CARE HOMES FOR OLDER PEOPLE
Merryfield House Nursing Home 33 New Yatt Road Witney Oxfordshire OX28 1NX Lead Inspector
Jan Walsh Unannounced 9th June 2005 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 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. Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Merryfield House Nursing Home Address 33, New Yatt Road Witney Oxfordshire OX28 1NX 01993 775776 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Kuldip Kasur Dhanani Jill Timms Care Home with Nursing (N) 24 Category(ies) of Old age, not falling within any other category registration, with number (OP) of places Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Condition 1. Admission of one resident only under the age of 65 in the PD category at any one time. Date of last inspection 11th October 2004 Brief Description of the Service: Merryfield house is a care home with nursing, providing care and accommodation for 24 residents. The home is situated in a residential area of Witney, close to amenities, and is surrounded by its own grounds. The building is a converted and extended older property, with a passenger lift to the first floor of the orginal building. The extension is at ground level, and is connected to the main house by a covered corridor which also provides a small seating area. The majority of the rooms are for single accommodation and five rooms can be shared. The home has a laundry and kitchen on the premises. Care is organised by the registered manager and the deputy manager, and the nursing, care and housekeeping staff provide the services. Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector made an unannounced visit to the home lasting 4 hours. During this time a tour of the building was made. The water temperature was taken in one en-suite shower room. Two care staff, one registered nurse, the deputy manager and the manager were spoken to. Four residents and two relatives were also spoken to. Five records of care, and four staff records were looked at in detail. Records of accidents and medication were also checked. What the service does well: What has improved since the last inspection?
Evidence was seen that information kept on staff meets the legal requirements and therefore helps to maintain the safety of the residents. The residents activities are now planned monthly and several residents said they how much they enjoyed them. The manager is planning further activities to be incorporated into the plan. Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 Page 6 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. Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 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 standard(s) 3, 4, and 5 The home makes sure it is a suitable placement for the prospective resident by careful assessment of the residents’ needs and its ability to meet them. The prospective resident and their family are kept informed and encouraged to view the home prior to admission.. EVIDENCE: Evidence of a comprehensive pre admission assessment was found in the five records of care examined. The manager confirmed she went out to the resident’s home or to the hospital to assess the prospective resident. The manager confirmed they do not take emergency admissions and that a fuller assessment is undertaken over the first two weeks of admission and a plan of care is generated. The manager said that the resident is only admitted if the home can meet their needs and that this is explained to the resident and/or their family. Evidence was seen of the involvement of other health professionals in the assessment process. During the inspection the manager spoke to a relative of a new resident to discuss how they were settling. Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 Page 9 The manager confirmed that residents come in for a visit if possible before admission. Family and/or friends are encouraged to come look round before admission to see if the home is suitable for the prospective resident. The manager confirmed she was waiting at the moment for a family to confirm a placement after they had viewed the home. Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 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 standard(s) 7,8 and 9 The residents’ needs are assessed regularly and reviewed. The care is well planned to ensure that the residents’ health care needs are fully met. In one case for a newly admitted resident this was not in written form. The home safely administers medication. EVIDENCE: Records examined contained evidence of professional visits by the GP, community psychiatric nurse, optician and chiropodist. Two residents confirmed they were able to see the GPs when they visited. Four records of care had detailed plans of the care to be given plus evaluation if the care given and monthly reviews. One new resident’s plan had an assessment but no plan of care. Two members of staff confirmed they were given detailed instructions of how to care for this resident at each handover of staff, as different ways of addressing his needs were being tried. One record of care gave detailed instructions for feeding a resident via a gastric tube, the procedure and the care of the tube. Evidence was seen of weight charts and nutritional assessments. Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 Page 11 Risk assessments for pressure sores and action plans, plus ways of recording the details of a pressure sore or leg ulcer were in evidence. Two residents confirmed they could see the doctor when they wanted to. One resident confirmed the visits of the chiropodist. A relative who visits her mother approximately 3 times a week said she was very happy with the care and thought it was the best home around. The manager confirmed no resident is self administering medication. All medicines were seen to be stored safely in the medicine cupboards. Prescribed medication is received in blister packs from the pharmacy and was seen to be stored in a locked cupboard. Controlled drugs were stored in locked cupboard but 2 packets of medication were dated ’03, the manager confirmed the resident still used them occasionally. It is recommended that the manager contacts the pharmacy for advice as to the effectiveness of these tablets and should consider having the medication re-prescribed by the GP if necessary. Medicine administration sheets were seen and were correctly filled in. Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 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 standard(s) 12 and 13 Residents are very pleased with the social activities and the links with the local community. Families and friends are encouraged to keep in contact. EVIDENCE: A monthly newsletter is produced to enable good contacts with families to be maintained. A copy was made available. May 05 contains details of a recent resident relative customer service questionnaire and the actions that would be taken. It also gives details of activities planned for the month plus an invitation for relatives to join the residents for a service on a Sunday. Residents confirmed the activities and how much they enjoyed them. One lady confirmed the service on a Sunday. One resident confirmed that they would be playing bingo later and he always played the piano before hand. He said the other residents enjoyed it and it kept him active. Other residents confirmed the exercise class. One lady said she liked to join in even if her legs did not work to well. One person pointed out the collage on the wall and said several residents had help to complete it. Residents also said that their visitors were made welcome at all times this was also confirmed by two relatives. The manager said that members of the local community took some residents out for tea and that they also took them to local church services.
Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 Page 13 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 standard(s) 17 an 18 The home protects the residents legal rights and the residents from abuse. EVIDENCE: The manager said 6 residents had had a postal vote in the recent general election. One resident had used an advocate to resolve a dispute between themselves and the person acting for them with power of attorney. The matter was now resolved. A copy of the details of the Age Concern Advocacy service was seen pinned to the notice board in the dining room. The manager confirmed said abuse training has been given to all staff. This was confirmed at staff interviews. An independent trainer has given two training sessions at the home on the prevention of abuse. Copies of the certificate of attendance, were seen in the staff files. The home also has a video on abuse to use for in house training. The manager confirmed this is used for new staff induction and for refresher training. Accident records were seen at inspection and are well maintained. Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 Page 14 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 standard(s) 19, 20 and 26 The residents live in a clean, pleasant and well maintained environment. The home does not have a dining room but plans are in progress to rectify this. EVIDENCE: The tour of the building showed that the home was clean and well maintained. It is homely and full of character. One relative said ‘it is homely not clinical’. A cleaner was seen working around the home at the time of inspection. Residents confirmed that the home is kept clean and pleasant. Water temperature in the en-suite facility was 43 C. Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 Residents are cared for by adequate, well-trained and competent staff. EVIDENCE: At the time of inspection there were five carers on duty plus the deputy manager and manager who are RGNs. In the kitchen was a cook and a kitchen assistant. Two cleaners were working one on each side of the building. Two carers, one RGN at the change of shift, the deputy and the manager were interviewed. The staff confirmed regular training and supervision. The two carers have recently completed their NVQ 2. the staff confirmed good handover reports telling them of any changes in the care that was being given. They confirmed they had adequate information to give appropriate care to their new resident. RGNs confirmed regular up dating of their knowledge and evidence was available to support this. The home has been judged as an appropriate centre for foreign nurses completing the Nurses Overseas Programme by an academic centre. Evidence of this was also seen. Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36, 37 and 38 The home is run in the best interests of the residents and the health and safety of the residents and staff are promoted. Staff are appropriately supervised. Some of the residents’ confidential records are not kept secure. EVIDENCE: Risk assessments for residents were seen in their records. Training on prevention of abuse was well documented and confirmed by staff. Good information was available in the records of care to enable staff to give competent and appropriate care. Evidence was also seen to show the involvement of other care professionals including a specialist nurse. The care plans are kept in an unlocked office. Some of the information seen was confidential. It is however recommended that information such as letters from other health professionals are kept secure with a basic plan of care to be made easily accessible to all care staff or that the office is locked when not in use. Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 Page 17 Evidence was seen of regular questionnaires filled in by the resident/ and their family to help achieve a cycle of planning and improvement to the home with input by the residents. The staff files, showed staff have regular and appropriate supervision and this was confirmed by staff on duty. One member of staff who works extra hours confirmed it is her choice and that she has signed a paper to confirm this. Records show staff receive induction training and regular updates in safe work practices. Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 2 x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 3 x x 3 x x 3 2 3 Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 Page 19 No Are there any outstanding requirements from the last inspection? 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 Regulation Requirement Timescale for action 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 7.2 Good Practice Recommendations It is recommended that a basic plan of care is written from the initial assessment of new residents on the day of admission, to be built on as the resident continues to be assessed. It is recommended that all sensitive information regarding residents is kept secure as required by the Data Protection Act 1998. It is recommended that the manager seeks advice from the pharmacist in regard to Temazepam stored since 2003 and the need for this medication is reviewed with the residents GP. The residents need to have an area where they can dine at a table and socialise with other residents. The home is planning to have a new room built for this purpose and is waiting for planning consent. 2. 3. 37.3 9.9 4. 20 Merryfield House Nursing Home HO57-H08 S27164 Merryfield V231848 090605 Stage4.doc Version 1.30 Page 20 Commission for Social Care Inspection Burgner House 4630 Kingsgate Oxford Business Park (South) Cowley, Oxford, Ox4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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