Inspection on 15/03/10 for Merok Park Nursing Home

This inspection was carried out on 15th March 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Merok Park Nursing Home 08/12/09

Merok Park Nursing Home 30/06/09

Merok Park Nursing Home 10/07/07

Merok Park Nursing Home 15/05/06

Merok Park Nursing Home 17/01/06

Merok Park Nursing Home 15/04/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Random inspection report Care homes for older people Name: Address: Merok Park Nursing Home Merok Park Nursing Home Park Road Banstead Surrey SM7 3EF zero star poor service 08/12/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Ruth Burnham Date: 1 5 0 3 2 0 1 0 Information about the care home Name of care home: Address: Merok Park Nursing Home Merok Park Nursing Home Park Road Banstead Surrey SM7 3EF 01737352858 02086527702 cooppencare@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Maleenee Coopen,Mr Soondressen Cooppen care home 29 Number of places (if applicable): Under 65 Over 65 0 29 dementia old age, not falling within any other category Conditions of registration: 29 0 The maximum number of service users to be accommodated is 29 The registered person may provide the following category of service : Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Merok Park is a large detached property located within a five-minute drive or fifteen minute walk of Banstead town centre and its amenities. The home currently provides accommodation and nursing care to twenty nine service users who are elderly and Care Homes for Older People Page 2 of 14 0 8 1 2 2 0 0 9 Brief description of the care home some of whom suffer from dementia. The home has twenty-five single and two double bedrooms. Fourteen of the single rooms have an en-suite toilet and washing facility and all other rooms have a hand wash basin. The rooms are arranged over two floors and the first floor can be reached by staircase or passenger lift. There are three toilets, a bath and a shower on the ground floor and three toilets, a bath and a shower on the first floor. The toilets and bathrooms are located in such a way that all bedrooms have a toilet and bathing facilities nearby. There are two lounges and two dining rooms on the ground floor and a large kitchen. The home stands in its own large gardens and has parking spaces to the front of the building. Fees at this home are in the region of £550 to £750 per week and do not cover hairdressing and chiropody costs. Care Homes for Older People Page 3 of 14 What we found: We carried out a random inspection of this service on 15 March 2010. This included a site visit by 2 inspectors were were in the home from 09:15 to 15:00. The focus of the visit was to check compliance with statutory notices issued on 23 February 2010 following our last Key inspection in December 2009. A number of the requirements appear as outstanding in this report. Compliance with these requirements was not checked during this visit, these issues will be looked at a t our next key inspection. We spoke to 3 members of staff, two care staff and one nursing. We also spoke with 2 resident, in private, in their rooms and a relative who was visiting the home. The relative told us they were very happy with the care and support provided. We observed and spoke with other residents around the home. We provided feedback at the end of our visit to the person in charge and the providers. We looked at the steps taken to comply, by 12 March 2010, with the requirement to ensure that pre-admission assessments cover all the identified needs of people who are admitted to the Home, taking into account information from, and consultation with, other agencies involved in their assessment of need. There have been no new admissions since our visit to the home in December 2009. Shortfalls identified in the homes assessment information in relation to three service users have now been addressed. This information has now been included in care plans. Staff who we spoke to all knew about risks due to unpredictability and challenging behaviours. There was still some concern about potential risk to the safety of staff and other residents although staff and management who were spoken to gave assurances that there had been no actual violent behaviours since the person had moved into the home. Two members of staff agreed that there had been some verbal aggression v towards other residents, particularly one person when they get in the way. There was some degree of unease expressed by staff when they provide personal care to this person. We discussed with the provider our concerns re the continued failure to comply with the conditions of registration in that people have been admitted to the home who do not fall into the category of older people or older people with dementia. The provider agreed that this was the case and gave assurances that this would not happen in the future. We looked at the steps taken to comply, by 12 March 2010, with the requirement to ensure that all of the service users care needs are clearly recorded in their care plans. This area has improved in that individual needs are now being identified. We looked at six care plans. These now identify individual needs including mental health needs, challenging behaviours, visual and hearing impairment. We looked at the steps taken to comply, by 12 March 2010, with the requirement to ensure that the care plans are sufficiently detailed with clear action plans in place to ensure the identified needs of all the service users are fully met. Compliance has not yet been achieved in that care plans currently accessible to staff are Care Homes for Older People Page 4 of 14 not sufficiently clear in providing guidance about the action they need to take to ensure peoples health and welfare is promoted through consistency of approach and personalised care. We observed staff support for one person. Staff were not consistent in the support they gave in that different approaches were used. One resident was seen to be distressed. They were being encouraged to go into the dining room for lunch but were vehemently refusing to do so. Eventually the resident was led by the member of staff up the stairs. This distressed the resident further who appeared afraid and cried out as they were encouraged to mount each step, The member of staff was walking backwards in front and holding the persons hands. We looked at the care plan to determine what guidance was recorded re the use of the stairs as the home has a passenger lift. There was no guidance at all about supporting the resident to access their room on the first floor. The person in charge of the home told us the resident did use the lift without any problem and did not know why they would be taken up the stairs. There was no guidance for staff on how to manage distress or refusal. The risks observed in moving and handling practice were discussed with the person in charge and the provider. Care plans are recorded using 3 sections. The first column identifies the need, the second states the aim/goal and the third is headed care intervention