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Inspection on 02/06/09 for Merseybank Nursing Home

Also see our care home review for Merseybank Nursing Home for more information

This inspection was carried out on 2nd June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

People told us their needs were met at the home. They said, "I feel I am well looked after, very happy here". Relatives told us, "I can go on holiday and not have to worry about him, I know he`s well cared for", and, "Mum is happy, clean and well looked after". People told us they liked the staff at the home. They said "the staff are all very good", "friendly", "patient", "they listen to me", and "they treat us well". Most people said staff were competent and able to meet their needs, (or the needs of their relative).

What has improved since the last inspection?

The care plans were better organised and more detailed than at the previous inspection. Most of the care plans covered all the assessed needs of the person and had good details of the action required by staff to meet those needs. Mealtimes on the Wilman unit had been improved by having more staff available, by providing dining chairs, and by making the dining room look more attractive with table cloths and flowers on the tables. The ground floor had been refurbished and redecorated to create a bright, pleasant environment. People told us they were pleased with the improvements made. People told us the continuity of staffing had improved as more staff had been recruited and there was far less reliance on using agency staff. This meant that care was usually provided by staff who knew their needs. Two clinical managers had been appointed. From talking to people in the home, visitors and staff, observation, and looking at records, we saw that the clinical managers had helped to improve care planning and standards of care.

What the care home could do better:

