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Inspection on 07/08/09 for Meppershall Nursing Home

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

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

What the care home does well

The way that the staff look after small amounts of monies on behalf of the people living at the home is good. They make sure that they keep separate records for everyone and keep receipts for any purchase; this means that people feel that their money is safe and that staff will manage their finances in their best interests. Information that people can be given about the service, prior to deciding if they wish to move into the home is good. These documents are called the statement of purpose and service user guide. They are written in a way that is easy to understand. They let the reader know about the qualifications of staff, room sizes and services available for example. This means that people are clear what they should expect if they decide to move in to the home, and they provide a useful aid in helping them come to this important decision. The accommodation available is clean and spacious. The home is surrounded by large grounds and parking is available for staff and visitors. 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 throughout the home. One person spoken with said, "I`m more than happy with my room if I look out of this window I look onto fields and it`s lovely".

What has improved since the last inspection?

There had been many improvements since the homes previous key inspection, although there does remain a need for further development and change. The service has received a significant amount of time and support from the local authority within the past 6 months, the owner and management still need to demonstrate their ability to be able to run this service without additional input and/or assistance from outside agencies. The main area of improvement that we saw was in the management of medication. The improvements that we noted was that people were now receiving their prescribed medication when they should have. There had been an error in June 2009 by an agency nurse, however management had acted upon this quickly and made sure the people involved were safe. The error was not due to a poor system, but an individual error by the nurse.Meppershall Nursing HomeDS0000015039.V377017.R01.S.docVersion 5.2People reported that they felt that they had opportunities to participate in a variety of activities. The main ground floor lounge within the nursing home contains many items to show the varying arts and crafts undertaken by the people living in the home. One person said, "I always enjoy anything that goes on, music, anything really, I do have enough to do, it`s up to you really if you want to be involved".

What the care home could do better:

There remains areas that still need to improve, these include: Management need to improve in the way they respond to complaints, and increase their understanding of their responsibilities when a complaint has been made. We received a complaint in July 2009, we asked that the service investigate and respond to the complainant. Management sent information to us and asked the complainant to contact us to ask if they could receive all the information. This was not acceptable for the complainant, and this action demonstrated that managements understanding of our role in their complaints is inadequate. A service is responsible for responding in writing following a complaint; it is not our role to decide what information a complainant receives. We had made a requirement on the management of wound care at the last key inspection. One of the people selected for case tracking was receiving care by the nursing team for a wound, the care and support being provided was sufficient for that person. However we had asked management to make sure that up to date guidance was available in the home in the management of wounds, including research based protocols. We asked for this as there was no continuity in the approach to wound management, for example an automatic nutritional and pain assessment being carried out. This was not done. This is very important because if a person has a wound it can change their nutritional needs significantly. Also sometimes people are unable to express that they are in pain verbally due to a medical condition, so a system has to be in place that staff follow so that staff can pick up signs that indicate the person is in pain.

