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Inspection on 15/12/06 for Merry Hall Nursing & Residential Care Home

Also see our care home review for Merry Hall Nursing & Residential Care Home for more information

This inspection was carried out on 15th December 2006.

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

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

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

What the care home does well

Detailed records were in place that gave nursing and care staff information that enabled them to provide the help that residents needed. Residents felt safe and secure and happy that staff could look after them properly and treated them with respect. Residents and relatives described the staff group as friendly and relationships between staff and residents were relaxed and informal. The home`s routines were flexible and residents were encouraged to make choices for themselves and exercise personal autonomy as far as was reasonably possible. Residents were positive about the food that the home provided and were pleased with the range of activities in which they could participate and the condition of the accommodation that they occupied. Staff, residents and relatives had confidence in the effectiveness of the home`s manager. Management systems and procedures in the home worked well including, the administration of medication, dealing with complaints, quality monitoring, and health and safety. There was a strong commitment to staff training and development to ensure that staff were able to fulfil their roles and responsibilities and meet residents needs.

What has improved since the last inspection?

New staff working in the home were only confirmed in their posts after satisfactory checks had been completed. They should however not have started working in the home until such pre-employment checks had been completed (see below) The home`s facilities had been improved by the construction of an extension to the building providing more communal space and additional facilities.

What the care home could do better:

Records examined indicated that not all statutorily required pre-employment checks had been completed before staff had started working in the home. This has the potential for allowing someone who may be considered unsuitable to work with vulnerable adults have access to them. All statutorily required pre-employment checks must be completed and the information received before new staff commence employment in the home in order to protect residents as far as is reasonably possible from harm.