where guidance for staff should be recorded. The third section consists mainly of statements rather than clear personalised guidance for staff to follow. many of these statements are generic rather than person centred. We looked at the steps taken to comply, by 12 March 2010, with the requirement to have a system in place to ensure that the care plans contain up to date and accurate information, that is cross referenced and corresponds to information provided in assessments. We found that existing care plans are still inadequate. New care plans are still being formulated and are on computer awaiting relatives agreement. Samples of these plans were viewed and still indicate a lack of understanding of personalised care planning and do not provide clear guidance to staff on how to provide care and support for each person in a consistent manner. It was of particular concern that new care plans have not been cross referenced with assessment information. In one example it was documented clearly in the assessment information on the residents file that they were of a different faith. The existing and new care plans indicate their religious faith is Church of England and staff are instructed to ensure they attend Communion regularly. None of the staff spoken to knew the resident was not C of E. We looked at the steps taken to comply, by 12 March 2010, with the requirement to ensure that the care plans are reviewed at least monthly and revised whenever individual needs change. Current care plans seen show some evidence of compliance with this requirement in the form of recorded dates to show that reviews have taken place each month. However, although some improvement is noted, the continued use of generic phrases, lack of clear guidance, inconsistency of approach and conflicting information between assessment and care plans indicate that reviews are not being carried out effectively. We looked at the steps taken to comply, by 12 March 2010, with the requirement to ensure that each identified risk has a clearly documented action plan in place to ensure that the risk to the persons health and safety is minimised or eliminated. Care Homes for Older People Page 5 of 14 Individual risk assessments in care plans show some improvement in identifying risk although guidance to minimise risk is still not clear. Again the use of generic statements are employed rather than clear person centred guidance on how to minimise risk. For example risk assessments in relation to falls contain phrases such as: .... will wear his own shoes. During our visit we identified further risks which had not been identified or managed effectively. These were drawn to the attention of the provider. There does not appear to be any system for identifying or managing environmental risks. We were disappointed and concerned to note that the carpet in the lounge still posed a trip hazard, there were still numerous raised ridges across the whole area where people walk. The ornamental fire was still in situ without any barrier or guard. Sharp metal edges and spiked finials pose a risk should anyone fall in this area. This was discussed at length with the person in charge at our last visit when we received assurances that an immediate risk assessment would be carried out. This has never been done. The provider told us the carpet was being replaced later in the week but had no explanation of why there was no interim risk assessment and action to minimise risk and make the area and fire safe in the meantime. He agreed to do an immediate risk assessment and take any action necessary to ensure the safety of residents. The provider also told us the fire was being taken out and the carpet replaced shortly. We looked at the homes incident/accident records. Staff who complete these forms do not always state the location of the event so it was not possible to see how many falls had occurred in addition to the three falls recorded in the lounge since June 2009. A carpet in a residents room was badly worn and also posed a trip hazard, this risk had not been identified and was also drawn to the attention of the provider during our visit. We noted further risk where people are not being adequately supervised. While we were observing the lunchtime meal being served in the new dining room one resident was wandering around the home. They attempted to move the DVD player in the lounge which was plugged in. There was no member of staff allocated in this area where some residents were eating their lunch. The resident also approached another resident, causing them some distress. We discussed these events with the provider and manager who said that staff are around. It was brought to their attention that staff were not specifically allocated to remain in the lounge during the meal therefore there was no one supervising residents in this area. Another resident was observed in the lounge. A member of staff assisted him to his chair with his zimmer frame. The resident objected to this assistance, he got up again and moved the frame to opposite side of room, then walked back unsupported to the chair. There was no guidance in risk assessment documentation about staff approach or action to take when people are uncooperative or refuse support. This persons risk assessment simply states Staff will supervise/assist during mobility but gives no guidance on how to do this. Documents seen, observations made and absence of environmental risk assessment continue to indicate that there is a lack of understanding of risk management in the home which is placing people at risk of harm. We looked at the steps taken to comply, by 12 March 2010, with the requirement to ensure that the risk assessments and corresponding action plans are reviewed at least monthly and updated according to the persons changing needs. Care Homes for Older People Page 6 of 14 There was some documented evidence of review of individual risk assessments in the form of dates recorded at monthly intervals. Observations recorded above show a lack of effective risk management processes both for individual and environmental risks. There was further concern where care staff informed us that there were occasions when one resident expresses anger and frustration verbally when other people who live in the home get in their way. There were no records of such incidents on daily notes which are only completed by nursing staff. The nursing staff we spoke to were not aware of these incidents. Therefore risk assessments were not updated to reflect this risk. There is no moving and handling risk assessment with appropriate guidance for staff to ensure the safety of people who go or are taken up and down stair although we observed this practice during our visit. We looked at the steps taken to comply, by 12 March 2010, with the requirement to submit an action plan to the Commission on how you are going to ensure that the Home provides adequate dining room facilities in a congenial setting to meet the specific numbers and needs of service users living in the Home. Although no action plan has been submitted