Inspection on 10/07/07 for Merseybank Nursing Home

This inspection was carried out on 10th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Merseybank Nursing Home 02/06/09

Merseybank Nursing Home 17/06/08

Merseybank Nursing Home 07/06/06

Merseybank Nursing Home 01/09/05

Merseybank Nursing Home 25/05/05

Merseybank Nursing Home 16/03/05

Merseybank Nursing Home 14/07/04

Merseybank Nursing Home 17/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Merseybank Nursing Home Carriage Drive Hadfield Glossop Derbyshire SK13 1PJ Lead Inspector Rose Veale Key Unannounced Inspection 10:00 10 and 11th July 2007 th Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 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 Merseybank Nursing Home DS0000025442.V340253.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 and Care Homes for Adults 18 – 65*. 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. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merseybank Nursing Home Address Carriage Drive Hadfield Glossop Derbyshire SK13 1PJ 01457 855175 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) merseybank@craegmoor.co.uk www.craegmoor.co.uk Parkcare Homes Limited Vacant Care Home 74 Category(ies) of Dementia (18), Old age, not falling within any registration, with number other category (18), Physical disability (38) of places Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 2006 Brief Description of the Service: Mersey Bank Nursing Home is registered for the care of 74 residents with nursing and personal care needs, including up to 18 residents with dementia and up to 38 younger adults with physical disability. The home is situated in Hadfield, near to the town of Glossop. The home is divided into four separate units on 3 floors. The units are staffed separately. There are large, accessible gardens, including a patio area. Information about the home, including CSCI inspection reports, is available in the home or from the acting manager. Fees at Mersey Bank range from £409.40 to £934.20 per week. This information was provided by the acting manager on 24th July 2007. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and took place over 2 days, (14 hours in total). The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 64 residents accommodated in the home on the day of the inspection, 35 people with physical disabilities and 29 older people. 10 residents, 2 visitors and 9 staff were spoken with during the visit. The acting manager and area manager were available and helpful during the inspection visit. The responsible individual for the organisation was visiting the home on the second day of the inspection and had a short discussion with the inspector. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. The inspector was accompanied by an ‘expert by experience’, Teresa Waldron, for part of the second day of the inspection visit. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert by experience spoke to 5 residents from the part of the home for people with physical disabilities about the lifestyle in the home and their views of the service. Information from the findings of the expert by experience has been included in the body of this report. Records were examined, including care records, staff records, maintenance, and health and safety records. Most communal areas of the home were seen and some of the bedrooms. The home had completed and returned the Annual Quality Assurance Assessment, (AQAA), prior to the inspection visit and information from this has been included in the body of this report. There was a random unannounced inspection in September 2006 to look at the areas of staffing, management arrangements, and the environment of the home. There was a random unannounced inspection by a pharmacist inspector in April 2007 as concerns had been raised about poor medication management at the home. Information from the findings of both random inspections has been included in the body of this report. The previous acting manager had left towards the end of April 2007 and a new acting manager had been in post since the end of April 2007. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Some care plans lacked detail of residents’ personal preferences about how they wanted their care and support to be provided. Residents/their representatives could be encouraged to be more actively involved in care planning and review. The needs of some residents were not fully met because of a lack of staff training and awareness, particularly residents with dementia and mental health needs. The range and choice of activities did not provide for the needs and preferences of all the residents. Although the home had its own vehicle, use of this was restricted so that residents were unable to go out as often as they would have liked to. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 7 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. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 (Adults 18 – 65), 1, 3 and 6 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a good assessment process, but a lack of information available to residents and some gaps in staff training so that residents’ needs were not fully met. EVIDENCE: The acting manager said that the Statement of Purpose and Service User Guide were being reviewed and updated and so were not available for inspection. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 10 The care records of 8 residents were examined, 2 from each unit. All the records seen had a range of assessment information obtained before and after the resident was admitted to the home. Residents and/or their representatives had been involved in gathering assessment information. Assessments had been regularly reviewed and updated. Each resident had a care plan produced from the assessment information. Residents spoken with said their basic needs were met at the home. There was evidence that the mental health needs of some residents were not fully met. (See Individual Needs and Choices section of this report). It was commented that a wider range of activities was needed to meet the needs of all residents at the home. (See Lifestyle section of this report). The staff training programme included some training specific to residents’ individual needs, such as how to manage challenging behaviour. Staff working with people with dementia had not received appropriate training. (See Staffing section of this report). Standard 6 (Older People) did not apply to this service. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 (Adults 18 – 65) 7 and 14 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a range of information in care plans and risk assessments to ensure that staff knew how residents’ needs should be met. However, residents/their representatives were not actively encouraged to be involved in care planning so residents personal preferences were not well detailed or met. EVIDENCE: Each of the care records seen included care plans and risk assessments. The acting manager said that new care plan documentation had recently been Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 12 introduced so that some records were in the new format and some in the previous style. The new format was based on person centred planning principles. All of the care plans seen included information about all of the assessed needs of the residents. All the plans had been reviewed regularly, most of them monthly. Some of the care plans referred to ensuring privacy and dignity, and to encouraging and respecting choices. Some care plans lacked detail of the resident’s personal preferences about how personal care and support was provided and about their preferred daily routines. There was no evidence of the involvement of the resident and/or their representative in the care plans seen. Most of the residents interviewed by the expert by experience said they had not seen their care plans. There were regularly reviewed risk assessments in place. Some risk assessments had been discussed and agreed with residents and/or their representatives. The expert by experience observed that the services provided by the care home were based on a medical model of disability. The expert by experience commented that training for staff and residents on the Social Model of Disability would “encourage them to stop looking at their disability as being the problem. This should encourage them to take a more active part within and outside the Home and therefore will promote healthier lifestyles for the residents themselves.” There was some evidence that residents were encouraged and supported to make choices about their daily lives. For example, it was observed residents were encouraged and assisted with personal grooming, and residents living on the ground floor were involved in choosing the décor for the entrance area and main corridor. Notes were seen of recent residents meetings where items discussed included meals, activities and the décor of the home. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 14 12, 13, 15, 16 and 17 (Adults 18 – 65) 10, 12, 13 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There was limited choice and availability of activities within the home and little encouragement for residents to access local community resources so that their social, cultural and intellectual needs were not well met. EVIDENCE: The home employed 2 full time activities staff and 1 part time driver for the home’s minibus. The activities staff were experienced and enthusiastic. There was a range of activities offered, including trips out, bingo, games, a weekly art class, and music and movement. There were also one to one activities, such as manicures, and reading the newspaper to a resident with limited sight. The care records included a plan for each resident of their preferred social activities and records of activities they had taken part in. As at previous inspections, it was commented that there were not enough activities hours provided to ensure all residents had access to a range of appropriate activities in and out of the home. Residents and staff reported that there had been problems with the availability and maintenance of the minibus. As the driver only worked on Monday and Tuesday each week, trips out were limited. The expert by experience found that this had a knock on effect on residents’ morale as they were not able to go out as often as they would like. Some residents said they had been told that they would have to wait a while before being able to go out on the minibus again. One resident said they were told they would have to wait for 7 weeks. Another residents said that 8 visits had been cancelled in the last month due to the tail lift not working. Another resident said the last time they went out was 3 months ago. Residents commented that they felt ‘imprisoned’ in the home with such limited access to the minibus. The expert by experience found that residents’ intellectual needs were wide ranging and the in-house activities were not suitable for all. The expert by experience commented that “those with high intellectual abilities will need to be given opportunities to access activities such as Open University courses, book reading club, photography, computer courses - ECDL, etc. The residents had vast resources that were not being utilised by the Home. Using residents’ skills and expertise could boost their self esteem, confidence and morale including staff’s.” Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 15 Residents said they enjoyed the activities provided and said they were regularly consulted about activities at the monthly ‘Your Voice’ meetings. The expert by experience commented that these meetings were chaired by staff when they could be chaired and the minutes taken by some of the residents on a rota basis. The expert by experience commented that the home’s tuck shop could also be run by some of the residents. The expert by experience found that some residents expressed an interest in gardening, but the greenhouse and garden shed were not accessible for residents to use independently. Residents said that the home’s computer was not working well and kept ‘crashing’. This was making it difficult for residents to access the internet and write letters. The expert by experience commented that residents were not encouraged and supported to make and utilise community links. For example, one resident had a vast knowledge and expertise of a medical condition that could be shared amongst others who had the same condition within the community. Residents and staff spoken with said that meals at the home had generally improved since the last inspection. The menus seen were varied and offered choices. The care records included assessments and care plans to cover the nutritional needs of residents. The expert by experience fund that most residents were pleased with the meals. Residents felt able to raise grievances about meals. They said they were consulted by the chefs at the monthly residents’ meetings. Some residents felt that their preferences were being ignored. The Wilman unit at the home provided care for older people with dementia. It was observed that meals were served to Wilman residents on plastic plates and they were given plastic cutlery to use. Other residents at the home were provided with ordinary crockery and cutlery. This was discussed with the acting manager who said that the plastic plates had been used as a temporary measure whilst the lift was out of action recently so that staff were not carrying heavy crockery up and down stairs. The use of plastic plates should have stopped when the lift was back in working order. There appeared to be no choice of drinks for Wilman residents at lunchtime as all were offered tea after their lunch. The Kinder unit at the home provided care for older people. It was observed at lunchtime in the Kinder unit that most residents were encouraged to use the dining room. There were several residents who needed help to eat and it was observed that staff gave assistance in a sensitive and unhurried way. There was a pleasant atmosphere with residents chatting to each other and to staff. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 16 The menus in each unit were pinned up on the wall higher than the height of a wheelchair user. This meant that people in wheelchairs were unaware of the menus, or were dependent on care staff to ask them to read out what was on the menu. The menus were in small print. On the Wilman and Kinder units there were menus displayed for 3 weeks with no indication of which menu applied that day. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 (Adults 18-65) 8, 9 and 10 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents (and/or their representatives) were not sufficiently involved and consulted about personal care and support so that their needs and preferences were not fully met. EVIDENCE: Some of the care plans seen included the residents’ preferences about how their personal care and support was to be carried out. Some care plans did not have sufficient detail about residents’ personal preferences. Although mental health needs were included in the care plans, the emotional and psychological Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 18 needs of some residents were not fully met. There was little evidence of access to counselling, self-help or support groups, particularly for the residents with physical disabilities. The expert by experience commented that “there are little or no opportunities for the residents to undergo bereavement counselling. People generally underestimate the trauma that one goes through when suddenly acquiring a long term health condition or a disability. Residents who have experienced this will be grieving for their loss of a previous life.” There was a lack of training for staff working with people with dementia so that staff were not fully aware of residents’ psychological needs and how to provide effective support. The care records seen included reference to maintaining residents’ privacy and dignity. Staff spoken with were clear on how to ensure privacy and dignity for residents. The care records seen included details of the input of other healthcare professionals, such as GP, chiropodist, optician, physiotherapist. There was evidence that residents were referred promptly for specialist advice and support, such as Speech and Language therapist, tissue viability nurse, and community diabetic nurse. Residents appeared to be referred promptly for medical advice and treatment. For example, one resident reported to have a chesty cough was seen by the GP and antibiotic medication started on the same day. There was little evidence that the residents with physical disabilities were encouraged and supported to be independent and pro-active in accessing healthcare services. There was an unannounced random inspection by a pharmacist inspector in April 2007 because of concerns raised about poor management of medication. It was found that medication was managed well on the Kinder and Wilman units, but there was poor management of medication on the 2 units for people with physical disabilities. 