Inspection on 07/06/06 for Merseybank Nursing Home

This inspection was carried out on 7th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Merseybank Nursing Home 02/06/09

Merseybank Nursing Home 17/06/08

Merseybank Nursing Home 10/07/07

Merseybank Nursing Home 01/09/05

Merseybank Nursing Home 25/05/05

Merseybank Nursing Home 16/03/05

Merseybank Nursing Home 14/07/04

Merseybank Nursing Home 17/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Merseybank Nursing Home Carriage Drive Hadfield Glossop Derbyshire SK14 7PH Lead Inspector Rose Veale Unannounced Inspection 7th June 2006 10:30 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Merseybank Nursing Home DS0000025442.V298387.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.V298387.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merseybank Nursing Home Address Carriage Drive Hadfield Glossop Derbyshire SK14 7PH 01457 885175 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) www.craegmoor.co.uk Parkcare Homes (No. 2) Limited Vacant Care Home 74 Category(ies) of Dementia (18), Old age, not falling within any registration, with number other category (18), Physical disability (38) of places Merseybank Nursing Home DS0000025442.V298387.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 1st September 2005 Brief Description of the Service: Mersey Bank Nursing Home is registered for the care of 74 residents with nursing and personal care needs (including up to 18 residents with dementia and up to 38 younger adults with physical disability). The home is situated in Hadfield, near to the town of Glossop. Accommodation is provided on three floors with passenger lift and staircase access provided. The home is divided into four separate units. The units are staffed separately. There are expansive gardens, including a patio area. Fees at Mersey Bank are £547 per week for residents in the units for older people and £774 per week for residents living in the units for younger physically disabled people, (information supplied by the deputy manager on 07/06/06). Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 2 days. Residents and staff were spoken with during the inspection. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Records were examined including care plans, staff records, policies, maintenance records, and health and safety records. A tour of the building was undertaken. Concerns about the home had been raised with CSCI and Social Services and the home was subject to monitoring by the contracts section of the local Social Services department. The deputy manager and staff were supportive of the inspection and monitoring processes and were working towards meeting the requirements of CSCI and Social Services. What the service does well: What has improved since the last inspection? What they could do better: There was no Service User’s Guide available in the home, consequently residents did not have all the information they needed. Residents were not as fully involved and consulted as they could be about life in the home. Residents could be more involved in areas such as care planning, staff recruitment, planning the activities programme, and planning menus. The staffing levels and organisation of the ground floor unit for younger adults with physical disabilities needed review in consultation with residents and staff to ensure residents’ needs were fully met. The quality assurance system needed further development to ensure that the home was run in the best interests of residents. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 6 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. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 (Older People) 1, 2 (Adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Although the assessment process was satisfactory, residents did not receive sufficient information about the service and were not all confident that their needs could be fully met. EVIDENCE: The care records of 10 residents were examined, including residents from each of the four units. All the records seen included assessment information obtained before the admission of the resident, plus assessments following admission. Assessments had been regularly reviewed in all the records seen. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 9 A care plan had been produced from the assessment information in all the records seen. There was evidence that some staff training had taken place to ensure the specific needs of individual residents were met. For example, training in sign language for a resident with communication difficulties, training in managing challenging behaviour and training in the care of people who need enteral feeding. Residents spoken with said that generally their needs were met by the home. Some residents on the YPD units said that not all their needs were met. Examples were a lack of privacy for one resident and a wider range of appropriate activities wanted for two residents. There were concerns expressed by some residents and staff that residents were admitted whose needs could not be properly met in the home. All the records seen included a statement of terms and conditions of living in the home signed by the resident or their representative. The contract between the home and the resident was kept separately from the care records. The contract did not include a breakdown of the fees payable to show the Registered Nursing Care Contribution as required. There was no Service User Guide available in the home. It was stated that this was being reprinted. Residents spoken with were not aware of the Service User Guide and were unable to recall having seen a copy. Standard 6 (Older People) did not apply to this service. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 (Older People) 6, 9, 16, 18, 19 and 20 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Improvements had been made in care plans and risk assessments, ensuring that most of the residents needs were suitably met, although there was little evidence of the involvement of residents in care planning. EVIDENCE: The care records examined all included a care plan. The care plans and risk assessments mostly included all the assessed needs. One care plan did not Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 11 include the spiritual needs of a resident and another did not include a risk assessment and care plan following a recent incident where the resident was potentially at risk of harm. All the care plans and risk assessments seen had been regularly reviewed. All the care plans included a falls risk assessment as recommended at the last inspection. A few risk assessments and care plans had been signed by the resident or their representative to indicate involvement. Only one resident spoken with was aware of their care plan and said they had been involved in planning care. Residents or their representatives were usually involved in the review of care at meetings with social workers or care managers. Most of the care plans seen referred to maintaining privacy, dignity and independence for residents. Residents spoken with generally felt that staff were respectful in their approach and protected residents privacy. Staff spoken with were knowledgeable about the care of individual residents and were clearly aware of supporting dignity and privacy. It was observed that staff spoke to residents in a respectful way, knocked on doors before entering, and assisted residents with eating and drinking in a way that supported dignity. It was observed on the ground floor YPD unit that staff appeared ‘rushed’ at times, asking residents to wait for assistance. It was observed that the nurse call buzzers on this unit frequently sounded for several minutes before being answered. Residents spoken with on this unit said staff were ‘busy’ but were generally available when they were needed. Residents on other units said their nurse call buzzers were answered promptly and that staff were always available when needed. All the care records seen included details of the input of other health care professionals, such as GP, District Nurse, physiotherapist, chiropodist, dentist and optician. There was evidence that residents were appropriately and promptly referred for advice and treatment. For example, residents with pressure sores were referred to the tissue viability nurse, and residents with specific nutritional needs referred to the dietician. Residents spoken with said they were able to have access to medical and other services as required. Medication systems and administration were found to be satisfactory at the previous inspection and so were not thoroughly assessed at this inspection. The Medication Administration Records, (MARs), were seen for 10 residents. The MARs were correctly completed. Medication storage on the three of the units appeared satisfactory. The door to the medication room on the ground floor YPD unit was awaiting replacement and was secured with a padlock. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 (Older People) 12, 13, 15 and 17 (Adults18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. On the whole, residents found the lifestyle in the home matched their expectations and preferences. However, lack of consultation with residents/ their representatives, particularly regarding activities and meals, meant that control and choice was not always available. EVIDENCE: Residents spoken with said they could choose when to get up and go to bed and said preferences regarding their daily routines were generally respected by Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 13 staff. For example, residents could smoke when they wanted to in the designated areas and they could choose whether or not to join in with the activities offered. The bedrooms seen were personalised with residents’ own possessions. Residents said they could see their visitors in private if they wished. There were two activities coordinators working in the home. Both were enthusiastic, experienced and committed to their role. There was a good range of activities offered, including trips out, quizzes, crafts, music, gentle exercise, bingo and games. The activities coordinators kept records of residents’ preferences regarding activities, previous hobbies and interests, and details of activities residents had taken part in. Activities offered were appropriate to the needs of residents, such as reminiscence for older people with dementia. The activities offered tended to be group activities so that more residents could be involved, though the records showed that one to one activities were offered as appropriate. Residents spoken with said they enjoyed the trips out and would like more of these. Staff spoken with said they thought the activities provision was good and that it could be improved by having more activities hours available. Residents spoken with said they were not regularly consulted about their views on life in the home. Minutes of residents meetings were seen and these appeared to be held approximately every 3 months. Residents’ relatives / representatives were also invited to these meetings. Resident satisfaction surveys were seen dated 2004. There was no quality assurance report available that analysed and reported on the findings of the surveys. Residents were mixed in their comments about the meals provided. One resident said the food was “sometimes great, sometimes not so great”, one resident said there was too much “fried food and chips”, and two residents said that there was not enough fresh fruit and vegetables. Staff spoken with commented that usually the same meal choices were offered to all the units and that this was not always appropriate for all residents in the home. For example, pizzas offered to older people with dementia when a more traditional meal would have been appropriate. The menus seen offered a choice of main meal and there were occasions when different meals were offered to the YPD units and the units for older people. The menus seen included fresh vegetables, fruit