this course in October 2006 was held on file. There were no documents on file in relation to this person’s qualification prior to this date, evidence of induction into the role they had held with the company prior to the completion of the conversion training, no contract for either role or evidence of permit to work. There was no employment contract on the personnel file for a carer who had commenced at the end of May 2007. Dates when employment had commenced were not set out clearly in these files. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 23 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): Standards 31,33,35,37,31 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager had endeavoured to run the home in the best interests of the people using the service. Aspects of the administration of the service that were in need of improvement were not within her brief. There evidently therefore needs to be some improvement in the communication and support from the directors of the company who hold these responsibilities. EVIDENCE: Previous reports had recognised that the manager was qualified and experienced to run a care home. Given the size of the home and the complexity of needs to be met, the manager at this inspection showed considerable awareness about individual’s needs and the skills of her staff. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 24 She was supported with the operation of the service by one of the directors who took responsibility for various aspects of the administration of the home, including some recruitment matters. Whilst meetings with people using the service and with staff were infrequent, it was evident that she kept in touch with both groups of people through an “ open door policy”. People spoken to said that they knew who the manager was and described her as “approachable” and “willing to listen”. A relative, as detailed previously in this report, found enquiries to the manager about staffing levels to be unsatisfactory. The proprietor must take account of this feedback and empower the manager to make decisions about staffing arrangements in accordance with assessed needs rather than numbers of people in occupancy. The home had formal systems to assess the quality of the service through an annual consultation with users of the service and a systematic approach to the monitoring of the operational systems of the service. As detailed previously, the manager maintained these systems manually, which in a home of this size was not the moist effective use of her time. The lack of provision for access to the Internet meant that the manager had to use private resources to access sites in relation to current best practice in the care/nursing sector. Records in relation to monies held in the home on behalf of people using the service had been well maintained and were substantiated by receipt. One record showed that the bulk of monies held on their behalf were held at head quarters, there had been no update on the record since early in this tear to show the current balance. There were no records such as bank statements or similar to show that monies were held in an account not connected with the operation of the home. Record keeping as detailed previously was inadequate in relation to the information that must be held on site in personnel files and in relation to people’s personal monies. Systems to manage health and safety throughout the home were thorough. Information provided pre-inspection showed that equipment had been regularly serviced and maintained within the last year. This was confirmed during the inspection by visual checks. Records indicated that staff had received appropriate training in safe working practices. Practice observed showed that members of staff were aware of safe practice in relation to moving and handling, infection control and administration of medicine. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 25 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 x x 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 2 x 2 3 Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 16(2)(m) 18(1)(a) Requirement The registered person must ensure that sufficient personnel are scheduled to work each day to meet people’s assessed needs. The deployment of staff must take account of dependency levels, people’s need for activities for stimulation and recreation and the layout of the building, The registered person must ensure that staff must report issues of concern re people’s welfare, accidents and similar to the manager so that she in turn has a view on what action is to be taken next. Incidents were people have received an injury, even if unwitnessed, must be noted as an accident and a corresponding risk assessment must be carried out to remove or minimise any further risks. The registered person must ensure that recruitment procedures are sufficiently robust. There must be evidence to show that previous DS0000015039.V346418.R01.S.doc Timescale for action 31/10/07 2. OP8 12(1)(a) 13(4)(b) (c) 07/10/07 2. OP29 19 31/10/07 Meppershall Nursing Home Version 5.2 Page 27 3. OP35 20(1)(a) (b) 4. OP37 17(2) Sch4 (6) qualification and training have been verified and that work permits have been checked were applicable. The registered person must maintain in the care home records of the total balance of any monies held on behalf of any person living in the care home. Such monies must not be held in any account used for the operation of the home. The registered person must maintain records as required in relation to staff employment records to include contracts and start dates. 31/10/07 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations People living in the home should be provided with opportunities to take part in activities and recreation that suit their needs and preferences. It is recommended that people be consulted about the current arrangements. The system for the monitoring of the tracking tool in place for mandatory training should be reviewed to ensure that inadvertent omissions are always quickly identified. (Subsequent monitoring of the tool should be audited to check that it is robust.) (Carried forward from the previous inspection) The directors and manager should give consideration as to whether the manager would benefit from additional training or support in the areas of human resources and employment law. (Carried forward from the previous inspection) It is recommended that the home be provided with Internet access so that its personnel are able to access information about current best practice in the provision of DS0000015039.V346418.R01.S.doc Version 5.2 Page 28 2. OP18 3. OP31 4. OP33 Meppershall Nursing Home nursing and care in a residential care home setting. Meppershall Nursing Home DS0000015039.V346418.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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.V346418.R01.S.doc Version 5.2 Page 30 - 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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