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 oftenAll staff at the home should have training about the Mental Capacity Act 2005 to ensure people in the home are protected and their rights are upheld. The planned refurbishment of the home should be completed as soon as possible and should take into account the views of people living in the home and/or their representatives. This will ensure the environment meets the needs and preferences of people in the home. A suitably qualified and experienced permanent manager should be appointed as soon as possible to ensure strong, pro-active management of the home.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Merseybank Nursing Home Carriage Drive Hadfield Glossop Derbyshire SK13 1PJ Lead Inspector Rose Moffatt Unannounced Inspection 2nd June 2009 09:50 Merseybank Nursing Home DS0000025442.V375696.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.V375696.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.V375696.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.V375696.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 18 elderly mentally ill; Aged 55 years and over; 1 first level registered nurse throughout 24 hours. 18 elderly physically infirm; Aged 55 years and over; 1 first level registered nurse throughout 24 hours. The Home Manger shall be supernumerary to the stated staffing levels for 37.5 hours per week. 38 young disabled aged between 18 - 55 years; 1 first level plus 1 first/second level registered nurse over 24 hours. The Home Manager to be supernumerary for 37.5 hours per week Date of last inspection 17th June 2008 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 start from £439.42 per week. Weekly fees for younger adults with physical disabilities are individually assessed depending on their needs. The acting area manager provided this information on 3rd June 2009. Merseybank Nursing Home DS0000025442.V375696.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 the service experience adequate quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. The last key inspection of this home was on 17th June 2008. We looked at all the information 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 has 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 - these are called notifications and are a legal requirement • the previous key inspection and the results of any other visits we have made to the service in the last 12 months • relevant information from other organisations; and what other people have told us about the service. We carried out an unannounced inspection visit that took place on 2nd and 3rd June 2009, 14 hours in total. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out 10 surveys to people living in the home and received 1 completed response. We sent out 10 surveys to the relatives or representatives of people living in the home and received 2 completed responses. We sent out 10 surveys to staff employed at the home and received 3 completed responses. There were 56 people accommodated in the home on the day of the inspection visit. 6 people who live in the home, 5 visitors and 10 staff were spoken with during the 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. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 6 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 quality of the care they received was assessed by speaking to them and / or their relatives, observation, reading their records, and talking to staff. What the service does well: What has improved since the last inspection? What they could do better: 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. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 7 All staff at the home should have training about the Mental Capacity Act 2005 to ensure people in the home are protected and their rights are upheld. The planned refurbishment of the home should be completed as soon as possible and should take into account the views of people living in the home and/or their representatives. This will ensure the environment meets the needs and preferences of people in the home. A suitably qualified and experienced permanent manager should be appointed as soon as possible to ensure strong, pro-active management of the home. 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.V375696.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.V375696.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 good. This judgement has been made using available evidence including a visit to this service. People were properly assessed before admission to ensure the home was able their needs. EVIDENCE: The Statement of Purpose had been updated since the last inspection and included nearly all of the required information. People in the home and visitors spoken with were not aware of the Service User Guide. The acting area manager said a copy of the Service User Guide and Statement of Purpose would be provided to each person in the home. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 10 We looked at the records of 8 people living in the home. All except one had an assessment carried out prior to their admission by staff at the home, plus assessment information from social services and / or hospital staff. One person had come to the home as an emergency and so there was no opportunity for staff to assess the person prior to admission. People told us their needs were met at the home. They said, “I feel I am well looked after, very happy here”. Relatives told us, “I can go on holiday and not have to worry about him, I know he’s well cared for”, and, “Mum is happy, clean and well looked after”. A relative said the person in the home had not received specific rehabilitation to meet their needs. Generally, people had suitable equipment to ensure their needs were met, such as specialist beds and mattresses, manual handling aids, and wheelchairs. We found that one person had not been appropriately referred for assessment for a suitable wheelchair and was using a wheelchair that had not been designed to meet their needs. The AQAA said that people were invited to visit the home before admission with their families if they wished. The AQAA said the home planned to improve by having open days to show local people and others the opportunity to view the home and make them aware of the service available. Standard 6 (Older People) did not apply as there were no people receiving intermediate care in the home. Merseybank Nursing Home DS0000025442.V375696.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 good. This judgement has been made using available evidence including a visit to this service. There was an improved, more consistent and more person centred approach to care planning so that people received care and support to meet their needs and preferences. EVIDENCE: People and their representatives said they were aware of the care plan and were involved in care planning and reviews. They said they usually received the care and support as expected and agreed. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 12 Each of the 8 care records we saw had an individual care plan. The care plans were better organised and more detailed than at the previous inspection. Most of the care plans covered all the assessed needs of the person and had good details of the action required by staff to meet those needs. The care plans had all been regularly reviewed. There was some evidence of the involvement of the person and / or their representatives in care planning, though no formal agreement of the care plan. There were appropriate risk assessments in place in each of the care records seen. The risk assessments had been reviewed and updated regularly. Personal choices were recorded in the care plans and staff were reminded to ensure personal choices were respected. People in the home were encouraged to attend the regular ‘Your Voice’ meetings. The Statement of Purpose said there were regular meetings for relatives of people in the home. There was no involvement of local advocacy services in the home. The AQAA said the home had improved in the last 12 months by implementing a person centred approach to care. The AQAA said the home planned to improve by developing a dementia care strategy to ensure people in the home with dementia receive “optimum care within a dementia friendly environment”. Merseybank Nursing Home DS0000025442.V375696.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.V375696.