Key inspection report CARE HOMES FOR OLDER PEOPLE Meppershall Nursing Home 79 Shefford Road Meppershall Bedfordshire SG17 5LL Lead Inspector Katrina Derbyshire Key Unannounced Inspection 7th August 2009 09:00 DS0000015039.V377017.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Meppershall Nursing Home DS0000015039.V377017.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Meppershall Nursing Home DS0000015039.V377017.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 Manager post vacant 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.V377017.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 25th February and 10th March 2009 2. Date of last inspection Brief Description of the Service: Meppershall is a purpose built care home with nursing on the outskirts of the village of Meppershall, in Bedfordshire. The service is registered to provide residential and nursing care for 84 people: 54 in the main nursing home and 30 in the dementia care unit. 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. There is a large day care facility attached to the nursing home, which is not Meppershall Nursing Home DS0000015039.V377017.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 people with its sister home. Information about this home can be obtained by phoning and visiting, and there is also an entry for this company on several care home websites. Hairdressing, newspapers, toiletries/tissues, and staff escorts to medical appointments are not included in the fees. People who have their own telephone are responsible for all the bills. Meppershall Nursing Home DS0000015039.V377017.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 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection carried out on the 7th August 2009 by two inspectors. The care of six people was looked at in detail and this is known as case tracking. Tracking people’s care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. During the visit the communal areas of the home were seen alongside some of the individual rooms. Time was spent with many of the people who live at the home in two of the sitting areas. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The management’s submission of documentation was also considered prior to the site visit. In addition following the previous ratings given for this service we had been working closely with the local safeguarding teams. There had been numerous visits to the home since March 2009 by different health or social care professionals. The purpose of these visits was to provide constant supervision, look at the level of care being provided to the people living at the home and ensure that they were safe, guidance to the staff at the home, meetings with the owner and manager and training of staff. The level of input by health and social care professionals has been significant, and their input and support should be acknowledged as a considerable source of the improvements seen at this inspection. In addition we also carried out an additional inspection on 9th June 2009; we specifically looked at medication management and wound care. A copy of our findings is available upon request, although we did note there to be improvements in medication systems. At the previous inspection in February and March 2009, we reported that there were 14 people living within the dementia care unit. This area was where our main concerns were. At this inspection there were now 24 people living within this unit. The safeguarding team had taken a collective decision to lift the full embargo of admissions to the home. Meppershall Nursing Home DS0000015039.V377017.R01.S.doc Version 5.2 Page 7 The focus of this inspection was to look at the key standards. What the service does well: The way that the staff look after small amounts of monies on behalf of the people living at the home is good. They make sure that they keep separate records for everyone and keep receipts for any purchase; this means that people feel that their money is safe and that staff will manage their finances in their best interests. Information that people can be given about the service, prior to deciding if they wish to move into the home is good. These documents are called the statement of purpose and service user guide. They are written in a way that is easy to understand. They let the reader know about the qualifications of staff, room sizes and services available for example. This means that people are clear what they should expect if they decide to move in to the home, and they provide a useful aid in helping them come to this important decision. The accommodation available is clean and spacious. The home is surrounded by large grounds and parking is available for staff and visitors. 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 throughout the home. One person spoken with said, “I’m more than happy with my room if I look out of this window I look onto fields and it’s lovely”. What has improved since the last inspection? There had been many improvements since the homes previous key inspection, although there does remain a need for further development and change. The service has received a significant amount of time and support from the local authority within the past 6 months, the owner and management still need to demonstrate their ability to be able to run this service without additional input and/or assistance from outside agencies. The main area of improvement that we saw was in the management of medication. The improvements that we noted was that people were now receiving their prescribed medication when they should have. There had been an error in June 2009 by an agency nurse, however management had acted upon this quickly and made sure the people involved were safe. The error was not due to a poor system, but an individual error by the nurse. Meppershall Nursing Home DS0000015039.V377017.R01.S.doc Version 5.2 Page 8 People reported that they felt that they had opportunities to participate in a variety of activities. The main ground floor lounge within the nursing home contains many items to show the varying arts and crafts undertaken by the people living in the home. One person said, “I always enjoy anything that goes on, music, anything really, I do have enough to do, it’s up to you really if you want to be involved”. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Meppershall Nursing Home DS0000015039.V377017.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.V377017.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3 4, & 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information available to people prior to admission about the home is sufficient to assist them in making a decision on whether to move into the home. EVIDENCE: The home continues to have an information pack for people who are interested in moving into the home. This document had been updated; information included the qualifications of staff, room sizes and how to complain. Copies were seen to be available in both areas in the home. Feedback from people living at the home indicated that they were aware of it and its contents. Meppershall Nursing Home DS0000015039.V377017.R01.S.doc Version 5.2 Page 11 We looked again at the paperwork the home has to keep about the people who live there. We saw that pre-admission assessments of people’s needs are on the files. When people move in, the staff assess their level of dependency and this is re-assessed each month. Assessment documentation was in place for people that had moved into the home recently. As previously assessed this showed that the social, psychological and physical needs of the person had been looked at to ensure staff would know if they had the skills and experience to meet their needs. Each person, or their representative, signs a contract with the home. Copies of contracts were seen on the individual files showing the terms and conditions of their stay at the home including notice periods on each side. Intermediate care is not offered at the home. Meppershall Nursing Home DS0000015039.V377017.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inconsistencies in the standard of care planning, support and record keeping means not everyone receives continuity of care and the support that they need to meet their needs in full. EVIDENCE: Care records were examined within both units. The standard and quality of care plans and record keeping differed from each unit. Within the nursing unit, care plans were written to provide sufficient guidance to staff in the type and level of care a person needed. These plans were all hand written and individual to each person, although the files were disorganised resulting in difficulty locating some information. The care plans within the dementia unit were mainly standard typed documents, not individualised and not person centred. Meppershall Nursing Home DS0000015039.V377017.R01.S.doc Version 5.2 Page 13 One person had throughout their assessment documentation their love of football; this was not mentioned in their plan of care. Another person recently admitted to the home had typed plans in place only, their name had not even been written on them. Inconsistencies in standard continued with other care documentation. One person living within the dementia care unit was assessed by the home and social services prior to moving as being at very high risk of falling; it was following a fall at home that they moved into the service. The risk assessment in place had been calculated incorrectly indicating that the person was a score ‘16’ medium risk, they were in fact a ‘20’ and high risk. Their care made no mention of needing two people to walk with the person, even though this had been stipulated by social services. Assessments and other records within the nursing unit were sufficient. Written entries within the care files evidenced that some people had access to health care professionals when they needed. One persons weight had changed, documents were in place to show that staff had requested a referral to be made, this was done and a dietician had visited the person and made recommendations that staff were now following. However one person diagnosed with depression had recently increased the amount of time they were spending time on their own in their room. Information within the history of this person indicated that behaviours such as this should alert staff that additional support would be needed. Daily records showed that staff had been recording this, but no action had been taken. Staff were questioned on this and were not able to demonstrate that they were aware of the persons history or that they may need additional help. We had asked the manager at the random inspection in June 2009 to ensure that clear guidance was available to the nursing team on the approach to wound care in the home, this had not been done. She had secured a folder from a wound dressing company; this was not what was asked. A need to have straight forward guidance on what assessments and action need to be taken by staff when someone has a wound is required. The storage, receipt and administration of medication was examined in all the areas of the service. The medication administration sheets were noted to be correct in most instances; however the balances of two medications for two different people had not been carried forward onto the new medication administration record. The system for recording balances was therefore not sufficient to enable an audit to be carried out and this needs to be changed. Staff confirmed that they did receive regular updates in the administration of medicines and certification of training was seen in staff files and observations were made of medication and noted to be appropriate and follow safe practice guidelines. All other balances were noted to be accurate as was the storage. Meppershall Nursing Home DS0000015039.V377017.R01.S.doc Version 5.2 Page 14 An observation of a medication round within the dementia care unit showed that the nurse followed best practice guidance in this area. The physical appearance of those people living within the dementia care unit was improved in comparison to the previous key inspection. People’s hair now looked combed, their clothes were neat and tidy and no remnants of food were noted to be on anyone’s face. Observation at this visit showed staff approach and engage with people in a courteous manner. Interaction was polite and people were seen to be asked their views, for example at breakfast. Meppershall Nursing Home DS0000015039.V377017.