and salad on most but not all days. The menus appeared to rely on processed and convenience foods, such as beefburgers, fish fingers, prepared chicken in breadcrumbs, tinned tuna, baked beans and spaghetti in tomato sauce. The main meal served on one unit on the first day of the inspection appeared bland and unappetising, consisting of mashed potatoes, cauliflower and fish fingers. Residents were encouraged and assisted to eat in the dining areas on each unit. It was observed in the ground floor YPD unit that there were many residents who needed assistance to eat and drink and that staff appeared Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 14 ‘rushed’ when doing this. The atmosphere was not relaxed or conducive to enjoyment of the meal. In the unit for older people with dementia, there were 6 people needing assistance with eating and drinking and 3 staff on duty. It was therefore necessary for some residents to wait for their meals whilst other residents were being helped. In the unit for older people needing nursing care residents were allowed to smoke in the dining room, (though not at mealtimes), as there was no other area available. There was a small extraction fan in use, but this did not adequately remove all the smoke. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 (Older People) 22 and 23 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were generally protected by the systems in place in the home, although response to concerns was not always consistent or robust. EVIDENCE: The complaints procedure and complaints file were seen. The complaints procedure included all the required information. Records of complaints indicated that complaints were dealt with promptly and action taken as necessary. Residents spoken with were aware that they could complain if they wanted to. One resident said they were able to complain directly to the staff on duty if there were any problems. Concerns about the home had been raised with CSCI and Social Services and the home was subject to monitoring by the contracts section of the local Social Services department. The deputy manager and staff were supportive of the inspection and monitoring processes and were working towards meeting the requirements of CSCI and Social Services. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 16 Staff had recently completed training in the protection of vulnerable adults. Staff spoken with were aware of adult protection procedures, though a recent incident showed that procedures were not always consistently followed. One care record seen included the input of an advocacy service for the resident. Details of the advocacy service were available to residents on a communal notice board. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 (Older People) 24 and 30 (Adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Homely and comfortable surroundings were provided for residents. However there were environmental issues to address to ensure the home was suitably equipped and safe. EVIDENCE: Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 18 Some progress had been made since the last inspection to meet requirements made about the environment of the home. Some requirements had not been met and other environmental issues were identified as follows: Ground floor YPD unit • the main corridor in the older part of the building was in need of redecoration as the walls and woodwork were marked and shabby. • the flooring in the shower room was cracked and needed repair or replacing. • the wall tiles in the sluice had not been replaced as required at the previous two inspections. The sluice was not being used. • the door to the treatment room had been damaged as staff had to break in when the key was inadvertently taken away from the home. The door was secured temporarily with a padlock. The deputy manager said that a new door was ordered and would be fitted as soon as possible. • the toilet next to the smoking lounge needed repair / replacement of a broken radiator cover and rusted toilet frame, and was in need of redecoration. • the smoking lounge was in need of redecoration and the smoke extraction unit was in need of cleaning First floor YPD unit – • adequate ventilation had not been provided to the smoke room as required at the last inspection. • the broken radiator cover in the toilet needed repair or replacement. • a shower had not been provided as required at the last inspection. • one resident requested redecoration of the bedroom as it was shabby with marks to the walls, woodwork and carpet, and was stated not to have been redecorated for at least 5 years. Wilman unit – • the floor covering in the corridor outside the bedrooms at one end of the unit was cracked and needed repair or replacement • there were wall and ceiling tiles missing in the toilet. The radiator was not guarded. • one bedroom had wallpaper and borders pulled off requiring redecoration Kinder unit – • an alternative smoking area was needed as residents were smoking in the dining room, or adequate extraction to ensure a smoke-free atmosphere. • the shower was not useable as the floor did not slope sufficiently to allow water to drain properly and the shower unit was missing several parts. It was required at the last inspection that a shower must be provided for this unit. Staff spoken with said there were some residents on the unit who were unable to use the bath due to physical difficulties, but who would be able to use the shower. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 19 • there was a linen trolley stored beneath a staircase which presented a potential fire hazard. It was reported that there had been 2 full-time maintenance men in the home but that when one had left the job had not been filled. The deputy manager confirmed that this was so and that there were plans to recruit another maintenance person. The home appeared clean throughout on the days of the inspection. There were some areas of the home where there were odours, particularly the unit for older people with dementia. Staff spoken with said they had done some infection control training and they were aware of measures to take to protect residents. Staff were observed to wear disposable gloves and aprons for assisting with personal care, and disposable aprons for helping with meals. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 (Older People) 32, 34 and 35 (Adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Although staff were competent and adequately trained, residents needs were not always fully met by the staffing levels in place. EVIDENCE: The staff rotas were seen for all four units of the home. The manager had been off sick for several months and the deputy manager had taken on the role of manager. The deputy manager’s hours working as a nurse in the home had not been replaced. With the exception of the ground floor YPD unit, staffing levels were reported to be satisfactory by residents and staff. The ground floor YPD unit accommodated 25 residents at the time of the inspection. 10 of these were assessed as highly dependent needing a minimum of 2 carers to assist them. The Residential Care Forum guidelines indicate that the staffing levels should be 8 staff during the day and 3 at night. The staff cover provided was a registered nurse plus 5 care assistants in the morning, 4 Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 21 in the afternoon and 2 at night. One resident spoken with said staff were ‘always busy’ and that care was ‘rushed’ and that buzzers were not always answered quickly. Other residents spoken with said staff were available when needed. Staff spoken with said the staffing levels were not enough to ensure the needs of all residents were properly met. Staff said they felt they were able to do ‘the bare minimum’ of care and said they would like to be able to spend more time with residents. It was noticeable that the smaller first floor YPD unit appeared calmer and residents were pleased with the care provided. Staff spoken with said they would prefer the ground floor unit to be run as two smaller units if sufficient staff were provided. Staff spoken with said that there was a high rate of sickness and staff turnover on the ground floor YPD unit because of the demanding workload. Staff training records were seen and showed that all staff were up to date with required training such as fire safety, moving and handling and the protection of vulnerable adults. Staff spoken with confirmed that “lots of training” had taken place. More than 50 of the care staff had achieved or were working towards NVQs in care. Staff records seen included all the required information, such as Criminal Record Bureau disclosures photographs and written references. Residents were not involved in the recruitment process. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 (Older People) 37, 39 and 42 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Generally, the home was run and managed with the best interests of residents in mind, although there were gaps in the quality assurance system. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager of the home had been on sick leave for several months and the deputy manager was acting as manager with the support of the area manager. Most residents and staff spoken with appeared satisfied with the management of the home, although some were dissatisfied and said that the management was not always responsive to the concerns of residents and staff. There was a formal quality assurance system in place, including regular audits of the environment, residents’ meetings, provider visits, and resident satisfaction surveys. There was no report available of the findings of satisfaction surveys and the most recent surveys seen were from 2004. Health and safety records sampled were satisfactory, including the fire log book, gas safety records and water safety and testing records. Staff had received training in safe working practices, such as moving and handling. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 2 34 X 35 3 36 X 37 X 38 3 Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5(1)(2) Requirement There must be a Service User’s Guide available to all residents that includes all the required information. The contract between the resident and the home must specify the fees payable for nursing care. There must be evidence of service user/representative involvement in the drawing up of and review of care plans. Original timescale 31/10/05 Individual care plans must include all the assessed needs of residents. An action plan must be produced to address the items in the environment section of this report with timescales for completion of the work required. A copy of the action plan to be sent to CSCI. At all times there must be staff in sufficient numbers to ensure the health and welfare of residents. Timescale for action 31/07/06 2. OP2 5A(2)(a) 31/07/06 3. OP7 15(1)(2) 31/07/06 4. 5. OP7 OP19 YA24 15(1) 23(2) 31/07/06 31/07/06 6. YA33 18(1)(a) 31/07/06 Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 26 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. Refer to Standard OP1 YA1 OP12 YA14 OP12 YA14 OP15 YA17 YA33 Good Practice Recommendations The Service User’s Guide should include information about how residents can access local advocacy services. Residents should be fully consulted on the programme of activities offered. The activities staff hours provided should be increased to allow a wider range of activities to be offered. Residents should be fully consulted on the choice of meals offered in the home and involved in the regular review of menus. Residents and staff should be fully consulted and involved in the review of staffing levels and the organisation of the ground floor YPD unit. Merseybank Nursing Home DS0000025442.V298387.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 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.V298387.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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