Inspection on 17/06/08 for Merseybank Nursing Home

This inspection was carried out on 17th June 2008.

CSCI found this care home to be providing an Adequate service.

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 9 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 10/07/07

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 28/09/2008.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Merseybank Nursing Home Carriage Drive Hadfield Glossop Derbyshire SK13 1PJ Lead Inspector Rose Moffatt Unannounced Inspection 17th June 2008 09:30 Merseybank Nursing Home DS0000025442.V366553.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.V366553.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.V366553.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 Ltd 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.V366553.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th July 2007 Brief Description of the Service: Mersey Bank Nursing Home accommodates up to 74 people with nursing and personal care needs, including up to 18 older people 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. Fees at Mersey Bank range from £334.45 to £972.00 per week. The acting manager provided this information on 1st -July 2008. Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of our inspections is on outcomes for people who live in the home, and their views on the service provided. The inspection process looks at the provider’s ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • Surveys returned to us by people using the service and from other people with an interest in the service. • Information we have about how the service has managed any complaints. • What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement. • The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. • Relevant information from other organisations. • What other people have told us about the service. We carried out an unannounced inspection visit that took place over 15 hours on 2 days. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 63 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The acting manager was available and helpful throughout the inspection visit. Some people 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. ‘Case tracking’ was used during the inspection visit to look at the quality of care received by people living in the home. 8 people were selected and the Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 6 quality of the care they received was assessed by speaking to them and /or their relatives, observation, reading their records, and talking to staff. Denise Clark, a CSCI pharmacist inspector, carried out an inspection of medication in the home on the first day of the inspection visit. What the service does well: What has improved since the last inspection? What they could do better: Care plans could have more detail to ensure people’s privacy and dignity are respected and upheld. People (and/or their representatives) could be more involved in planning care to ensure their personal preferences and expectations are met. Meal times could be better organised and more pleasant, particularly for people living in the Wilman unit for older people with dementia. Increased staffing levels, better organisation, and improvements to the dining room would make mealtimes a more enjoyable experience for people. The home could be refurbished and redecorated to ensure a safe and pleasant environment that meets the needs of people living there. People could be better consulted and involved in the plans for refurbishment. Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 7 Improvements to the continuity of staffing and staffing levels would help to ensure that the needs and expectations of people living in the home were met. 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.V366553.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.V366553.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): 2 (Adults 18-65) 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 satisfactory assessment process so that people’s needs were recognized and well documented. However, there were staffing issues that affected the delivery of care so that the needs of people living in the home were not always well met. EVIDENCE: A new Statement of Purpose and Service User Guide were made available to all people living in the home on the second day of this inspection visit. The Statement of Purpose included most of the required information, although it Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 10 did not give details of the range of needs the home intended to meet, and also did not specify that nursing care was provided. The records of 8 people were seen. All had a range of assessment information, including the assessments by social services and hospital staff where applicable. There were 5 surveys received before the inspection from people living in the home. 2 people said they had received enough information about the home, 3 said they had not. 3 people said they always received the care and support they need, 1 person said they usually did, and 1 said they sometimes did. There were mixed comments from people spoken with during the inspection visit. Some people said their needs, or those of their relative, were met at the home. Others felt some needs were not met, for example, that the person should have “more active rehabilitation”, and that staff were competent to meet “basic needs”, but did not always have the confidence or experience to understand people’s mental health needs. There were comments about the lack of staff continuity and consequent problems with communication and continuity of care. (See Staffing section of this report). It was observed during the inspection visit that the needs of some people in the home were not fully met. (See Individual Needs and Choices, Lifestyle, and Staffing sections of this report). The Annual Quality Assurance Assessment (AQAA) received before the inspection visit recognized that there was a need to improve communication within the home and noted plans to address this. Standard 6 (Older People) did not apply as there were no people in this category receiving intermediate care. Merseybank Nursing Home DS0000025442.V366553.