CARE HOMES FOR OLDER PEOPLE Merry Hall Nursing & Residential Care Home 30 Kiln Road Fareham Hampshire PO16 7UB Lead Inspector Tim Inkson Unannounced Inspection 15th December 2006 09:30 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 Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merry Hall Nursing & Residential Care Home Address 30 Kiln Road Fareham Hampshire PO16 7UB 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) 01329 230024 01329 825562 merry.hall@virgin.net Buckland Care Limited Mrs Barbara Joan Hare Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability (3), Physical disability of places over 65 years of age (32), Terminally ill (3), Terminally ill over 65 years of age (32) Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users must be over 60 years. Service users requiring personal care only may be accomodated in Room 16. Date of last inspection Brief Description of the Service: Merry Hall is situated in a quiet residential area, close to local amenities, being only a short distance from the centre of Fareham. An Edwardian house, Merry Hall has been carefully restored and retains much of its original period character. The Home is registered as a care home with nursing for thirty two service users over the age of 65; in the categories of old age, physical disability and terminally ill. Potential residents and/or their representatives are provided with a brochure describing the home and the service it provides. They are also made aware of the availability of a copy of a report of the most recent inspection of the home by the Commission for Social care Inspection (CSCI) and are invited to visit the home and view the premises. On moving into the home individuals and/or their representatives are provided with a detailed and comprehensive Service Users Guide and terms and condition/contract. The home’s fees at the time of a site/fieldwork visit to the home on 15th December 2006, ranged from £550 to £750 and this did not include the cost of hairdressing, chiropody treatment, newspapers, magazines and toiletries. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit of this inspection process of this home was unannounced and took place on 15th December 2006, starting at 08:50 and finishing at 16:10 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. Residents, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 30 residents and of these 3 were male and 27 were female and their ages ranged from 78 to 100 years. No resident was from a minority ethnic group. The home’s registered manager was present throughout the visit and was available to provide assistance and information when required. Other matters that influenced this report included a pre-inspection questionnaire with documentation completed and provided by the registered manager. Also information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 17th October 2005, such as statutory notices received about incidents/accidents that had occurred. What the service does well: What has improved since the last inspection? Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 6 New staff working in the home were only confirmed in their posts after satisfactory checks had been completed. They should however not have started working in the home until such pre-employment checks had been completed (see below) The home’s facilities had been improved by the construction of an extension to the building providing more communal space and additional facilities. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 7 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 Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were procedures in place to ensure that the home identified the assistance and support that potential residents needed before they moved into the home. EVIDENCE: A sample of the records of 4 residents was examined including those concerned with the actions that the home took to identify the help and care that people needed. There was evidence from these documents that the admissions to the home of the individuals concerned had all been planned with staff with the appropriate knowledge and skills and that the process included visiting potential residents and identifying the help and support that they needed before they moved into the home. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 9 The home’s pre-admission assessments were complemented by more thorough and comprehensive assessments of a resident’s needs when they actually moved into the home. Residents and relatives spoken to commented about the process referred to above and comments included: • “I came and looked around before I moved in …..K (Registered Nurse) talked to me about what help I needed” There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. The home does not provide intermediate care. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems in place to ensure; the personal and healthcare needs of residents were met and medication was managed safely and effectively. Among other things staff working practice helped to ensure that residents’ privacy and dignity was promoted. EVIDENCE: The care plans were examined of the same sample of 4 residents as in the section above at page 9. Among the sample was an individual who was receiving treatment for a pressure sore. The documents examined were comprehensive and the plans were based on the assessments the home carried out in order to identify what help individuals needed (see pages 9 and 10). Assessments included a range of potential risks to residents e.g. pressure sores; falls; moving and handling; malnutrition; etc. Where a pressure sore assessment indicated that an individual was at risk it Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 11 was noted that the corresponding plan of care for the person concerned referred to the use a pressure relieving aid. The plans examined also set out clearly the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required. There was evidence from documentation and discussion with residents and relatives that wherever possible individuals and/or their representatives had been involved in developing the plans and agreed with the contents. Where care plans referred to the use of equipment or how a specific need was to be met this was observed to be available, provided or in place e.g. pressure relieving aid; Zimmer frame; or hoist. Records indicated that care plans were reviewed at least monthly and daily notes referred to the actions taken by staff to provide the needs set out in those plans. Staff spoken to knew the needs of the individuals whose records were sampled and they were able to describe the contents of the care plans. Comments from residents about the abilities of staff the care and support that they provided included: • “The staff are very good, they are very friendly, nothing is too much trouble ….. I feel safe when they are helping me. I think that they are skilled ….. I had a hypo last night and I pressed the buzzer and the staff came they knew what was wrong and what to do”. (A record of the incident in the relevant daily notes confirmed this last statement). • “The staff are wonderful, excellent. They help me with a bath … I feel safe and comfortable when the staff help me”. Care plans examined were not simply task focussed but also included references to the fundamental principles that underpin social and health care such as privacy, dignity and choice and entries in plans illustrating this included the following: • Ensure privacy and dignity at all times • Encourage to wash her face and hands • Encourage to clean own teeth • Needs assistance to wash – able to choose dress • Comb hair herself • Ensure enough time and privacy to use toilet The records examined indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Residents said that they saw and received treatment from among others, doctors, podiatrists and opticians and when required arrangements to attend outpatient clinics were made by the home. There was documentary evidence that when an individual had a wound/pressure sore that specific plans were implemented to manage the wound and monitor progress with healing. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 12 There were also very specific plans in place where weight loss or eating difficulties had been identified as a problem for an individual. The plans specified how this would be managed e.g. what food supplements would be provided and how i.e. mixed with drinks or other food and the amount of calories required each day. It was noted that one of the cooks working in the home had attended a training course about the nutritional needs of older people. Individuals’ health was monitored routinely and regularly e.g. weight, blood pressure and temperature. The home had written policies and procedures concerned with the management and administration of medication. A range of reference material about medication was readily available including a relatively recent copy of the British National Formulary (BNF). Medication was kept in locked and secured medicine trolleys, cupboards and where required in a medical refrigerator. Controlled drugs were stored securely and appropriately. A sample audit of controlled drugs indicated that the records were accurate and up to date. All medication was dispensed from its original container and the only staff in the home that dispensed and were responsible for the management and administration of medication on a day-to-day basis were registered nurses. Good practice noted during the fieldwork visit included: • Recording the temperature of the refrigerator used for storing some medication • Sample copies of the signatures of the Registered General Nurses that dispensed medication • Some sedative medication was treated as if it was a controlled drug • The dating of all medicine containers when they were opened. The home strongly promoted the independence of residents and those residents assessed as being able and who wished to were encouraged to keep, and take their own medication. At the time of the fieldwork visit however no resident was managing all of his or her own medication. Records were kept of the ordering, receipt, administration and the disposal of medicines and these were accurate and up to date. The contents of a recent medical device alert sent out to all care homes and concerned with “Lancing Devices” used for blood glucose monitoring was discussed with the registered manager. She stated that the practice in the home was, “One needle for one person and then disposal”. There was only one shared bedroom in the home. Consequently the privacy of vast majority of residents was promoted by the fact that they were accommodated in singe rooms. All bedrooms were provided with en-suite WCs. Residents spoken to said that staff always knocked before entering their rooms. This latter practice was observed during the fieldwork visit. Residents and relatives spoken to described the staff as respectful and polite. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 13 The one shared bedroom in the home was provided with screening to ensure that the privacy of its occupants could be maintained. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home organised a range of social activities that provided stimulation and it also promoted residents self-determination, enabling residents to exercise choice about all aspects of their daily life. Residents were able to maintain links with relatives and representatives. The dietary needs of residents were well catered for with a balanced and varied selection of food available that met their tastes and choices. EVIDENCE: The home employed a part-time activities organiser and residents spoken to said that they had the opportunity to participate in a range of organised activities that they found interesting. The activities programme was printed out and copies were made available to residents or they were made aware of its contents. During the month in which the fieldwork/site visit took place the events that had or were due to take place included • Bingo • Games and craft • Visiting musical entertainer Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 15 • • • • • • Carol service at a local Church Pantomime by visiting arts’ company Christmas decoration making Visiting classical singer Trip out to Christmas lights Visiting piano accordionist All residents spoken to indicated that their life style preferences were respected and that routines in the home were flexible and relationships were informal. Comments from residents about the activities that were organised, their ability to exercise choice and day-to-day routines in the home included: • “I prefer to eat in my room because I choke when I am in company …. I went to the pantomime …. Usually the night staff get me up, I could say no if I chose to they always ask me if I am ready to get up”. • “I join in the activities if it is something that appeals to me. They have a programme and someone tells me what is on. We had a lovely singer yesterday and a harpist recently, they appealed, as I am a classical enthusiast”. • “I get up and dressed by myself. I go to the dining room for meals. They call me about 8:20 for breakfast ….. The staff are very good, very friendly, I pull their legs. They are polite and really helpful …. The activities lady works hard. I go on all the outings. There are some things I would not do if I was not living here …. but I join in and make the best of it”. Residents and relatives spoken to confirmed that there were no restrictions concerned with visiting the home and relatives said that they were always made welcome. There was information in the entrance of the home with details about an organisation that could provide impartial advice, information and guidance to residents and/or their families. At the time of the fieldwork/site visit no resident was managing their own financial affairs. The responsibility had been delegated to either relatives or representatives. It was apparent from discussion with some residents that this had been their choice. Residents were able to bring personal items into the home including furniture and it was apparent from discussion with residents and observation during a tour of the building that many individuals had taken trouble to personalise their bedroom accommodation. Sensitive information that the home held about residents was kept secure and the home had written policies and procedures about maintaining confidentiality and residents rights to access their personal files and case notes. