Inspection on 08/08/05 for Minshull Court Nursing Home

This inspection was carried out on 8th August 2005.

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

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

Other inspections for this house

Minshull Court Nursing Home 25/07/07

Minshull Court Nursing Home 22/01/07

Minshull Court Nursing Home 20/11/05

Minshull Court Nursing Home 15/11/04

Minshull Court Nursing Home 12/05/04

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

CARE HOMES FOR OLDER PEOPLE MINSHULL COURT MENTAL NURSING HOME Minshull New Road Crewe Cheshire CW1 3PP Lead Inspector Anthony Cliffe Announced 8 August 2005 09:00 th 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 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. 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. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Minshull Court Mental Nursing Home Address Minshull New Road Crewe Cheshire CW1 3PP 01270 257917 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Christopher Chawner Mrs M Niblett Care Home 34 Category(ies) of DE(E) Dementia over 65 (34) registration, with number of places MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for a maximum of 34 service users to include: * Up to 34 service users in the category of DE(E) (dementia over the age of 65) 2 Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commisison for Social Care Inspection. 3 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 15th November 2004 Brief Description of the Service: Minshull Court care home is a converted detached two-storey property situated in its own grounds approximately two miles form the centre of Crewe. The home provides care with nursing for adults aged over 65 years of age diagnosed with dementia. There is a passenger lift and internal staircases and wheelchair access throughout the home. The home has two lounges and two dining rooms. Bedroom accommodation comprises of 34 single rooms all with hand-wash basins. There are no en-suite facilities. There is an enclosed garden and patio area to the rear and with ample car parking at the front. The home is on a bus route and the main railway at Crewe town centre. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was postponed from June 2005 at the request of the registered person due to the ill health of the manager. The inspection took place over seven hours. It included inspection of records, observation of staff practice and discussion with residents a relative and staff. Feedback was given to the manager immediately following the inspection. Two requirements remain outstanding from previous inspection visits and the Registered Provider will be contacted regarding potential enforcement action. What the service does well: What has improved since the last inspection? Record keeping has improved. The manager completes pre-admission assessments to decide whether individuals needs can be met at the home. Management and administration of medication has improved to ensure the safe storage and administration of residents’ medicines. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 6 What they could do better: 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. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Assessments of needs are completed, before residents move into the home, to ascertain if their needs can be met. EVIDENCE: The records of three residents who had recently moved into the home were examined. The manager completed a pre-admission assessment. The information includes the residents’ previous history, physical illnesses and current medication. Copies of the care management assessment and care plan and NHS care plan were obtained prior to admission. These documents were used to develop a plan of care to meet residents’ needs. Minshull Court does not provide intermediate care facilities and this standard is not applicable. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. 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 feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Residents care plans ensure that health and social care needs are identified and met but improvements in the review of these are needed. The procedures for managing medication ensures residents receive there prescribed medication. EVIDENCE: A number of care plans were examined. All plans had a comprehensive range of assessment documents completed in full with a care plan to address their identified needs. A relative visiting the home said that he had been involved in the care planning process. He said that he had been consulted about his wife’s appetite, which had improved and she had gained weight. He put this down to staff ‘persevering and making sure she finished her meals’. Evidence from care plans, and from conversations with a resident and relatives, indicated that the health needs of residents were met. Care plans demonstrated when the mental health and physical needs of residents had been reviewed and treatment from a general practitioner or NHS mental health services was needed. Care plans demonstrated that the staff had acted promptly to have a resident reviewed following an increase in aggressive behaviour. Care plans were reviewed monthly but did not record the outcome of the review to verify if the care plan was working or required some change. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 10 Medicines records had been completed with signatures for the administration of medicines recorded. The home has introduced a monitored dosage system, which the manager stated had some teething problems but had improved. The manager was able to demonstrate that satisfactory arrangements had been made for the disposal and collection of waste medicines. Residents were treated with privacy and dignity. A resident said ‘I am happy here, the staff look after me and Margaret makes sure I look after myself as I can care for myself’. A relative said ‘residents always look clean and tidy, and if anyone has an accident with a drink or meal staff talk to them and explain they need to get changed. Staff explain why and take the resident and change them in their bedroom’. They do this for my wife and other residents, they always explain what they are doing’. See recommendation 1. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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 maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 15 Residents maintain contact with their relatives who are welcomed into the home. Residents have a good choice of meals in pleasing surroundings. EVIDENCE: A visitor to Minshull Court said he was always welcomed into the home. He said ‘I can visit every day without a problem’. I am welcomed, staff go out of the way to make you feel welcomed it’s like a happy family. I am going to play bingo this afternoon. I help my wife and staff make sure I have a drink. Drinks are served all day. I see juice given during the day as well as hot drinks. Residents are served biscuits. I think this place is value for money, if I wasn’t happy I would talk to Margaret, she is a very good manager and sorts things out’. A relative spoke about how his wife’s appetite and weight had improved. ‘She had deteriorated physically at the other place and I had her transferred. I heard the care was good here. I visit places where they charge £500 a week and in my opinion she is better cared for here than those places. Since she has been here she has put on weight and can communicate better, and staff tell her what time and what day it is’. They offer her a choice of meals’. A resident said ‘before I came here I was not eating or looking after myself. I am now eating well and have put weight on’. Meal arrangements are flexible to suit residents. Breakfast was served to residents as and when required. A choice of hot and cold cereals, hot porridge, toast and boiled eggs were available. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 12 The mid day meal was a choice of braising steak and vegetables or a ham salad. Portion sizes were generous and staff assisted residents. The menu covers a four-week period and offers an alternative at lunchtime and teatime. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 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’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents and relatives have access to a satisfactory complaints procedure and complaints are taken seriously. Staff training on adult abuse needs to improve so residents are protected. EVIDENCE: The records complaint showed one complaint which has not yet been resolved. This was regarding the state of the windows in the ground floor dining/lounge areas. The complainant described the windows as ‘ drafty and in disrepair’. The complaint was referred to, and acknowledged by, the registered person. The complaint is not yet resolved due to the failure to meet the requirement for the registered person to ensure that the windows identified on the ground floor are replaced. See requirement 1. Staff had not received recent training on adult abuse procedures. The Primary Care Trust is providing training but staff had not attended this. The home had received the Cheshire County Council amended adult protection procedures. The manager contacted the adult protection coordinator for Cheshire County Council regarding staff training and was advised this would commence in September 2005. See recommendation 2. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 25 and 26. The maintenance of the building needs to improve to ensure a safe environment for residents. EVIDENCE: A programme of maintenance is in place, which the manager identifies. This is given to the handyman for attention, on a monthly basis. The décor is kept in good condition. Externally the paintwork of the building is in poor condition. An assisted walk in bath has been purchased. In both ground floor lounges, windows identified at previous inspections as warped are not closing into their frames; sealed units are no longer functional, are cloudy and misted and had not been repaired. The standard of these four large windows has deteriorated. Two of the windows do not have fasteners on them to maintain security or provide ventilation. These windows have to be pushed open or shut by staff. A complaint was received that these windows had been screwed shut and no ventilation could get into the dining areas. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 15 Since the complaint the screws have been removed. The manager provided quotes for the repair of the windows. This is the third consecutive inspection where these windows have been required as needed repairing or replacing. Heating is supplied by overnight storage radiators, which have the temperature controlled to provide safe heating temperature in the bedroom areas. Radiators in the lounge, dining areas, toilets and corridors identified as excessively hot to the touch as the last two inspection visits had not been guarded. The manager was able to demonstrate that the temperature of these radiators could be controlled from the main boiler. She had undertaken a risk assessment of these radiators. Part of the risk management to maintain the safety of residents is that the handyman checks the boiler temperature monthly to ensure the radiator surface temperatures are safe. The need to provide radiator guards has been changed to a recommendation. The home was clean and free from odours. See requirement 1 and recommendations 3 and 4. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28, 29 and 30 The numbers and skill mix of staff are adequate to meet residents’ needs. The home’s recruitment procedures were not completed and do not ensure residents are protected. The home promotes staff training to provide a skilled workforce. EVIDENCE: The manager, deputy, senior care and care assistants were on duty in sufficient numbers to meet the needs of residents. Only one new staff member has been recruited as there is a stable staff team. A core of staff have been employed at Minshull Court for a number of years, which provides consistent care to residents. Discussion with the manager, a recently appointed staff member and examination of records of employment, found recruitment procedures were not followed. A staff member had been recruited and commenced employment in June 2005 without a POVA First check being obtained. The home had accepted a Criminal Records Bureau check from a previous employer. In interview the staff member was not aware of what POVA was and the need to have a POVA First check completed. A recently employed staff member discussed her induction programme. She said she had worked alongside another staff member. She said the manager had been through the induction programme with her. ‘I have had lots of training, including moving and handling, PEG feeding and changing a stoma. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 17 I was shown the fire exits on my first day and am due to have a fire lecture’. I have been very welcomed here. I can ask the staff anything. I was given advice on how to deal with a resident who gets aggressive after he hit me when my guard was down. The staff member confirmed that she had not completed an accident or incident from following the assault. The manager confirmed the incident had not been reported under Regulation 37. The staff member said she had previously worked at another care home and described the management at Minshull Court as ‘a more relaxed atmosphere, the management style is open but fair. You can be a few minutes late and not be in trouble but if you don’t do your job you will know about it’. There are nineteen care staff employed at the home with an NVQ level 2 qualification. Seven staff are currently undertaking an NVQ level 2 qualification. The senior care staff also hold an NVQ level 2 qualification and are working toward an NVQ level 3. A training programme is in place and the home is part of the training partnership with the Primary Care Trust. The home has a training provider for statutory training. The manager was able to provide evidence that staff attend regular training and all but one staff had attended a fire lecture. See requirements 2 and 3. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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 the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35 and 38 The manager needs supernumerary hours to be able to discharge her responsibilities fully. Residents’ access to their personal monies needs to improve. The management routines and maintenance and testing of equipment safeguards the health and safety of people living in the home. EVIDENCE: Since her return, the manager continues to work as part of the staff establishment and does not have any supernumerary hours for her managerial responsibilities. The manager lacked knowledge about the financial interests of residents. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 19 Residents’ personal monies or records pertaining to these are still not kept at the home, despite a requirement regarding this being made at the previous three inspection visits. The manager stated that all monies are held at the registered provider’s other care home. Monies belonging to residents are not available or accessible to them at Minshull Court. The manager could clarify the arrangements for accessing by stating ‘they are brought here from Audlem’. The manager said she was unaware of whom personal monies were kept for and this was ‘dealt with by the accountant’. The records maintained within the home relating to the health & safety of residents was examined. These included; Fire Log Book, Accident Book, Risk Assessments, Portable Electrical Appliance Tests, HACCP Records Maintenance Records for Hoists and Records of Discharged Hot Water. The testing of the fire alarm system had been completed weekly as required. The registered person had commissioned a risk assessment of the building and working practices. The manager had completed the necessary risk assessments for working practices within the home. See requirement 4 and recommendation 5. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 1 x x 3 x x 1 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 x x x 1 x x 3 MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 21 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 OP19 and 25 Regulation 23(2)(b) Requirement Timescale for action 1.11.05 2. OP29 3. OP29 4. OP35 The registered person must ensure that the windows identified on the ground floor are replaced. (Timescale 1.9.04 and 31.1.05 not met). 19 The registered person must not 1.11.05 employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. 37 The registered`person must 1.11.05 inform the Commission without delay of any event ikn the care home which affects the wellbeing of residents. 16(2)(l)17 The registered person must 1.11.05 (2) ensure that the home provides Schedule on site, accessible facilities for 4 (9)(a) service users to deposit monies, and that records of all transactions regarding personal monies/ allowances of service users are recorded and kept at the home. (Timescale 1.8.04 and 31.1.05 not met). MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 22 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 OP7 OP18 OP19 and 25 OP19 OP31 Good Practice Recommendations The reviews of residents care plans should be more detailed to demonstrate if the care plan is effective or not. Staff should receive training on the homes and local authority adult abuse policies and procedures Radiators in the lounges and corridors should be fitted with guards. The exterior of the building should be repainted. The manager should have supernumerary hours. MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D, off Rudheath Way Gadbrook Park Northwich Cheshire, CW9 7LT 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 MINSHULL COURT MENTAL NURSING HOME F51 F01 S18755 Minshull Court V223234 080805 Stage 4.doc Version 1.30 Page 24 - 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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