compliance has been achieved with this requirement. The providers have created a new dining room in the second lounge at the rear of the house overlooking the garden. They have purchased a commercial hot trolley from which they are serving meals at the tables providing more opportunity for choice. Several small tables have been purchased to ensure people who choose to eat in the lounge can do so comfortably.Some people were eating their meal in the dining room to the rear of the house and a group of people were seen taking their meal in a smaller room at the front of the property which has also been improved by rearranging furniture to create more space. These changes have greatly improved the mealtime experience for residents. The menu was recorded on a white board in both dining rooms. We observed staff to be providing support discreetly to people who require assistance with their meals and interaction was caring and friendly. Two choices of main course were offered, either chicken or savoury mince and vegetables. There were a variety of desserts on offer on the sweet trolley, including strawberry mousse, banana custard and cheese and biscuits. There is still more that could be done to increase peoples understanding of the choices on offer. For example the choice of main meal is offered verbally rather than by sight. One person was not offered gravy and their meal looked dry. Gravy is also served from the trolley rather than people having the opportunity to say where they would like it and how much they would like. Condiments were not available on each table and drinks were provided in opaque plastic jugs, which were coloured, this did not enable people to see what drink was available. Drinks are served in plastic beakers. We looked at the steps taken to comply, by 12 March 2010, with the requirement to have a system in place to ensure that visits to the Home by the provider or their representative are undertaken each month and a full written report of the conduct of the home is provided to the manager, the Commission and each of the partners. Compliance has been achieved with this requirement. We looked at reports the provider prepared for the last 3 months. Two of these reports were brief records which would have Care Homes for Older People Page 7 of 14 limited value as part of the homes quality assurance system. The latest report was recorded on a new pro forma and was more detailed and comprehensive. The provider has continued to rely on the person in charge to manage the home and comply with the statutory notices and the requirements from the last report. He was unaware that there was still no effective quality assurance system in operation. The provider has not overseen the process of updating care plans and risk assessments and was unaware of the content of these documents. The provider informed us of his intention to apply for registration as manager of the home until the person in charge is properly trained and qualified to carry out this role. He gave assurances that he would oversee all future activity to achieve compliance and meet the minimum standards required. He further gave assurances that he would operate as a full time manager in the home. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 8 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 12 The home must make proper 31/08/2009 provision for peoples health and welfare, so far as practicable ascertain and take into account their wishes and feelings. In that the service users plan must set out in detail the action to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. Care plans should be reveiwed regularly. To ensure people are cared for in a way that meets their needs and promotes their wellbeing 2 7 13 The home must ensure 31/08/2009 unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Including risks associated with heatwave in that temperatures, particularly in bedrooms should be monitored. To ensure the safety and comfort of people who live in the home. 3 12 16 The home must consult 31/08/2009 Page 9 of 14 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation. In that peoples interests should be recorded and they must be given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities with particular consideration given to people with dementia. Individual and group activity programmes should be in place. To improve the quality of life and physical, mental and emotional wellbeing of people who live in the home 4 14 12 The home must take into 31/08/2009 account peoples wishes and feelings and conduct the home so as to maximise service userscapacity to exercise personal autonomy and choice in all aspects of their lives by ascertaining and taking account of their views and presenting lifestyle choices in a way in which people with dementia can understand. To improve peoples quality Care Homes for Older People Page 10 of 14 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action of life by maximising the control people have over their own lives. 5 15 12 The home must take account 31/08/2009 of peoples wishes and feelings. In that meals must be provided in a congenial setting, offering a choice of food in an appropriate way to suit peoples capacities, including people who have dementia. To ensure mealtimes are enjoyable and people understand the choices on offer. 6 19 23 The Registered person must 31/08/2009 ensure that the physical design and layout of the premises meet the needs of the service users.They must ensure that all parts of the care home are kept clean and reasonably decorated; Shared rooms suitable to maintain adequate private space; the garden is suitable and safe for use and appropriately maintained with suitable seating. Bedroom doors should not be locked or rooms overly cluttered so as to impede peoples access to their own rooms. To ensure that everyone who live in the home, including people who have dementia, can find their way and are comfortable and safe. Care Homes for Older People Page 11 of 14 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Suitable locks should be fitted to toilet doors which can be overridden by staff in an emergency. 7 30 18 The home must ensure that 31/08/2009 staff employed to work at the care home receive training appropriate to the work they are to perform. Training provided in the home must be adequate to ensure all staff understand how to meet the specific needs of people who have dementia or mental health difficulties and documentary evidence of any relevant qualifications and training must be maintained. To ensure staff are competent to meet the needs and promote the wellbeing of people who live in the home. 8 31 18 The registered provider must 31/07/2009 make immediate arrangements to register a manager for the home who is skilled and competent to carry out this role. To ensure people can be confident in the management of the home to meet their needs and provide a good service. Care Homes for Older People Page 12 of 14 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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