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The approach to orientation and social engagement in parts of the home show a minimal amount of effort that means some people do not receive the support or motivation they need. EVIDENCE: As reported at the previous key inspection several of the people living within the nursing unit of the home reported that they felt there were a good amount of activities available to them in arts and crafts. On the day of this inspection the activities co coordinator had reported in sick. Staff advised us that they would not be able to cover the activities as they were to busy. However we later observed that the activities were going ahead, when questioned staff advised us that they had been instructed to by the management but they were still busy. Documents are maintained to show when a person has participated Meppershall Nursing Home DS0000015039.V377017.R01.S.doc Version 5.2 Page 16 in an activity, however one entry made for one person indicated that they had been party to having hot cross buns, they are nil by mouth. Within the dementia care unit an orientation board is in place on the ground floor, its only entry when the inspector first arrived was ‘July 2009’. We then observed after the inspectors arrival that it was changed by staff to include the actual date and weather. In addition the activity schedule on display was dated ‘w/e June 6th’, this was 9 weeks out of date. We only had the opportunity to speak with the relatives of one person at this inspection. They advised that they were always made to feel welcome into the home by staff. Their relative had lived at the home for over a year and during that time they had seen improvements. They did state that a further improvement would be if staff could keep them more up to date, their relative had had an accident, they only knew about this when they visited at the weekend and felt that a telephone call would have been nice as they would have decided to visit sooner. An observation of the breakfast meal was made. People were seen to be given sufficient time to eat and drink and were not hurried by staff. Comments from people living at the home on the food available to them were mixed, although in the main people did feel that the standard was good. Staff as previously reported advised that cooked breakfasts are always available, or there is a choice of cereals and/or toast. We observed staff sitting down to assist people with their meal if they needed assistance. We did not inspect the main kitchen on this occasion. We viewed a certificate on display in the main entrance hall showing that the home had been awarded four out of five stars for their most recent food safety inspection by the environmental health department. Meppershall Nursing Home DS0000015039.V377017.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inconsistencies in the management of complaints results in some people not being responded to in accordance with the homes own policy. EVIDENCE: The Care Quality Commission (CQC) received a complaint about the service in July 2009. We advised the complainant that the service would be asked to investigate their concerns and respond to them in writing, this would follow the homes own complaints procedure. We then asked the management of the service to do this and informed the safeguarding team. The complainant then contacted CQC again as they had received a letter from the service stating that they were to contact us for the outcome of the investigation. They had sent information to CQC, and asked that we decide on the information to be passed on and to respond to the complaint. This demonstrated that managements understanding of their responsibility in owning their own complaints and the role of CQC is not sufficient. A significant amount of support has been given to the service by the local safeguarding teams over the past 6 months, including training of the staff Meppershall Nursing Home DS0000015039.V377017.R01.S.doc Version 5.2 Page 18 team where a member of the safeguarding team actually visited the home to train the staff onsite. This was done following the last key inspection where we reported that only 26 of the 63 staff had received this training. A full assessment of the services competency in this area is not feasible at this visit; this is due to the high level of time and support that has been given by the local authority to the home. A full evaluation will only be possible when the service is operating without the additional support. Meppershall Nursing Home DS0000015039.V377017.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The general standard of the environment is good and provides an appropriate environment for everyone living at the home. EVIDENCE: The premises are purpose built. Accommodation available to people is across two floors at this time. The furnishings, fittings and décor in these areas is of a good standard. All people who were seen spoke highly of their environment and felt that the home catered very well for their needs. Rear garden areas provide spaces to sit out in the warmer months. Individual rooms contained personal items of the person to assist in creating a homely atmosphere. Meppershall Nursing Home DS0000015039.V377017.R01.S.doc Version 5.2 Page 20 All areas visited were noted to clean, tidy and free of odours. Staff were observed to wear suitable protective clothing when carrying out certain activities. Cleaning schedules were in place and clinical waste was disposed of in an appropriate manner. Meppershall Nursing Home DS0000015039.V377017.