CARE HOMES FOR OLDER PEOPLE
Merok Park Nursing Home Merok Park Nursing Home Park Road Banstead Surrey SM7 3EF Lead Inspector
Marianne Barham Announced Inspection 17th January 2006 10:10 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 Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 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. Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Merok Park Nursing Home Address Merok Park Nursing Home Park Road Banstead Surrey SM7 3EF 0208 652 7702 0208 652 7702 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) Mr Soondressen Cooppen To be confirmed Care Home 29 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (29) of places Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 2 beds may be used for respite care Of the 29 older persons accommodated, up tp 20 may be in the category DE(E) (Older people suffering from dementia) 15th April 2005 Date of last inspection Brief Description of the Service: 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 seven service users who are elderly and some of whom suffer from dementia. The home has been extended and 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 handwash 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 well maintained gardens and has parking to the front of the building. Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out at 10.10am by Marianne Barham, lead inspector for the service. The inspection was carried out over a period of four hours and ten minutes and was the second inspection in the Commission for Social Care Inspection (CSCI) year April 2005 to March 2006. Two additional visits in response to complaints made against the service have been carried out on 11th August and 27th October 2005 since the last inspection on 15th April 2005 and any requirements or recommendations arising from these visits have been followed up during this inspection. The registered provider of the home Mr Cooppen was present along with the acting manager Ms Nomsa Teixera and deputy manager/administrator Mr Hans Mungur. Nine staff members, twelve service users and two visitors were spoken with during this inspection. A tour of the premises was undertaken and records relating to the care of service users and the staffing and management of the home were examined. What the service does well:
The home was observed to be functioning well during the inspection and there was a calm and relaxed atmosphere throughout. Service users were observed to be well groomed and appropriately dressed, and were engaged in activities with staff and each other. Staff members were seen to interact in a positive and respectful manner with service users. Service users spoken with were complimentary about the care and services provided in the home and made comments such as the staff are lovely and they look after me well. All spoken with said the food was nice and they could choose what they had to eat. Several said that they liked their bedrooms and could have visitors when they wished. The home provides a good range of activities both inside and outside the home and an occupational therapist is employed to organise and carry out the timetable. Service users spoken with said that they enjoyed the activities and were able to relate their experiences of trips out to the pub, restaurants and shopping as well as activities in the home. A visitor from the local church said that the service users were well cared for and that there was an improvement in the care and comfort in the home in the last year. A visiting relative said that though initially they were worried about
Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 6 the changes to the way the home was run when the new owner took over, they now felt that improvements had been made. Members of staff spoken with said that they liked working at the home. All said that they get enough training, supervision and support to carry out their jobs and felt they could approach the owner or acting manager with any concerns. One member of staff said that during a recent episode of ill health they were supported really well by the owner and acting manager. What has improved since the last inspection? What they could do better:
Though service users risk assessments had been reviewed they did not contain any guidance for staff members to follow on how to manage or minimise identified risks. The home needs to obtain the most recent copy of the Surrey Multi-Agency Procedures for protection of vulnerable adults. Though the medication charts are now completed accurately there is still no guidance written to show when ‘as needed’ medication is to be given and handwritten entries on the medication charts are still not being signed and countersigned by staff members.
Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 7 The home has not had a permanent manager who is registered with the Commission for over six months and though the acting manager and deputy are competent it is important for the continuity of care of service users and support of the staff team to have a named manager with day to day responsibility of the home. The home has now implemented formal staff supervision however it is not carried out often enough and falls below the required minimum of six sessions a year. Requirements and/or recommendations have been made to address these issues. 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.
Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 8 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 Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Service users are given enough information to make an informed choice about where they live. EVIDENCE: The home has a comprehensive statement of purpose and service users guide that gives detailed information on the facilities and services provided by the home. This is given to all service users prior to admission to the home, meeting a requirement made at the last inspection on 15th April 2005. It was pleasing to see that both the statement of purpose and service users guide had been updated to reflect the change of ownership and management of the home. This also meets a requirement made at the last inspection on 15th April 2005. Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8, 9, 10 and 11 Service users healthcare needs are met by the home, however risk assessments need to be more detailed to ensure consistency and safety. The homes policies and practices generally protect service users however profiles detailing when as needed medication should be given need to be put in place to reduce the risk of errors. Service users and their families can be sure that their rights to privacy and dignity are upheld and that in the event of their death, they and their families are treated with sensitivity and respect. EVIDENCE: All service users are registered with a local GP of their choice and access specialist healthcare professionals through the GP practice. A chiropodist visits the home every six to eight weeks. A requirement was made at the last inspection on 15th April that service users risk assessments be reviewed with a further requirement made at an additional visit on 27th October 2005 that those service users at risk of falling out of bed have assessments carried out.
Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 11 It was pleasing to see that this had been done, however the assessments carried out identified any risk but had no guidance for staff to follow on how to manage or minimise the risk. A further requirement has been made to address this. A pharmacist inspection was carried on 14th April 2005 and requirements were made that complete and accurate records must be kept of all medication administered to service users, that records are kept of the medication refrigerator and that clear instruction is in place for all medications written as needed. Whilst it was pleasing to see that the records were being maintained accurately and temperature records kept for the fridge, it was disappointing to see that no profiles detailing what constitutes as needed had been put in place. A further requirement has been made to address this. The pharmacist also recommended that any handwritten entries on the medication administration charts be signed by a member of staff and a second carer checks for accuracy and then initials the entry. This has not been done and a further recommendation has been made. At an additional visit carried out on 27th October 2005 a requirement was made that staff members receive training on the promotion of service users privacy and dignity. It was pleasing to see that this had been done. The home has introduced a policy and procedure for dying and death of a service user and all staff members have been made aware of it. This meets a requirement made at the last inspection on 15th April 2005. Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 Service users have a lifestyle in the home that reflects their individual needs and preferences and satisfies their cultural and religious needs. They are supported to make choices about their lives. EVIDENCE: The home employs an occupational therapist who is responsible for organising leisure activities for the service users. A timetable of activities is in place that has been devised in consultation with the service users and records are kept of each individual’s participation in the activities. Religious services are held at the home and details of how the home aims to meet service users’ cultural and religious needs are contained in the home’s statement of purpose. Service users spoken with said they enjoyed taking part in activities and stated that they had had trips out to the pub, cinema and local shops recently as well as taking part in arts and crafts, bingo and quizzes in the home. The inspector was able to observe a quiz taking place during this inspection and all taking part appeared to be relaxed and enjoying themselves. Service users are asked about their individual likes and dislikes on admission to the home and these are recorded in their care plans. Service user meetings are held regularly though not recorded and a recommendation has been made that this is done. Service users get up and go to bed when they please, are
Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 13 able to choose what they have to eat and are involved in the planning of their care. A requirement was made at an additional visit on 27th October 2005 that the recently imposed restrictive visiting times be reviewed. It was pleasing to see that this has been done and that service users receive visitors at any reasonable time without an appointment. Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Service users concerns and complaints are listened to and acted upon by the home and they are protected from abuse. EVIDENCE: The home has a policy and procedure for dealing with complaints. All members of staff and service users are given a copy of the procedure. Records are kept of all complaints and the outcome. The home has received one complaint since the last visit on 27th October 2005 and evidence was seen that the procedures have been followed correctly. Service users spoken with said they knew how to raise any concerns they had. At the last inspection on 15th April 2005 a requirement was made that all members of staff undergo training on the protection of vulnerable adults from abuse (POVA). All staff members now have a copy of the home’s adult protection policy and have received training in house on the different types of abuse and procedures to follow. The owner stated that a new training provider had been contracted to supply training to the staff team on all mandatory subjects, with training on POVA issues included in the training programme. The home has a copy of the Surrey Multi-Agency Procedures for POVA, however these are not the most recent (February 2005) and a recommendation has been made for the home to acquire these. Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Service users live in a safe well-maintained environment that is clean, pleasant and hygienic. EVIDENCE: A requirement was made at the last inspection on 15th April 2005 to repair the cracked enamel on the bath in the upstairs bathroom and this has been done. The owner informed the inspector that he intends to refurbish the bathrooms as part of the ongoing maintenance and repair programme in the home. At the additional visit on 27th October 2005 a requirement was made to repair the radiator cover in room 23 and to ensure that the temperature in the home remained consistent. It was pleasing to see that this had been done. The home is clean and tidy throughout with no unpleasant odour. New carpets have been fitted in many communal areas of the home, with the remainder to be replaced in time. New armchairs and dining room furniture have also been purchased increasing the comfort for service users and making the lounge area more pleasant to relax in.
Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 16 The front of the building has been tidied up and made to look more attractive with flowers and shrubs being planted and turf laid and further improvements are planned. The owner is to be commended for his commitment to raising the standard of the environment of the home. Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Members of staff receive sufficient training to be able to carry out their jobs effectively. EVIDENCE: The home now has a programme of planned training in place and has appointed an external training provider to carry this out, meeting a requirement made at the last inspection on 15th April 2005. Members of staff spoken with confirmed that they receive training and were able to identify training courses attended since the last inspection such as first aid, fire safety and moving and handling. Records are kept of individual staff’s training with certificates held on file as evidence of attendance. Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 37 The home is well run by a competent acting manager and deputy manager, however a permanent manager needs to be appointed and registered with the Commission. Members of staff are generally well supervised however they need to receive more formal supervision. The home is run in the best interests of service users and their financial interests are protected. The homes policies and procedures and record keeping safeguard the rights of the service users. EVIDENCE: At present the home has an acting manager in post who is not registered with the Commission. The acting manager is a registered nurse who has many years experience working in the care sector. The acting manager is supported by, a deputy manager who also undertakes administration duties in the home. Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 19 The home has not had a registered manager in post for over a year now and this was discussed with the owner at a meeting on 5th December 2005 and again at this inspection. The owner informed the inspector that the manager’s post has now been advertised and that interviews would be arranged as soon as possible. A requirement has been made that an application to register a suitable manager for the home is received by 31st March 2006. The home has a policy in place for quality assurance and sends out questionnaires to service users and their relatives asking for feedback on the care and services provided. The information gathered is then collated and incorporated into the business plan for the coming year. It is planned to include health professionals and other involved people in the next quality audit. The owner also carries out monthly audits of the home and these identify any shortfalls in the service provided and actions taken to rectify them. The home is not involved in service users finances and any services or purchases not included in the fees are invoiced directly to the service user or a representative. The home has robust procedures in place for the accounting of such expenditure with individual records maintained for all service users and copies kept of all receipts. These records are complete from the date the present owner purchased the home. The owner stated that he does not have complete records of service users finances prior to his purchasing the home on 30th November 2004 and that the previous manager of the home told him that some records had been thrown away and receipts not kept. A requirement was made at the last inspection on 15th April 2005 that all staff members must receive formal supervision at least six times a year. It is pleasing to see that supervision is now taking place however it is still not frequent enough and falls below the required six sessions a year. A further requirement has been made. A requirement was made at the last inspection that the homes policies and procedures must be reviewed and updated to reflect the change of owner and management of the home. It is pleasing to see that this has been done, all procedures have been updated and the owner is in the process of signing them off. Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 20 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X 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 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 3 X Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 8 Regulation 14 (2) (a) Requirement Timescale for action 28/02/06 2 9 13 (2) 3 31 8 (1) (a) (b) 4 36 18 (2) (a) Individual risk assessments carried out for service users must contain clear information and guidance for staff to follow in order to prevent/minimise/manage the risk posed to them. The registered person must have 28/02/06 a clear plan, giving detailed instructions to staff as to what constitutes as needed for service users following consultation with the relevant practitioner. This will ensure that medication is administered in a clear and consistent way for the benefit of service users. The registered person must 31/03/06 appoint a permanent manager and submit an application to register the manager with the Commission. All staff must receive formal 28/02/06 supervision at least six times in a twelve month period and this must be recorded. Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 22 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 9 Good Practice Recommendations It is strongly reccommended as good practice that when it is necessary to handwrite a medication onto the medication administration record chart in the home, that the member of staff signs the chart and a second carer checks the entry for accuracy and then initials the chart. It is recommended that the home obtains the most recent copy of the Surrey Multi-Agency Procedures for protecting vulnerable adults from abuse. 2 18 Merok Park Nursing Home DS0000062507.V271725.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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