2 immediate requirements were made, plus 3 other requirements. Following the inspection, information was received from the providers detailing the measures that had been put in place to address the urgent issues in the immediate requirements and also the other concerns raised during the inspection. At this key inspection, the requirements made by the pharmacist inspector were followed up. From checking medication records and storage and speaking to staff it was clear that action had been taken to address the requirements. One requirement about the storage of medication has been carried forward in this report, as there were no records available of the temperature of the medication storage room on the ground floor unit. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 (Adults 18-65) 16, 18 and 35 (Older People) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were systems in place to ensure residents were protected from abuse and their complaints listened to and acted upon. EVIDENCE: Records of complaints were seen. The records were well kept with details of the action taken and the outcome of the complaint. Complaints were responded to within the timescales given in the complaints procedure. Residents with physical disabilities felt able to raise their concerns at the ‘Your Voice’ meetings, or directly to staff. Residents’ relatives/representatives were encouraged to attend the meetings. The expert by experience commented “It is good to see that the residents feel safe to state their opinions to the inspectors. This reflects that good, positive relationships are being fostered between staff and residents.” Some residents were frustrated that some issues raised at the meetings had not been acted on, such as asking for a Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 20 shower to be installed for the first floor unit for people with physical disabilities. Staff spoken with had received training about safeguarding adults issues and knew the correct procedures to follow. Records were kept of residents’ personal money held by the home. The responsible individual for the providers said that there was a system in place to ensure any interest accrued was added to residents’ personal money. It was discussed that there should be a clear explanation in the service user guide for residents about the systems in place regarding personal money. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 (Adults 18-65) 19 and 26 (Older People) Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although some improvements had been made, the home remained in need of general redecoration and refurbishing to provide a pleasant, well maintained environment for residents. EVIDENCE: Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 22 There was a random, unannounced inspection in September 2006 when the requirements made about the environment of the home at the last key inspection were followed up. Some progress had been made since the last inspection to improve the environment of the home. The expert by experience commented that the buzzers to enter and leave the building by the front door were placed higher than wheelchair height. This meant that people in wheelchairs would have to wait for care staff to press the buzzer or wait for someone to catch their eye to be let in. The ground floor unit for people with physical disabilities Work had been carried out to improve the smoking room, sluice room and a toilet. The main corridor remained in need with residents who were involved in been obtained for the work needed. area of the home would be included of redecoration. This was being planned choosing colour schemes. Quotations had It was planned that the main entrance in the redecoration. Carpets in the corridors were stained and worn in places. The first floor unit for people with physical disabilities The unit remained in need of general redecoration, particularly in the main corridor and the large lounge/dining room. The carpet to the kitchen area of the lounge/dining room was heavily stained in places. Staff said that the carpet could not be easily cleaned when food or drink was spilled. No progress had been made with providing a shower on this unit to give residents a choice of facilities. Wilman The lounge appeared in need of redecoration. The wallpaper border had peeled off in places. There were some missing and cracked tiles in the bathroom. The floor covering in the corridor outside the bedrooms at one end of the unit was cracked and in need of repair or replacement. There was a bolt fitted to the outside of a resident’s bedroom door. When discussed with the nurse in charge, it was said that this had been fitted so that the room could be secured against other residents walking in when the resident was not in. Locks had since been fitted to all bedroom doors and so the bolt was unnecessary and should have been removed. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 23 Kinder Since the last inspection in June 2006 no progress had been made with refurbishing the shower so that residents could have a choice of facilities. In the bathroom there were cracked tiles along the bottom edge of the wall. In one bedroom there was damage to a wall that needed repair and redecoration. Most areas of the home were clean and free from offensive odours. There was a smell of urine in most parts of the Wilman unit. One resident commented that there were strong, unpleasant smells from a sluice room near to their bedroom. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 (Adults 18-65) 27, 28, 29 and 30 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and staff training were sufficient to meet residents’ basic needs, but not enough to ensure a holistic, person centred approach to residents’ care and support. EVIDENCE: Staffing levels were checked at the random unannounced inspection in September 2006. It was found that staffing levels on the ground floor unit for people with physical disabilities had improved. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 25 At this key inspection it was found that the improved staffing levels had been maintained. The planned staffing level was 2 qualified nurses plus 6 care assistants on the morning and afternoon shifts, with 1 qualified nurse plus 2 care assistants for the night shift. Staffing levels on the Kinder unit were said to be adequate to meet the needs of the residents. There were comments that the staffing levels on the Wilman unit for people with dementia were not always sufficient to meet residents’ needs. Comments were received that there were problems with covering shifts on all the units when staff were off sick. It was commented that staff were sometimes sent from the ground floor unit to other units to cover for staff sickness, leaving the ground floor unit short staffed. There were comments that staff were asked to come in to work on their days off to cover for staff sickness and that they felt pressured if they refused. Comments were made that there was low staff morale in the home. The acting manager and area manager were aware of this and said it was being addressed through staff meetings, staff training, and changes in staff roles and responsibilities. The expert by experience commented that “Most of the residents praised the staff for being friendly, helpful and cheerful. They recognise how hard they work despite being short staffed for years. It seems that the residents have given up on expecting more staff in place.” The AQAA stated that 16 out of 45 care staff had already achieved NVQ Level 2 or above, and that 4 staff were working towards NVQ. Staff training records showed that most staff were up to date with the required training, such as manual handling and fire safety. Some staff had received training in areas specific to the needs of residents, such as training about challenging behaviour. Staff had not received training about other specific needs, such as people with epilepsy, diabetes, and multiple sclerosis. The staff working with residents with dementia on the Wilman unit had not had training about dementia. It was clear from observation and from talking to staff that there was a lack of awareness of the needs of people with dementia. Staff records seen generally included most of the required information, such as a Criminal Records Bureau (CRB) disclosure and 2 written references. 2 records seen did not have a full explanation of gaps in employment histories. None of the records seen included a photograph of the member of staff as required. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 27 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was effective management of the home and an awareness of the areas where improvement was needed to ensure the service was run in the best interests of residents. EVIDENCE: The acting manager was new in post since April 2007. She had experience of managing a care home within the same organisation and had achieved the Registered Manager’s Award. She had not applied for registration with CSCI, but started this process during the inspection visit. She was supported by an experienced area manager. The acting manager was clearly aware of areas of concern within the home and was working with the area manager and staff to resolve issues. Staff spoken with were generally positive about the acting manager. There were some comments that management directives and changes in policy were not always well communicated and this had caused confusion, frustration and resentment amongst staff. There was a quality assurance system in place that included regular residents meetings, monthly reports by the area manager, and surveys sent out to residents/their representatives to assess their satisfaction with the service. The surveys were returned to the organisation’s head office to be analysed and a report compiled detailing the findings and the action to be taken in response. The acting manager said that because of the recent change in management, the surveys had not been sent out and so there was no report available. It was planned that surveys would be sent out as soon as possible. The fire log book was fully up to date except for records of fire drills. Staff spoken with were not all clear on the fire procedure to follow and were not all sure that they had taken part in fire drills. Other maintenance records sampled were well kept and up to date. It was not clear that the home was compliant with the recently introduced legislation about smoking in public places. There were designated smoking rooms in the two units for people with physical disabilities. The door to the ground floor smoking room was open, allowing smoke to drift out into the main corridor. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 YA/OP1 1 YA2/OP 3 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No YA6/OP7 YA7/OP14 8 YA9/OP7 10 Score CONCERNS AND COMPLAINTS Standard No Score YA22/OP16 3 YA23/OP18 3 ENVIRONMENT Standard No Score YA24/OP19 2 25 X 26 X 27 X 28 X 29 X YA30/OP30 2 STAFFING Standard No Score 31 X YA32/OP28 2 33 X YA34/OP29 2 YA35/OP30 2 36 X CONDUCT AND MANAGEMENT Standard No Score YA37/OP31 3 38 X YA39/OP33 3 40 X 41 X YA42/OP38 2 43 X 2 2 X 2 X LIFESTYLES Standard No Score 11 X YA12/OP12 2 YA13/OP13 2 14 X YA15/OP13 2 YA16/OP10 2 YA17/OP15 2 PERSONAL AND HEALTHCARE SUPPORT Standard No YA18OP10 YA19/OP8 YA20/OP9 21 Merseybank Nursing Home Score 2 2 2 X DS0000025442.V340253.R01.S.doc Version 5.2 Page 29 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 YA1 OP1 Regulation 5(1)(2) Requirement There must be a Service User’s Guide available to all residents that includes all the required information. This will ensure that residents have the information they need to make choices about living in the home. Original timescale 30/11/06 Residents/their representatives must be involved in devising and reviewing care plans. This will ensure that residents’ personal preferences are recorded and met. Original timescale 31/10/05 Medication must be stored within the temperature range recommended by the manufacturer to ensure that it has not lost its potency or is at risk of contamination. Original timescale 07/06/07 The entry buzzer at the main entrance must be accessible to all residents so they can gain entry to the home independently. The cracked and missing tiles in DS0000025442.V340253.R01.S.doc Timescale for action 31/08/07 2. YA6 OP7 15(1)(2) 30/09/07 3. YA20 OP9 13(2) 30/09/07 4. YA24 OP19 23(2)(a) 30/09/07 5 YA24 23(2)(b) 30/09/07 Page 30 Merseybank Nursing Home Version 5.2 OP19 6. YA30 OP26 13(3) 7. YA34 OP29 19(1)(b) 8. YA35 OP30 18(1)(c) 9. YA42 OP38 23(4)(e) the identified bathrooms must be repaired and/or replaced to reduce the risk of injury to residents and to ensure the home is kept in a good state of repair. The home must be free from offensive odours to ensure a clean and pleasant environment for residents. Staff records must include all the required documents and information to ensure that residents are protected by a robust recruitment system. Staff who are supporting people with dementia must have appropriate training to ensure that residents’ needs are recognised and met. Fire drills and practices must be held at regular intervals, and records kept, to ensure that staff are aware of the correct procedures to follow in the event of fire. This will ensure the safety of residents and staff. 31/08/07 30/09/07 30/11/07 30/09/07 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 YA1 OP1 Good Practice Recommendations The Service User Guide should include information about how residents can access local advocacy services and also details of how the home manages residents’ personal money. This will ensure that residents have clear information about their rights and the choices available to them. Residents should be given the opportunity to chair the ‘Your Voice’ meetings and to run the home’s ‘tuck shop’. This would help to boost residents’ self-esteem, confidence DS0000025442.V340253.R01.S.doc Version 5.2 Page 31 2. YA8 Merseybank Nursing Home 3. 4. 5. YA14 OP12 YA14 OP12 YA14 OP12 6. YA14 OP12 7. 8. 9. 10. YA17 OP15 YA17 OP15 YA18 OP8 YA35 OP30 11. YA42 OP38 and morale. The range and choice of activities should be increased to ensure that the needs and preferences of all residents are met. There should be a more flexible and imaginative approach to the use of the home’s vehicle, taxis and community transport so that residents are able to go out more often. The computer for residents to use should be kept in good working order and consideration given to providing another computer so that residents are able to access the internet when they want to. The garden, greenhouse and shed should be made fully accessible for residents. This would enable residents to be independently involved in gardening, if they wished, and would encourage them to be more involved in the home, for example, by growing vegetables for use in the home. Residents should be offered a choice of drinks at mealtimes to ensure their preferences are met. The menus should be displayed in a suitable format and position for residents to see. This will ensure residents are able to find out independently about the meals offered. Residents should be encouraged and supported to access services such as counselling and support groups. This would help to address residents’ mental health needs. Staff should have training to meet the specific needs of residents, for example those with multiple sclerosis, epilepsy, or diabetes, to ensure that staff are competent to meet residents needs. The acting manager should ensure that the home is compliant with the new legislation about smoking to promote the health and safety of residents and staff. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. Merseybank Nursing Home DS0000025442.V340253.R01.S.doc Version 5.2 Page 33 - 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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