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) 7,14 and 33 (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 an improved, more consistent, approach to care planning. However, people (or their representatives) were not sufficiently involved in care planning to ensure their individual preferences were detailed and fully met. EVIDENCE: Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 12 All of the care records seen had care plans produced from the assessment information. New documentation had been introduced since the last inspection so that the care plans were all written using the same format. The format was person centred and ensured a wide range of the persons needs and preferences could be included. The care plans were easy to follow and included relevant risk assessments. Most of the care plans had sufficient information to ensure that staff knew how to meet the person’s needs. Some of the care plans lacked detail of the person’s individual preferences. Some of the care plans were not completed in a person centred way, showing a lack of understanding by staff of a person centred approach to care. Care plans and risk assessments had all been reviewed regularly, most of them monthly. There was very little documented evidence of people, or their representatives, being involved in planning care. Some people spoken with were aware of the care plans and had seen them. There was evidence that people were involved in care reviews. People were encouraged to take part in regular meetings to voice their ideas and opinions. People spoken with said that action had been taken as a result of these meetings, such as a new vehicle provided to take people out. People said that sometimes action was promised but not delivered, and that sometimes improvements were made, but then “things slide back again”. Merseybank Nursing Home DS0000025442.V366553.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.V366553.R01.S.doc Version 5.2 Page 14 12, 13, 15, 16 and 17 (Adults 18-65) 10,12, 13 and 15 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The range of activities offered was not sufficient to meet the social and intellectual needs of all the people living in the home. The food provided and the meal time experience did not meet the needs and expectations of all the people living in the home. EVIDENCE: The care records seen included a life history of the person. Most of these were detailed with useful information about the person’s family, social and work history, plus some details of their personal preferences. There were 2 activities staff employed by the home and a range of activities was offered, including bingo, games, art, music and movement, and gardening. There were also one to one activities, such as manicures, reading and chatting. The home had been without a vehicle for some time and so people had not been able to go out on trips. A new vehicle was delivered on the second day of the inspection visit. The activities coordinator said that local trips out were planned. The acting manager said that she was looking into providing another driver for the vehicle to ensure more people would be able to go out. The activities coordinator said that they were working more hours than the previous activities coordinator, and it was planned to provide some activities in the evenings and at weekends. Activities were observed during the inspection visit. People appeared to enjoy the activities and there were good interactions between people and staff. 3 of the people surveyed said there were always activities they could take part in and 2 said there usually were. One person said, “I like the activities they have on offer. I join in as many as I can”. Another person said, “I enjoy the quizzes and trips out when minibus is available”. One person said they had enjoyed a holiday abroad last year with another person living in the home and 2 members of staff. There were comments that there were not enough activities provided for people living in the Wilman and Kinder units. Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 15 There was a computer available for people to use and support was provided by an external trainer to enable people to use the internet. People commented that, as there was only one computer, it was not always possible to use it when they wanted to. There was a greenhouse in the garden that people were able to use. The activities coordinator said that some people had been involved in growing plants and vegetables. People from a local church visited the home each week, and 2 people from the home regularly went out to church. There was little other evidence of involvement with the local community, although the AQAA said that people were supported to attend social activities in the community. 3 people who completed surveys said they usually liked the meals at the home, 1 said they sometimes did, and 1 said they never did. People spoken with were mostly happy with the meals provided. One person with specific dietary preferences said they did not have enough choice, and sometimes were not properly catered for. Other comments included, “if I don’t like the meal on offer I have to have a sandwich”, “I like carrot cake it was stopped as it is too dear”, “ the meals could be a lot better and more choice of what I would like to eat”, “the food is average”. One person commented that the choices on the menu could be improved as sometimes the only alternative offered to the main hot meal was sandwiches. The dining room in the ground floor younger adults unit was bright and spacious. The lunchtime meal appeared appetising. 