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 are is adequate. This judgement has been made using available evidence including a visit to this service. Improvements had been made to ensure mealtimes were a more pleasant experience for people in the home. There was a reasonable range of suitable activities provided. However, due to the size of the home and the diverse needs of people living there, this was not sufficient to ensure everyone had the opportunity to be involved in meaningful activities according to their needs, interests and capabilities. EVIDENCE: People living in the Rosewood and Bankswood units told us there were usually activities provided they could take part in. They said there were trips out, games, arts and crafts, and musical entertainment. People said they would like more opportunities for trips out and we saw that this had been brought up at the ‘Your Voice’ meetings. Trips out were limited because there was only one driver for the home’s vehicle who only worked on 2 days per week. This was also an issue raised at the previous inspection in June 2008. There appeared to be a more limited range of activities provided for people living in the Wilman and Kinder units. Some people joined the trips out and joined in with other activities taking place on the Rosewood and Bankswood units. There were few specific activities for people with dementia. The care records we looked at included details of the person’s life history, their family and other people important to them, and any hobbies / interests / ideas for activities they would like. There were also details of any spiritual needs. Some people in the home attended a local church. A youth group from the church visited the home every week to provide a social activity, such as a quiz or a game. The garden was easily accessible to people living on the ground floor and we observed people using the garden, enjoying sitting out in the fine weather.. People on other floors used the lift to the ground floor to get out into the garden. One person had recently started growing tomato plants in the greenhouse with the help of staff. People in the Wilman and Kinder units could only use the garden when staff were available to take them and staff said this was not possible every day. Details of the person’s preferred daily routines were in the care records. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 15 People told us they could usually do what they wanted to during the day. We observed people moving freely around the home and garden. We observed that people on the Kinder unit were just starting breakfast at 10.15am on the first day of the inspection visit. Staff told us breakfast was often late because of the time it took to help people to get up and ready for the day. There were kitchen areas on each of the unit so that visitors and some people living in the home could make drinks. Visitors told us they could visit at any reasonable time and were always made welcome. The menu for the week was displayed on the notice board in the main entrance and was available in the kitchen area of each unit. The menus appeared varied with choices available for each meal. People told us they usually liked the meals provided, though they said that sometimes choices offered on the menu were not available. Since the last inspection mealtimes on the Wilman unit had been improved by having more staff available, by providing dining chairs, and by making the dining room look more attractive with table cloths and flowers on the tables. We observed that the arrangement of the tables in the dining room was not well organised as staff could not easily move around and there was limited space for staff to sit with people to help them. The fridges in the kitchen areas in the Bankswood and Rosewood units had food belonging to people in the home. For some opened food, there was no date to indicate when it had been started on. There was no system in place to ensure the fridges were regularly checked for out of date food. The AQAA said that the home had improved documentation in relation to social activities and that they planned to recruit an additional driver for the home’s vehicle. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 16 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. Improvements in care planning and better continuity of staff ensured that peoples personal care and healthcare needs were usually met. EVIDENCE: People told us they usually had the personal support and nursing care they needed. They said the staff “treat us well”, and “they listen to me”. Some people told us the continuity of staffing had improved since the last inspection so that care was usually provided by staff who knew their needs and Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 17 preferences. However, some people said staff were often moved around to cover for sickness etc and this was frustrating for them and for the staff. One relative said the person’s needs were not fully met at the home, although they said they were satisfied with the basic personal care of the person. We observed that the needs of some people were not fully met, for example: the kitchen area in the Rosewood unit was not suitably adapted to encourage people to use it independently; the environment of the Wilman unit was not suitably adapted for people with dementia; a person on the Wilman unit had not been assessed for a suitable wheelchair. The care records we looked at included details of the person’s preferences regarding personal care. The care plans included references to maintaining the person’s privacy and dignity. Relatives told us they were kept up to date with any healthcare concerns about the person. A relative said prompt, appropriate action was taken when there were any concerns – “they don’t let things slide”. The daily records showed that appropriate action was taken to address any concerns about the person’s health. Some daily records were repetitive and not usefully informative. There were some spaces left in daily entries. Medication was securely stored in the home. There were good records of the receipt, administration and disposal of medication. The AQAA said the home promoted the independence, preferences and choice of people in the home. The AQAA said the home had improved in the last 12 months by implementing a person centred approach to care. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 18 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 and 18 (Older People) Quality in this outcome are is good. This judgement has been made using available evidence including a visit to this service. There were appropriate policies in place and good staff awareness so that people were protected and their concerns effectively dealt with. EVIDENCE: People told us they knew how to make a complaint and that concerns raised with staff were usually sorted out promptly and effectively. Some people told us they could bring concerns to the regular ‘Your Voice’ meetings. The complaints procedure was displayed in the home and was also included in the Service User Guide in a suitable format for people in the home. We saw the record of one complaint with details of the action taken and the outcome. Staff had received training about safeguarding vulnerable adults and were aware of the correct procedures to follow. We found one incident of alleged abuse we had not received a notification about. The acting area manager said Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 19 a notification had been sent to us, but a copy could not be found during the inspection visit. We had received appropriate notifications about other allegations and events in the home. A few staff had received training about the Mental Capacity Act 2005. Since the last inspection, we had received 4 complaints about the home, all regarding staffing issues. We referred all the complaints to the provider and received satisfactory responses that action had been taken to address the issues raised. Since the last inspection we received information about 4 safeguarding referrals made to social services. All of the allegations had been appropriately dealt with. The AQAA said the home had improved in the last 12 months with significant changes to the management of the home to ensure that all people in the home are safeguarded. The AQAA said the home planned to improve by providing additional staff training about the Mental Capacity Act 2005 and Deprivation of Liberties. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 20 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. Improvements had been made to the ground floor of the home, creating a bright, welcoming environment for people living there. Other areas of the home remained in need of refurbishment to ensure a pleasant environment, suitably arranged and equipped to meet peoples needs. EVIDENCE: Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 21 Since the last inspection, the ground floor had been refurbished and redecorated to create a bright, pleasant environment. People told us they were pleased with the improvements made. The rest of the home was awaiting refurbishment. The acting area manager said this had been planned and approved, but no timescales were available for when the work would be started. On the Kinder and Wilman units there were ceiling tiles missing in the main corridor. We were told that replacement tiles had been ordered but it was not known when the work would be completed. Also on the Wilman and Kinder units, there toilets had been out of order for at least 3 weeks. We found that these repairs had not been reported. Action was taken on the second day of the inspection visit and we were told that repairs would be carried out the following week. There was no shower room on the Rosewood unit. People who preferred a shower, rather than a bath, had to go onto one of the other units when a shower room was available and when staff were available to go with them. Suitable equipment was provided to ensure people’s needs were met, such as profiling beds, pressure relief mattresses and cushions, assisted baths, and grab rails. As noted in the Personal and Healthcare Support section of this report, one person had not been referred for assessment of their needs regarding a suitable wheelchair. People told us the cleanliness of the home had improved – “it looks cleaner and smells better”. People said the home was usually clean and fresh. Staff had received training about the control of infection and were aware of the correct procedures to follow. The AQAA said the providers had made a significant financial investment in the home in the last 12 months. They had received positive feedback from people in the home, visitors and other healthcare professionals regarding the refurbishment of the ground floor. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. Staffing levels and staff continuity had generally improved so there were sufficient staff to meet peoples needs. The recruitment systems in place ensured people were protected. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 23 EVIDENCE: Most people told us there were usually enough staff available when needed, though one person said there were “never enough staff”. People in the Rosewood unit were frustrated at times when their staff were moved to cover shortages in other areas of the home. People told us the continuity of staffing had improved as more staff had been recruited and there was far less reliance on using agency staff. People told us they liked the staff at the home. They said “the staff are all very good”, “friendly”, “patient”, “they listen to me”, and “they treat us well”. Most people said staff were competent and able to meet their needs, (or the needs of their relative). Staff told us they were pleased that new staff had been recruited as covering sickness and holidays was easier. Staff working in the Kinder and Wilman units said staffing levels were generally sufficient, though there were busy times when an extra care assistant would be beneficial. We observed that there generally sufficient staff available, although we found people in the Kinder unit having their breakfast quite late, and some staff told us they sometimes did not have time for a break. We looked at 3 staff files and found all the required documents and information were in place. There was no evidence of the involvement of people in the home, particularly the younger adults, in the selection of new staff. The induction programme for new staff met Skills For Care standards. Staff told us that training had improved over the last year and there was a wider range of training available to them. Staff were up to date with all the required training. Most staff had not received training about the Mental Capacity Act 2005. The AQAA said that 20 out of 55 care staff had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. The AQAA said the current turnover of staff was low, approximately 2 . The home planned to improve by ensuring all staff have received training for them to undertake their roles to a high standard. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 24 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.V375696.R01.S.doc Version 5.2 Page 25 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. The home lacked strong, consistent management so that people in the home, their relatives, and staff were not confident that changes made in the last year would be sustained. EVIDENCE: The registered manager had left the home since the last inspection. The providers had appointed an acting manager in August 2008 and then a permanent manager from January 2009. However, this manager had also left the home shortly before the inspection visit. We were told during the inspection visit that the acting area manager and 2 managers from other homes would temporarily provide management cover until another permanent manager was appointed. Visitors and staff told us they were disappointed the home was once again without a permanent manager. They were concerned that improvements made in the home in the last 6 months would not be sustained. Since the last inspection, 2 clinical managers had been appointed. From talking to people in the home, visitors and staff, observation, and looking at records, we saw that the clinical managers had helped to improve care planning and standards of care. The clinical managers each worked full time, and each worked approximately half of their hours as supernumerary. This ensured there was always a management presence in the home for people in the home, visitors and staff to go to with any concerns about the care of people in the home. The quality assurance system in the home included regular meetings for people in the home, surveys sent out to people in the home and their representatives, and internal audits. Some people told us they used the regular meetings to voice their opinions. There was no evidence of the use of local advocacy services for people in the home. The AQAA was completed by the manager appointed in January 2009. The self assessment section gave a reasonable picture of the current situation within the home. There were some areas where more supporting evidence would have been useful to show what the home had achieved in the last year and how it was planning to improve. The data section of the AQAA was not fully completed. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 26 The AQAA showed that the home had relevant policies and procedures in place, though some had not been reviewed for over 2 years. The AQAA showed that maintenance of equipment and systems in the home was up to date. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 2 40 X 41 X 42 3 43 X 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Merseybank Nursing Home Score 2 2 3 X DS0000025442.V375696.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 23(2)(b) Requirement The repairs identified must be carried out, that is – replacement of the ceiling tiles and repair of the toilets on the Wilman and Kinder units. This will help to ensure a safe and properly equipped environment for people in the home. Timescale for action 31/07/09 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 Good Practice Recommendations The Statement of Purpose should include the address of the provider and should be amended to show the correct number of people that can be accommodated in the home. 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. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 29 2 YA6 3 YA14 There should be written evidence of the agreement of the person in the home and/or their representative to their care plan. This will help to ensure that people are involved in planning the care they need in the way they prefer. 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 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. 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 All staff at the home should have training about the Mental Capacity Act 2005 to ensure people in the home are protected and their rights are upheld. A shower should be provided for the people living in the Rosewood unit to meet their needs and preferences. 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 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. 4 YA14 5 YA17 6 7 8 9 YA18 YA23 YA24 YA39 10 YA42 Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Care Quality Commission 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. Merseybank Nursing Home DS0000025442.V375696.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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