Inspection on 15/10/08 for Merstone Hall

This inspection was carried out on 15th October 2008.

CSCI 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.

Other inspections for this house

Merstone Hall 04/06/09

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Merstone Hall 20-22 Florence Road Bournemouth Dorset BH5 1HF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joanne Pasker     Date: 1 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Merstone Hall 20-22 Florence Road Bournemouth Dorset BH5 1HF 01202309813 01202304128 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sarah Louise Fincher Type of registration: Number of places registered: Merstone Hall Ltd care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability terminally ill Additional conditions: The maximum number of service users who can be accommodated is 45. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender. Date of last inspection Brief description of the care home Merstone Hall was originally a hotel. It was then converted to a nursing home in 1992. The home is registered to provide personal care for up to 45 older people, 32 of whom can require nursing care with a maximum of six younger adults. Mrs Sarah Fincher Care Homes for Older People Page 4 of 26 Over 65 0 0 45 0 0 45 45 0 45 45 Brief description of the care home (Matron) is registered with the CSCI to manage the home on behalf of Mr Zamir Afghan. The property is located close to all the amenities in Boscombe and is a short level walk from these. There are outdoor seating areas to the front and rear of the building with easy level access for service users. Merstone Hall has a wide selection of accommodation set on three floors, all areas being serviced by a passenger lift. The rooms are of varying sizes and many have full ensuite facilities. The communal areas situated on the ground floor consist of two lounges, one of which is very large and a separate dining room. The large lounge is shaped to ensure those service users wishing not to participate in a larger group or organised activities can find quieter corners to sit in. In addition there is a sizeable reception area. All parts of the home are centrally heated.The fees range from 750 to 1500 pounds. The higher rate relates to residents who receive continuing care funded by health. Additional charges include hairdressing, chiropody and newspapers. See the following website for further guidance on fees and contracts: www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out over approximately 6 hours on the 15 and 16 October 2008. This was a statutory inspection and was carried out to ensure that the residents who are living at Merstone Hall are safe and properly cared for. The Registered Manager, Mrs Sarah Fincher, was on hand throughout to aid the inspection process. Information gathered for this report came from several sources including: Care Homes for Older People Page 6 of 26 -Reports made to the Commission for Social Care Inspection by the home. -The annual quality assurance assessment (AQAA) completed by the home. -5 questionnaires completed by residents. -Tour of the premises. -Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. -Discussion with residents and staff. What the care home does well: What has improved since the last inspection? What they could do better: The home should ensure that care plans are discussed and agreed with individuals or Care Homes for Older People Page 8 of 26 their representatives. All necessary and appropriate documentation regarding the recruitment of staff must be obtained prior to anyone starting work at the home. The use of a training matrix to give an overview of all staff training and needs, would improve the record keeping in this area. The quality assurance process could be further improved, including the use of various audits, evidencing stakeholders opinions of the home and providing an annual development plan. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admissions procedure enables prospective residents (and/or those acting on their behalf), to make informed decisions about admission to the home and ensures that only residents whose needs can be met by the home are offered places there. Evidence: The pre admission documentation for two residents was inspected. This showed that the home has a good procedure in place and ensures that a full assessment of needs was taken with the prospective resident, family and hospital staff prior to them moving into the home. Despite one of the people being admitted for emergency respite, all the necessary pre admission assessment areas were covered to ensure that a comprehensive plan of care could be written for staff to follow and ensure all individual needs are met. The homes statement of purpose clearly and accurately reflects what people and Care Homes for Older People Page 11 of 26 Evidence: needs they are able to care for, so families and healthcare professionals can confidently make a decision regarding appropriate placement of a person. Of the five residents who responded to the surveys sent out, one replied that they had received a contract, three said they had not and one said they were unsure if they had. However, all replied that they had received enough information, about the home before they moved in, to help them decide if it was the right place for them. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed care plans, good support from appropriate community health professionals and safe medicine handling and recording show that peoples needs are well met and they are safeguarded from risk. Everyone is treated with dignity and respect however some improvements could be made with regard to discussing care plans with individuals, to ensure that their rights are upheld. Evidence: The care files for 3 people were reviewed and contained a variety of assessments. The information from the assessments is used to formulate a plan of care for each resident and they contained clear details and actions so that staff could give the appropriate care. However, there was no evidence that care plans had been discussed with the resident or their representative and one was not dated. Care plans had been regularly reviewed and it was clear from discussions with staff, residents and visitors that there is access to the health services needed. There was evidence to show that residents get support from General Practitioners, the district Care Homes for Older People Page 13 of 26 Evidence: nurse and chiropodist. Appropriate referrals are also made to specialist services, such as speech and language therapy, when needed. Of the 5 residents who responded to the surveys sent out, 3 replied that they always received the care and support needed, 2 responded usually. When asked if they received the medical support they needed, 3 replied always and 2 said usually. Medicines were stored securely and records indicated that they are properly administered as prescribed. Regular audits and checks of storage were documented and good procedures were in place to ensure that risks to people are minimized. Everyone seen appeared well cared for and people spoken with confirmed this, commenting that Staff are lovely. They also confirmed that staff treated them with respect and were observed to speak to everyone appropriately and with kindness and care. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides activities and events for residents and they are encouraged to maintain contact with the local community. Friends and relatives are also warmly welcomed by the home. Both relatives and staff members assist residents to make choices about their daily lives and the meals offered provide choice and variety ensuring that people receive a wholesome diet. Evidence: An activities co ordinator is employed part time and organises some group activities as well as working with people on a one to one basis. A hairdresser visits once a week and the home pay for a masseur to come in twice a week, who spends time with bedbound residents and the more able, giving hand massages etc. Life books have also been started with individuals however, the activities records were not available to review during the inspection, as the activities organiser was not present. The home has developed close links with the local community with some people attending church services regularly, visits from the local school and Salvation Army singers and have a church outreach worker visit people receiving palliative care. Merstone Hall also join up with another local care home twice a year, for the residents Care Homes for Older People Page 15 of 26 Evidence: to see a play performed. Surveys sent out asked people if there were activities arranged by the home that they could take part in, four replied always and one replied usually. Residents and visitors spoken with confirmed that visitors are made welcome at any time and that they are able to spend time privately in residents rooms if wished. All rooms seen also contained personal pictures, photographs and items of furniture. Meals provided vary on a four week rolling menu and offer individual choice when needed. Dietary requirements are well met and likes and dislikes catered for. The kitchen appeared clean and tidy and good supplies of appropriate food was seen, including plenty of fresh produce. When asked if they liked the meals at the home in the survey, three people replied always and two responded usually. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a good complaints system, which ensures that complaints are managed properly and residents and relatives can be sure that their concerns will be listened to and acted upon. Policies and practice, in order to safeguard residents from potential abuse and harm, are also promoted. Evidence: Residents said that they knew how to complain and felt confident that if they had concerns or complaints they will be listened to and taken seriously. The home has a robust complaints policy in place and this was clearly displayed within the home. The home or the Commission in the last year had received no complaints. Of the five people who responded to surveys, four stated that they knew how to make a complaint and one said no. When asked if they knew who to speak to if they were not happy, two replied always, 2 said usually and one said sometimes. The home has policies and procedures for the protection of residents from abuse or neglect and provides all staff with training in this area. Staff spoken with confirmed that they had received training and demonstrated a clear understanding of the homes procedures. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides residents with an environment that is safe, clean and well maintained. Evidence: A tour of the premises found it was comfortable, clean and well maintained with an on going programme of maintenance in place. The top floor bathroom appears in need of some renewal but the registered manager said that this is planned. There are small kitchens on each floor where breakfast is prepared and visitors can make hot drinks. There are also water dispensers on each floor for the use of all. When asked if the home was fresh and clean, four people responded always and one person said usually. The laundry was seen and appeared clean and tidy, with a good system in place. All staff receive infection control training, including some on MRSA and adequate supplies of gloves and hand washing facilities were seen to be appropriately used by staff. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient care staff are employed and receive the training and support needed, so that they can give a good standard of care to the residents living at Merstone Hall. Recruitment procedures need to improve to ensure residents are protected from the risk of unsuitable staff working at the home. Evidence: Staff rotas demonstrated that there were sufficient staff on duty to meet the needs of the residents and this was observed in practice, during the inspection. Residents spoken with confirmed that staff were available when they needed them and from surveys returned, four people said that this was always the case and one said usually. The home also employs staff to undertake the cleaning, cooking, laundry and maintenance. The home has an ongoing training programme, which includes NVQ level 2 and 3 in care and at the time of inspection more than 50 of the care staff hold the minimum of a level 2 award in care. Three staff recruitment files were initially reviewed. One only contained one reference, another had no copy of a CRB and the third one only recorded verbal references as having taken place. These had also not been fully documented with the details of the Care Homes for Older People Page 19 of 26 Evidence: conversation. All other necessary documentation was present in the three files. However, following concerns received regarding recruitment procedures, a second days visit was carried out to specifically look at these. It was found that although appropriate checks, such as POVA First had been carried out, references were not adequate. Only one reference had been received and the home had not pursued gaining the second one. The first reference was also not made by the necessary person from the last employment, therefore important risk factors were not known. Training files demonstrated that staff were receiving induction training. The majority of staff have received all mandatory training required, including infection control, moving and handling and fire training. All training certificates were seen in staff members files however, the home does not maintain a training matrix which would give a useful overview of all training received, dates and renewal dates. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well managed, however improvements must be made in recruitment practice to ensure that the welfare of all people is well promoted and protected, ensuring that risks to health and safety are minimised. Good quality assurance systems are being developed and the daily management and running of the does appear to centre on the best interests of the residents. Evidence: Sarah Fincher, the registered manager is a first level registered nurse who has attained an NVQ level 4 in management and is also an NVQ assessor and student mentor. She is an experienced nurse manager who demonstrated a knowledgeable understanding of the needs of residents and running of the home. Staff and residents spoken with confirmed that they felt comfortable about approaching the manager with any issues and it was observed that Mrs Fincher spoke to everyone and clearly had a good rapport with all people. Care Homes for Older People Page 21 of 26 Evidence: However, the fact that recruitment procedures were clearly not properly applied, leaving people at potential risk from possible unsuitable staff, does reflect on the overall management and administration of the home. The home has submitted an annual quality assurance assessment (AQAA) to the Commission, detailing how they currently meet Care Standards and how they plan to improve. Annual questionnaires for residents are completed to gain their opinions on the running of the home and separate questionnaires are sent to the relatives of people who received palliative care. It was discussed with the registered manager that the use of more audit tools, an annual development plan and gaining the opinions of stakeholders, would further improve their quality assurance system. Copies of Regulation 26 visits should also be kept in the home. The home does not hold any money on behalf of residents and families or legal representatives deal with most peoples finances. The home pays for all extra services, such as hairdressing and chiropody, before invoicing families quarterly. Records showed that staff are appropriately supervised and staff spoken with during the inspection confirmed this. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly and adequate fire assessments were in place. Accidents were recorded and analysed and appropriate action was taken as necessary. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 The home must ensure that all of the required documentation according to Schedule 2 is in place for all new employees before they start work. Recruitment policies and procedures must be followed to ensure that people are protected from unsuitable persons working in the home and minimising the risk of abuse. 13/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The home should ensure that where possible, residents and/or their representatives are consulted about their needs and discuss and agree upon the plan of care in place. The introduction of a training matrix would improve the existing recording of staff training needs. It is recommended that the existing quality assurance system be improved by documenting the feedback of stakeholders regarding the running of the home, Page 24 of 26 2 3 30 33 Care Homes for Older People implementing more audits and having a copy of an annual development plan. Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!