2 people had chosen alternatives and several people were served with pureed food to meet their needs. People who needed help with eating were assisted appropriately by staff. People living in the Wilman unit were older people with dementia and many of them needed help with eating and drinking. At lunchtime there were 2 care assistants and a nurse to provide the assistance needed. It was clear from observation that there were not enough staff to meet people’s needs. One person had a meal placed in front of them but did not eat it as there was noone available to prompt and encourage them. It was noted in this person’s care plan that they had a poor appetite. Care assistants helping people to eat had to leave them several times to assist other people. One care assistant was helping to feed two people at the same time. Several people ate meals in other rooms, taking staff away from the dining room to serve their meal and provide any help required. One person had to wait 30 minutes after the meal Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 16 had started before staff were available to help, (their meal was kept in the heated trolley). The nurse in charge was helping people with their meals, but then had to leave to deal with a visit from a district nurse. The dining room on the Wilman unit was in need of redecoration as the paint and plaster on the walls was badly marked and scuffed. There were no dining chairs. People sat in wheelchairs or high back, high seat lounge chairs. The menu displayed was for the week and was not in an appropriate format for people with dementia to understand. Merseybank Nursing Home DS0000025442.V366553.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 are is adequate. This judgement has been made using available evidence including a visit to this service. The care plans were not sufficiently detailed and there was a lack of continuity of staff so that people’s individual needs and preferences were not fully met. Records relating to medicines and the care plans of people chosen for case tracking showed that medicines were well managed in the home. Observations made at the inspection indicated that staff followed the home’s procedures for giving people medicines. EVIDENCE: Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 18 The care plans seen included details of the person’s preferences about how personal care and support was to be carried out. Some of the plans did not have sufficient detail of personal preferences and did not always refer to maintaining privacy and dignity. Mental health needs were included in the care plans seen. As noted at the last inspection, there was little evidence of access to counselling, self-help or support groups, particularly for the younger adults with physical disabilities. Most people spoken with were generally satisfied that they had the care and support they needed. 3 of the people who returned surveys said they always received the care and support they need, 1 person said they usually did, and 1 said they sometimes did. 4 people said they always receive the medical support they need, 1 person said they usually did. Some people said their needs were not fully met at the home. 2 people said that the lack of continuity of staffing in the ground floor younger adults unit affected the care and support provided. One person said, “some staff are better than others”. Some people who could not contribute directly to the inspection process were observed and their needs did not appear to be well met. Examples of this were: lunchtime on the Wilman unit for people with dementia, (see Lifestyle section of this report); one person in the lounge of the Wilman unit was observed to look uncomfortable and became agitated about feeling cold; on the first floor unit for younger adults, the kitchen area was not suitably adapted to encourage people to use it independently, (see Environment section of this report). 3 of the 5 surveys from people living in the home said that staff listened to them and acted on what they said, 1 said staff did not listen, and 1 said, “sometimes they listen but sometimes they don’t”. People said that communication was affected by the lack of continuity of staffing in the ground floor unit for younger adults so that some staff were not aware of people’s personal preferences. People spoken with said that staff were generally “friendly” and “caring”. Staff were observed to have a friendly and respectful approach to people. The care records included the input of other healthcare professionals, such as GP, District Nurse, chiropodist, dentist, and Speech and Language Therapist. It was seen that people were promptly referred for specialist support when needed. For example, one person was referred for a specialist assessment following changes in their behaviour, and another person was referred to the tissue viability nurse for advice about a pressure sore. One person said, “I think the medical support I get is very good”. Another person said “they’ve sorted me out”, explaining that since coming to the home they had been Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 19 treated for an infection and had received physiotherapy and consequently their health had improved. The home had a well written policy and procedures for managing medicines. These procedures were followed by staff giving people their medication during the morning of the inspection. Records of the supply, administration and disposal of medicines were kept accurately. Instructions for giving medicines as directed by the doctor were included in peoples’ care plans. Medicine cupboards were neat and tidy. Medicines stored in refrigerators were not always kept at the right temperature. Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. There were satisfactory systems in place and good staff awareness so that people were protected. However, people were not always confident that their complaints would be taken seriously and appropriate action taken. EVIDENCE: The complaints records included details of the action taken and the outcome of the complaint. Complaints were dealt with in the timescales given in the complaints procedure. 3 of the 5 people who completed surveys said they knew how to make a complaint, 2 said they did not, 4 said they always knew who to speak to if they were unhappy, 1 said they sometimes did. There were regular meetings held for people living in the home and their relatives / representatives to air any ideas, views and concerns. People said Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 21 that sometimes action promised did not happen, and also that when action was taken sometimes “things slide back again”. CSCI received one complaint in March 2008 about shortages of staff and a lack of response from management to address this, the generally poor state of cleanliness and décor of the home, and low staff morale. The provider was asked to investigate and to send a report of their findings to CSCI. The response received answered all the elements of the complaint, although the general issues of shortage of staff and lack of management were not fully addressed. Staff had received training about safeguarding vulnerable adults and were aware of the correct procedures to follow. The acting manager was aware of the requirement to notify CSCI of any incidents of alleged abuse and had sent several notifications, although 2 incidents referred to Social Services as safeguarding issues had not been notified to CSCI. The AQAA said that the home had improved in the last 12 months by “encouraging an open culture of reporting all complaints to the Home Manager”. However, people spoken with said they did not always feel able to go to the acting manager with complaints and concerns. Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 22 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, 27 and 30 (Adults 18-65) 19 and 26 (Older People) Quality in this outcome are is adequate. This judgement has been made using available evidence including a visit to this service. Although some improvements had been made, the home environment did not always meet people’s needs and expectations. EVIDENCE: Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 23 The AQAA said that the providers had earmarked money for “significant refurbishment of all communal areas” in 2008. During the inspection visit, the acting manager confirmed that a schedule of work was being drawn up and that the work should be starting by August 2008. When asked how the home could be improved, most people spoken with commented on the need for refurbishment and redecoration of all parts of the home. Since the last inspection, the entry buzzer at the front door had been moved so that it was accessible to people using wheelchairs. The ramp from the car park to the front door was in need of repair as the concrete surface was crumbled and uneven at one end and there was also a ridge to negotiate. There were two sets of doors to get into the home and it was commented that this was difficult to do when pushing a wheelchair. The acting manager said the problems with the ramp and the doors had been reported to the providers and work was planned as part of the general refurbishment of the home. The main entrance area was bright and clean. There was a display of information about the home and about forthcoming events. The ground floor unit for younger adults remained in need of redecoration of the main corridor, lounge and dining area. People spoken with were disappointed that redecoration had not already taken place as it had been discussed and planned more than a year ago. The first floor unit for younger adults also remained in need of redecoration and also refurbishment of the kitchen / dining area. The kitchen area was not adapted for use by people in wheelchairs and there was no equipment provided that might encourage people to be more independent. The carpet in this area was heavily stained and greasy. As noted at previous inspections, there was no shower provided on this unit. Staff said that some people living in the unit preferred showers to baths and had to go onto other units to use their showers. Staff said that some people had difficulty in using the bath because of physical disabilities and the provision of a shower would make it easier to meet their needs. One person spoken with was pleased with their bedroom. They had recently moved bedrooms at their request as they wanted more space. The bedroom was in need of redecoration. Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 24 There was a smoking room provided for people living on this unit. It was observed that the door was always left open and so smoke drifted out into the main corridor. The lounge in the Wilman unit for older people with dementia remained in need of redecoration. There was a whiteboard on the wall of the lounge for the day and date to be displayed but this had not been filled in on the day of the inspection visit. There was a wall clock, but the design of the face was difficult to read, particularly for people with dementia. The dining room needed redecoration. The chairs provided were high seat, high backed lounge chairs, rather than dining chairs. Since the last inspection, the cracked and missing tiles in the bathroom had been replaced by a metal strip to the bottom of the wall. The bathrooms looked dingy, cluttered and unwelcoming. The lounge and dining room of the Kinder unit for older people remained in need of redecoration. Since the last inspection, a new shower room had been provided. This was bright and clean and staff said it was well used. The cracked and missing tiles