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 16 Residents were generally complimentary about the food provided and confirmed that they had 3 meals a day and could have snacks and drinks at other times. The menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided with a selection of choices every day. In addition special diets and individual preferences and needs were catered for e.g. soft and pureed meals, diabetics and vegetarian. Fresh ingredients were used in the preparation of meals and the ready availability of fluids was noted. The ingredients for some pureed meals were prepared separately. Residents could choose where to eat and some preferred to eat in their rooms. The list of menu choices for the week was on display in the entrance hall to the home. A member of staff asked individuals what choices they wanted during the morning of the meal in question. Individuals’ food preferences, dislikes, food related allergies and their nutritional and dietary requirements were recorded in their care plan documents and the information was also readily available to catering staff in the kitchen area. The main meal of the day was observed and it was unhurried and staff were sensitive when providing assistance. It was apparent from conversation around the two dining room tables in the dining room that the meal was enjoyable and the choice that they could make from a selection of some 5 different sweets was greatly appreciated. Comments from residents about the food provided included the following: • “The food is very good, we have 2 choices every day and they cater for me as a diabetic”. • “I find the meat tough. I am very critical when it comes to food. There is always a choice”. • “ I get 3 vegetables a day which I would not do if I was on my own .. The food is good but it depends on who is cooking, but there is ample”. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a clear and satisfactory complaints procedure to address the concerns of residents and relatives/representatives. Robust procedures were in place to protect service users from the risk of abuse. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was clearly displayed in the home’s entrance hall. All residents and relatives spoken to were confident about raising any concerns with the home’s manager or any of the senior staff working in the home. The home kept records of complaints that detailed the issue, and set out any agreed action to remedy the matter and its outcome. There had been one complaint made to the home since the last inspection on 17th October 2005, and it was apparent from the details kept by the home that the matter had been resolved satisfactorily. The Commission for Social Care Inspection (CSCI) had received no complaints about the home during the same period. The home had written procedures available with adult protection. These were intended to provide guidance and ensure as far as reasonably possible that the risk of residents suffering harm was prevented. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 18 There was information about adult abuse on display in the entrance hall to the home. Staff spoken to said that they received training about protecting vulnerable adults and an examination of staff training records confirmed this. Staff spoken to were also able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. Where subsequent to an assessment it was considered necessary for a resident’s safety to use bed rails written permission/consent was obtained. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment was safe and well maintained. There was an infection control policy and procedures in place and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: At the time of the fieldwork visit the exterior and interior of the premises, its décor, furnishings, fittings and equipment were in good repair. There was also no unpleasant odour anywhere in the building. The home employed maintenance personnel to; undertake minor repairs and re-decoration; keep the grounds and garden maintained; and ensure that safety systems were checked and serviced. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 20 The manager stated that when bedroom accommodation became vacant she “blitzed” it and replaced floor coverings and furniture. One such room was seen and it well presented, with matching furniture and furnishings. Since the last inspection of the home on 17th October 2005, an extension to the building had been completed that had resulted in additional bedrooms and communal space. The extension included fixtures that were unavailable in other parts of the building and that could assist residents maintain their independence and mobility i.e. wall rails. A new wet room/level access shower room had been installed from the conversion of an old facility. There was a choice of three communal lounge areas for residents to enjoy that enabled several different activities to take place at the same time and could also afford more privacy to relatives that were visiting if it was desired. An enclosed courtyard garden had been created by the construction of the extension and there was wheelchair access to its level and paved surface. The building was well provided with assisted bathing facilities and a number of hoists were seen throughout the premises. The home had comprehensive procedures in place concerned with infection control. It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers (that were full and working) and paper towels. There were alcohol gel disinfectant dispensers placed strategically throughout the building and staff carried personal dispensers. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. Individual and appropriate slings were provided for individuals who needed to be transferred by hoist. This practice among other things prevented the possibility of cross infection. The home’s laundry was appropriately sited and equipped and effective procedures were in place for the management of soiled laundry items. One relative spoken to about the condition of the home said: “It is lovely, it is so clean and there are no smells”. A resident spoken to commented, “The first thing my son said was, “It does not smell. They vacuum my room probably every day”. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was an appropriate and satisfactory level and mix of staff that ensured the needs of residents were met. There were procedures in place for the training of new and existing staff to ensure that they had the skills to meet residents’ needs. The home’s recruitment procedures were not sufficiently robust and must be improved to ensure as far as is reasonably possible that people unsuitable to work with vulnerable adults are not employed. EVIDENCE: The care team working in the home comprised, 8 registered nurses and 17 health care assistants. Out of the latter 9 (i.e. 53 ) had obtained a qualification equivalent to at least National Vocational Qualification (NVQ) at level 2. At the time of the fieldwork visit the care staff rota setting out the minimum number and skill mix deployed in the home was as follows: - Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 22 Registered nurses Health care assistants Total 08:00 – 14:00 2 4 6 14:00 – 20:00 1 4 5 20:00 – 08:00 1 3 4 Apart from registered nurses and health care assistants the home employed other staff and these comprised. Administrator Activities organiser Chefs Kitchen assistants Cleaners Laundry assistant Maintenance personnel All residents and relatives spoken to were complimentary about the staff and their abilities (see also at section about Health and Personal care above at page 12) Residents, staff and relatives spoken to about their perceptions of the adequacy of staffing levels indicated that generally the number of staff deployed in the home was sufficient and comments included the following: • “Sometime I think that they are a bit pushed, but it is swings and roundabouts” (resident). • “I think it varies a bit, staff numbers, sometimes they seem short but I am not too sure. They always answer the bell promptly” (resident). • “We have 2 registered nurses and 4 carers in the morning and 1 registered nurse and 4 carers in the afternoon. Sometimes it is difficult as we have a high ratio of