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment systems are not clear and do not protect the people living at the home. Staff training has not been effective to ensure that all staff have the needed levels of competency to keep people safe at all times. EVIDENCE: On questioning the acting manager she confirmed that the way the majority of staff are recruited results in her not having the opportunity to interview staff prior to their appointment. Staff files examined showed that many of the staff were recruited through an agency from outside of the UK. The information that was available to us was limited, for example the references in place were not sought specifically for their appointment to the home, but part of a pack developed at some point when they were seeking some form of employment. Staff files had information missing and the manager had to keep ringing the office to see if it was available. Recruitment of staff must demonstrate that the service has validated all information about the person and followed up on their employment history. In addition the contracts of staff were not clear enough, the owners had not employed them directly but some were working on a self Meppershall Nursing Home DS0000015039.V377017.R01.S.doc Version 5.2 Page 22 employed basis. The owners still have all the responsibilities of checking the suitability for anyone they allow to work in the home. Training records showed that there had been an improvement in the statutory training of staff, for example fire, food hygiene and moving and handling. However there was no evidence to show staff had received specific needs training. The varying needs of the people living at the home are wide ranging including stroke, heart diseases, high blood pressure and depression for example. No workshops had been carried out for staff to attend to at least be taught the basic information on a condition. Staff are providing support to people with needs that they do not understand. Inconsistencies in the standard of care as reported within the health and personal care section demonstrate that there remains some staff that are not sufficiently competent in their role. These include writing a care plan, adding up numbers correctly and having an activity schedule 9 weeks out of date on display. It is acknowledged that this is not all staff; some of the staff demonstrated a good level of knowledge and competency. Meppershall Nursing Home DS0000015039.V377017.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 & 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality assurance systems in the home are good and they help to identify any shortfalls in service delivery to improve standards for the people living at the home. EVIDENCE: The registered manager of Meppershall Nursing Home resigned in October 2008, following our inspection when many failures and breaches of regulations were brought to the attention of the provider. The provider had brought in a manager from another service, who had been trying to support the manager. Meppershall Nursing Home DS0000015039.V377017.R01.S.doc Version 5.2 Page 24 This person then took over as acting manager. In October 2008 Ms Colleen Brothers was appointed as deputy manager, then in February 2009 she was promoted to acting manager. There have been significant improvements since the previous key inspection, this has resulted in the rating of the service moving from ‘poor’ to ‘adequate’. However there remains several areas as outlined throughout this report that still require improvements. The owners and manager have received a high amount of support and guidance from the local authority within the past 6 months. There now needs to be a demonstration by the owners and manager that they are competent in running the home sufficiently without all the additional input they have been receiving and then to sustain any improvements made. The balances of small amounts of monies held on behalf of people living at the home were checked. The amount held for each person matched the amount detailed on their balance sheets. The home has a Health and Safety policy. There was evidence within the training records that some staff had undertaken fire, manual handling, food hygiene and first aid training. Risk assessments have been undertaken and were seen within the individual records examined. Records of the testing of water temperatures were maintained including the testing of the emergency lighting and fire equipment. Meppershall Nursing Home DS0000015039.V377017.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 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X X 3 Meppershall Nursing Home DS0000015039.V377017.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 OP7 Regulation 15(1) Requirement Care planning within the home must be person centred, making sure there is guidance for each assessed need that staff can follow to ensure continuity of care is given. Protocols and specific guidance that nursing staff must follow when someone has a wound must be in place, this is to make sure peoples nutritional needs are re assessed and a pain relief plan is in place. People who use services must be assisted to access healthcare support when their needs change, to help improve upon their health and well being. When medication remains from one cycle the remaining balance must be added to the new medication record, this will enable it to be added to any new amount and provide a total number so that an audit can be carried out. When a complaint is received the complainant must be responded to direct, showing them the DS0000015039.V377017.R01.S.doc Timescale for action 30/09/09 2. OP8 12(1)(b) 30/09/09 3. OP8 13(1)(b) 30/09/09 4. OP9 13(2) 31/08/09 5. OP16 22(4) 30/09/09 Meppershall Nursing Home Version 5.2 Page 27 6. OP29 19(4) 7. OP30 18(1)(a) 8. OP31 10(1) service has taken responsibility and that the persons concerns have been listened to and acted upon. Recruitment of staff must ensure that all information is validated by the service to check for its authenticity, to help safeguard the people living at the home. When a person has a specific need for example stroke or diabetes training in these needs must be provided to staff. The owners and management of the home must make improvements, sustain them and demonstrate their competency by operating the service safely and without additional help and guidance. 31/08/09 31/10/09 31/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Meppershall Nursing Home DS0000015039.V377017.R01.S.doc Version 5.2 Page 28 Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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