in the bathroom had been replaced by a metal strip along the bottom of the wall. One person spoken with liked their bedroom because it was bright and they liked the view. One person had their bedroom door wedged open all the time and their care records noted that the wedge should be removed by staff when the fire alarms sounded. There was a large, accessible garden to the back of the home. Some people spoken with used the garden. It was commented that more shade was needed, such as by using gazebos, so that people could safely sit out in sunny weather. People living on the Wilman unit were said to have little opportunity to use the garden or to go outside because there were not enough staff on duty to facilitate this. Most areas seen during the inspection visit were clean and free from offensive odours. One person said, “I think the home is nice and clean”. Some staff had received training about the control of infection, and some had received training specifically about the care of someone with MRSA. Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 25 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, 33, 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 were not always sufficient to ensure people’s needs were met. EVIDENCE: People said there was often a shortage of staff on the ground floor unit for younger adults. They said there was a lack of continuity of staff because agency staff were often used to cover for sickness of permanent staff, and also because staff were sometimes moved from other units to help out. Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 26 People said that communication was affected because staff on duty were not always fully aware of people’s needs and preferences. People said that action and initiatives started well but often failed because of staff shortages or use of agency staff. One example given of this was an information board showing the day and date not kept up to date. Another example was that the system of allocating staff to work with specific people became completely disrupted when there were staff shortages or agency staff on duty. This caused problems with continuity of care for people living in the home and frustration to staff as workloads were often not fairly distributed. 2 people commented that staff were able to meet the basic needs of people, but not other needs, such as emotional and social needs. The staffing levels on the Wilman unit for older people with dementia were not adequate to ensure the needs of people living there were fully met. The care records showed that some people regularly needed 3 people to assist them because of challenging behaviour. With 3 staff in total on duty this meant that there were times when other people would have to wait for help. Most people needed some assistance with eating and drinking and it was observed at lunchtime that some people did not get the help they required and their needs were not met, (see Lifestyle section of this report). From observation and discussion with staff and visitors, staffing levels on the first floor unit for younger adults and the Kinder unit for older people appeared to be sufficient for the people living there. The AQAA indicated a high turnover of 21 staff leaving the home in the last 12 months. Also, a high use of agency staff. The acting manager said that 6 new care assistants had been recruited in 2008 and a new registered nurse with a mental health qualification had been recruited for the Wilman unit. The home were advertising for a clinical manager to work alongside the acting manager. The records of 2 members of staff were seen. Most of the required information and documents were included, except for proof of identity including a recent photograph. Staff training records showed that most staff were up to date with required training, such as manual handling, fire safety, and safeguarding vulnerable adults. Some staff had received training about dementia and about challenging behaviour. Staff spoken with said the training was good quality and useful. The AQAA said that 17 out of 46 care staff had already achieved Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 27 National Vocational Qualification in Care at Level 2 or above, and another 3 staff were working towards the qualification. Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 28 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.V366553.R01.S.doc Version 5.2 Page 29 37, 39 and 42 (Adults 18-65) 31, 33, 35 and 38 (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 effective organisation of the home, but there were staffing, communication and environmental issues so that people’s needs and expectations were not fully met. EVIDENCE: The acting manager had been in post since April 2007. She was suitably qualified and experienced to manage the home. She had almost completed the registration process with CSCI. She had a good awareness of the problems and issues in the home, particularly around staffing. People spoken with said they did not find the manager easy to approach. Staff were sometimes frustrated that there appeared to be a lack of response from management to concerns raised. The AQAA was returned by the date given. The self-assessment section was brief and did not fully address all the outcome areas. There was some information about how people are consulted about the service. There were areas where more supporting evidence would have been useful to illustrate what the service had done in the last year and how it was planning to improve. The data section of the AQAA was completed, although there were a few inconsistencies. There was a quality assurance system in the home that included internal and external audits, and also surveys sent out to people living in the home and their representatives. The surveys were analysed at the provider’s head office and returned to the home for action to be taken on any issues raised. There was no report produced for people living in the home and their representatives to show the findings of surveys and any action taken as a result of issues raised. People were encouraged to attend regular meetings where they could voice their ideas, opinions and any concerns. People said action promised at the meetings did not always happen, and issues raised were not always fully addressed. Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 30 The fire log book showed that maintenance and servicing of fire equipment and systems was up to date, including fire drill practices. The AQAA said that equipment and systems had been maintained and serviced as required, such as hoists and gas appliances. There was no detail of when the emergency call equipment was last serviced. The AQAA said that some policies / procedures had been reviewed in the last 12 months, but most had not been reviewed for over 2 years. Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 31 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 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 2 40 X 41 X 42 2 43 X 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Merseybank Nursing Home Score 2 2 3 X DS0000025442.V366553.R01.S.doc Version 5.2 Page 32 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 4(1)(c) Requirement The Statement of Purpose must include all the required information. This will help to ensure people using the service have all the information they need to make a decision about living in the home. The ramp leading from the car park to the main entrance must be kept in a good state of repair to ensure the safety of people living in the home. There must be sufficient staff on duty at all times to ensure the needs of people are fully met. Staff records must include all the required documents and information, specifically proof of identity including a recent photograph. This will help to ensure that people are protected by a robust recruitment system. Fire resisting doors must be kept closed, unless held open by a device that shuts the door automatically when the fire alarms sound. This will help to ensure the safety of people living DS0000025442.V366553.R01.S.doc Timescale for action 31/08/08 2 YA24 OP19 23(2)(b) 31/08/08 3 4 YA33 YA34 OP29 18(1)(a) 19(1)(b) 30/09/08 30/09/08 5 YA42 OP38 13(4)(a) (c) 31/07/08 Merseybank Nursing Home Version 5.2 Page 33 in the home. 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 2 3 4 5 6 Refer to Standard YA1 OP1 YA6 OP7 YA6 OP7 YA14 OP12 YA14 OP12 YA14 OP12 7 YA14 OP12 Good Practice Recommendations The Statement of Purpose and Service User Guide should be available in appropriate formats to meet the needs of people in the home, such as large print or easy read. Care should be developed in consultation with people using the service (and/or their representatives) to ensure their personal preferences and expectations are included. Care plans should include more specific details of the action required by staff to ensure people’s privacy and dignity are respected and upheld. The range and choice of activities should be increased to ensure that the needs and preferences of all people living in the home 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 people are able to go out more often. The computer for people to use should be kept in good working order and consideration given to providing another computer so that people are able to access the internet when they want to. The garden, greenhouse and shed should be made fully accessible for people living in the home. This would enable people 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. The menus should be displayed in a suitable format and position for people to see. This will ensure people (and/or their representatives) are able to find out independently about the meals offered. Suitable dining chairs should be provided for people living in the Wilman unit to ensure their comfort at meal times. People should be encouraged and supported to access services such as counselling and support groups. This would help to address people’s mental health needs. DS0000025442.V366553.R01.S.doc Version 5.2 Page 34 8 YA17 OP15 9 10 YA17 OP15 YA18 Merseybank Nursing Home 11 YA20 OP9 12 YA24 OP19 13 14 YA27 YA35 15 YA39 OP33 16 17 YA40 OP37 YA42 OP38 The temperatures of all refrigerators used to store medicines should be monitored with a minimum/maximum thermometer. Prompt action should be taken if readings show that manufacturers’ recommended storage temperatures have not been maintained, to ensure that medicines are safe to use. People living in the home, their representatives, and staff should be consulted about the proposed refurbishment to ensure the home meets their needs, preferences and expectations. A shower should be provided for the people living in the first floor unit for younger adults to meet their needs and preferences. Staff should have training to meet the specific needs of people living in the home, for example those with multiple sclerosis, epilepsy, or diabetes, to ensure that staff are competent to meet people’s needs. There should be a report produced from the quality assurance audits and surveys, made available to people living in the home and their representatives. This would ensure that people know their views, ideas, and concerns are taken seriously and appropriate action taken. The home’s policies and procedures should be reviewed and updated at least annually to ensure they include correct and current information. The acting manager should ensure that the home is compliant with the new legislation about smoking to promote the health and safety of people living in the home, visitors and staff. Merseybank Nursing Home DS0000025442.V366553.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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