very dependent people, sometimes the buzzers are going non-stop, but at other times it can be quiet. Very rarely do we have to get agency because it is not difficult to get cover” (members of staff). • “I find that staffing levels are what we need, any less and we would be much busier and any more and things would not get done (registered nurse). • “The staff are lovely, Mum says they are sometimes short, but normally it is pretty good” (relative). Records were examined of 3 staff that had been employed to work in the home since the last fieldwork visit to the establishment on 17h October 2005. It was apparent that in all cases the enhanced certificate from the Criminal Records Bureau (CRB) had been obtained after the person had started work in the home and their was no evidence in any of the cases that a Protection of Vulnerable Adults (POVAfirst) check had been completed. In one case the Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 23 member of staff had been working approximately 3 months in the home before a satisfactory CRB certificate was received. The registered manager said that she was aware of the requirements of the Department of Health concerning the protection of vulnerable adults as set out in their practical guide published on 16th May 2005. She also said that she would take personal responsibility for ensuring that in future staff recruitment was conducted in strict accordance with the guidelines She stressed that all new health care assistants were provided with a copy of the General Social Care Council’s code of practice when they completed training about the protection of vulnerable adults. An immediate requirement form was left with the home’s registered manager as a result of the failure of the home to implement satisfactorily robust staff recruitment procedures. All new staff received comprehensive induction and health care assistants completed a programme that satisfied the requirements of the training body for the social care workforce i.e. Skills for Care (previously the Training Organisation for Personal Social Services [TOPSS]). Staff training needs were identified through appraisals and individual supervision sessions. The home had a staff training programme that included in the immediate future the following topics: Palliative care; medicines for trained staff; care planning; abuse; person centred care; health and safety; and moving and handling. It was apparent from discussion with the home’s registered manager that she was wholly committed to staff development and training and provided and led a lot of training in the home herself. Conversation with staff indicated that in addition to their induction training they attended training in subjects that ensured that they kept their clinical and other skills up to date. One registered nurse said that he had recently attended courses on, male catheterisation and tissue viability/wound care. Staff comments about their induction and further training opportunities included: • “We have done mandatory training, health and safety at work, moving and handling and fire. We have done abuse training”. • “I have done fire safety, abuse, moving and handling, health and safety and basic food hygiene”. • “There are loads of opportunities to train, Barbara (the registered manager) is very encouraging. You can have as much training as you want to it is just about fitting it in with your workload”. • “ She (the registered manager) is interesting to listen to, she keeps you interested”. • “The matron is a good teacher”. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s manager provided effective leadership There were systems and procedures in place for monitoring and maintaining the quality of the service provided and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The registered manager had been in post for 3 years and she was a registered nurse. She had managed several other care homes during her career and said that she had retired from work on a number of occasions but had returned Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 25 because she missed the work and when she had returned she had always initially started in a hands on role but because she wanted to “make a difference” had eventually sought promotion to a senior post again. From discussion with the registered manager, and from observation and discussion with staff, residents and relatives it was apparent that the registered manager was not only held in some esteem, but she was also organised; highly motivated; enthusiastic; concerned; sensitive and empathetic. Comments from staff, residents, and relatives about the registered manager were all very positive and included the following: • “She is extremely efficient, possibly the best manager I have worked with” (member of staff). • “She is firm but fair, she is approachable and you can talk to her about problems, she will do her best to help” (member of staff). • “The matron is excellent. I would not do her job for all the tea in China, it must be very onerous. We are all so different” (resident). • “Matron is very nice and friendly and we can talk to her if we have problems” (relative). The home had a system in place for monitoring the quality of the service that it provided that included the use of questionnaire to obtain the views of residents and relatives. The home’s registered manager also said, “Twice a year, in January and July, we have relatives meetings. We send out questionnaires but the response is usually poor”. Some recently returned questionnaires were seen and the registered manager said that the results were due to be collated and then if necessary an action plan would be set out. The home had a range of policies and procedures that staff spoken to said were useful for reference and advice. Copies were available in the office and the staff rest room.There was evidence that they were reviewed and up-dated as necessary. There were no outstanding requirements from previous inspections of the home. The home looked after small sums of money for some residents that was left with or handed over by relatives or representatives. A sample of records of monies held on behalf of residents was checked and they were accurate and up to date. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; fire safety equipment portable electrical equipment; hot water system; etc. There were contracts in place for the disposal of clinical and household waste. Records were kept of accidents. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 26 Staff said that they attended regular and compulsory fire and other health and safety training. There was a fire risk assessment for the premises and regular risk assessments of the premises and working practices were undertaken. Guards covered all radiators in the home and all windows above the ground floor were fitted with restrictors. The home’s registered manager was an accredited moving and handling trainer and there were hoists, and other equipment in the home to promote safe working practices. Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 28 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 OP29 Regulation 19 and Schedule 2 Requirement All statutorily required preemployment checks must be completed and information received before any person works in the home. Timescale for action 15/12/06 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 Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Merry Hall Nursing & Residential Care Home DS0000057235.V322343.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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