CARE HOMES FOR OLDER PEOPLE
Merry Hall Nursing & Residential Care Home 30 Kiln Road Fareham Hampshire PO16 7UB Lead Inspector
Sue Maynard Unannounced Inspection 17th October 2005 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.V257877.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. Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 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 27 Category(ies) of Old age, not falling within any other category registration, with number (27), Physical disability over 65 years of age of places (27), Terminally ill over 65 years of age (27) Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Room 16 to accommodate service user for personal care only. Date of last inspection 3rd May 2005 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 twenty seven service users over the age of 65; in the categories of old age, physical disability and terminally ill. Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second statutory unannounced inspection for the year 2005/2006. The inspection was undertaken by one inspector and lasted from 09.30 until 13.30. The registered manager was on annual leave. The deputy manager was on duty and provided the inspector with the records and information that she required. The inspector spoke to residents and members of staff. Residents spoken to stated that they were well cared for and that the staff were attentive and kind. The inspector spoke to some residents during lunchtime. Generally the comments about the meals were positive. There was a choice of meals available and the inspector saw that four different meals had been served to the residents in the dining room. The meals were well presented and a variety of fresh vegetables were served. Members of staff were seen supporting some residents to eat their meal and providing assistance in an appropriate manner. The staff stated that they enjoyed working in the home and that the trained staff supported them to provide a high standard of care to the residents. What the service does well:
The skill mix of staff, trained and untrained, in the home ensures that staff members are able to maintain a high standard of care for the residents. Student nurses from the school of nursing in the nearby university work supernumerary alongside the care staff in the home. The students are not only able to learn from the staff in the home and also bring knowledge and information to the home that they have learned as part of their training in other areas of health care. Communication systems in the home ensure that all the staff and the residents are made aware of any changes to be made in the home. A new extension to the home is due to be built and the residents and their families have been made aware of the impact this make to the daily lives of some of the residents. The deputy manager informed the inspector that they have been assured that any disruption will be kept to a minimum. Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 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.V257877.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was assessed at the previous inspection in May 2005 Standard 6 does not apply to this service. EVIDENCE: Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 9 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): 7 and 8 The care planning and communication systems in the home ensure that the health and care needs of the residents are consistently met. EVIDENCE: The inspector examined records for four service users. All the records examined contained a very comprehensive pre-admission assessment. On admission to the home a further assessment is undertaken to provide further information allowing the staff to identify the individual care needs of each resident. Personal details documented, included the contact details for the service user’s next of kin, date of birth, the date that they were admitted to the home, and the doctor with whom the service user was registered. Care plans had been drawn up to address all the care needs of the service users. The care plans identified the problem and clearly demonstrated the action plan and the outcome that was to be achieved, ensuring that the health care needs of the residents are met. The home has a very detailed care plan that is in use for wound care. This care plan details the wound when first identified, the choice of dressing and the rationale for its use. Evaluation of the progress of the wound is recorded at
Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 10 each change of dressing. There is also evidence that other health care professionals are consulted where necessary. There was evidence that all care plans were regularly reviewed and updated. Risk assessments have been undertaken for service users who are at risk from falling. Consent has been obtained from the resident or their family for the use of bedrails on the beds of residents who have been identified as being at risk from falls from bed. Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 11 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): All these standards were assessed at the previous inspection in May 2005. EVIDENCE: Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 12 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): Standard 16 and 18 were assessed at the inspection in May 2005. EVIDENCE: Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 13 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): Standards 19 and 16 were assessed at the inspection in May 2005. EVIDENCE: Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 14 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): 28 and 29 The staff undertake training that enables them to be competent to do their jobs. The home’s recruitment procedures do not adequately protect the vulnerable people living in the home. EVIDENCE: Care staff employed in the home are undertaking training for NVQ levels 2 and 3. It was reported to the inspector that three staff members are currently undertaking NVQ at level 2. One staff member has already achieved level 2 and one, level 3. The home also has staff members who are from overseas and have nursing qualifications from their own country. They are undertaking adaptation training provided by the home, which when successfully completed will enable them to work in the United Kingdom as Registered General Nurses with qualifications recognised by the Nursing and Midwifery Council for the United Kingdom. The inspector spoke to three of these nurses who stated that they were finding the training “hard work” but that they were enjoying it and were being supported by the other trained staff in the home to progress with their training. The inspector examined the recruitment files for four staff members.
Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 15 All the records examined contained completed application forms with past employment history. Two written references were available for all the members of staff. Proof of identity was available in the form of birth certificates and copies of passports including photographs. Details from one passport from a member of staff from overseas were very poorly reproduced and the inspector was unable to identify the staff member from the photograph or read the details on the passport. There was no evidence in any of the records examined that checks had been undertaken with the Protection of Vulnerable Adults register, (POVA). Only two of the records provided evidence that checks has been undertaken with the Criminal Records Bureau (CRB). The inspector was informed that the check for the remaining two members of staff had been applied for. It was reported to the inspector that these staff are currently working in the home and are supervised at all times. The lack of CRB and POVA checks were brought to the attention of the deputy manager, in the absence of the registered manager, that these checks must be undertaken before a new member of staff commences work in the home. She agreed to review all the staff files and would ensure that the checks are undertaken. Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 16 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 and 35 The appropriate qualifications of the manager ensure that the home is well managed. The home actively seeks the views of residents and their families and makes decisions on information received. Procedures are in place to ensure that residents’ financial interests are safeguarded. EVIDENCE: The home has a registered manager in post. At the time of the inspection the manager was on annual leave. Regular meetings are held with the residents and their families. Minutes from these meetings show that the meetings are well attended and a variety of subjects are discussed.
Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 17 The inspector saw questionnaires that have been sent out to the families of the residents. The responses were generally very positive. Some concerns were raised, mainly about the menus, variety of food and items of clothing mislaid in the laundry. It was reported to the inspector that these issues have been addressed. The activity co-ordinator for the home updates the programme of events that are planned and this information is displayed on the notice board in the entrance hall to the home. Relatives of the residents are invited to accompany them on outings arranged by the home. The home is looks after the pocket money for sixteen residents. A record of all outgoing and incoming monies is document in individual cashbooks, together with all receipts and the residents’ money. The families of the residents are informed of the balance of remaining money and are given the receipts for all purchases made on behalf of the resident. Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 18 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X Merry Hall Nursing & Residential Care Home DS0000057235.V257877.R01.S.doc Version 5.0 Page 19 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 Sch 2 Reg 7,9,19 Requirement All new staff must only be confirmed in post following a satisfactory police check and the Protection of Vulnerable Adults register. Timescale for action 30/11/05 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.V257877.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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