Inspection on 10/01/07 for Murley House Nursing Home

This inspection was carried out on 10th January 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Murley House Nursing Home 24/02/10

Murley House Nursing Home 10/12/09

Murley House Nursing Home 07/04/09

Murley House Nursing Home 28/04/08

Murley House Nursing Home 05/12/07

Murley House Nursing Home 03/08/07

Murley House Nursing Home 26/04/07

Murley House Nursing Home 09/05/06

Murley House Nursing Home 12/01/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Murley House Nursing Home Wyvern Road Taunton Somerset TA1 4RA Lead Inspector Stephen Humphreys Unannounced Inspection 10th January 2007 09:30 X10015.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 Murley House Nursing Home DS0000065815.V320342.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. 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. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Murley House Nursing Home Address Wyvern Road Taunton Somerset TA1 4RA 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) 01823 337674 www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Mrs Tina Mandy Marshall Care Home 105 Category(ies) of Dementia - over 65 years of age (105), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (105), Old age, not falling within any other category (105) Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A Nurse (RMN) on sub-part 1, RN3 or RNHM, of the current NMC register must be on duty at all times when nursing beds occupied exceed 34. Up to 45 places for Service Users requiring personal care only in the categories OP and DE(E) to be accommodated on Rose Wing. Up to 60 places for Service Users requiring nursing care in the categories DE(E) and MD(E) to be accommodated on Redwood Wing. 9th May 2006 Date of last inspection Brief Description of the Service: Murley House Care Home is purpose built and is situated in a residential development on the outskirts of Taunton. The registered provider is Ashbourne (Eton) Ltd a subsidiary of Southern Cross Ltd. The home is registered with the Commission for Social Care Inspection (CSCI) to provide a service for up to 105 service users to include personal and nursing care. Murley House consists of two units: Redwood House which provides nursing care, for service users over 65 years of age suffering with a dementia and Rose House which provides personal care for service users over 65 years because of old age or dementia. The main entrance to the home is at the front of the property. There is ample car parking to the front of the home. The main entrance is kept locked at all times for security of the home and the service users. There is a bell on the front door for visitors to make staff aware they are there. The current fees range from: £361 - £650 dependent on need. The home also provides day care for up to 14 service users, Monday to Friday. This provision is not registered with the CSCI. This service is staffed separately. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second key inspection of Murley House Nursing Home using the Inspecting for Better Lives methodology introduced by the Commission for Social Care Inspection in April 2006. The inspection methodology used by the Commission for Social Care Inspection enables the inspector to make a judgement on the quality of the service delivery based on the outcomes for service users. The trigger for this key inspection was to review the progress made in the delivery of the services to persons with dementia. During the site visit the two inspectors were able to spend time talking to staff relatives, service users and the registered manager. A tour of the home was made and the quality of the furnishings in the bedrooms was observed. The site visit was carried out over two consecutive days and was unannounced. During the site visit the manager discussed the proposed introduction of a new unit into the home being developed to provide care for service users with complex and challenging needs. The indication is that the service users accommodated into this unit will come within the current registration categories but need a closer care service. The inspectors were told that the discussions to move this unit forward would be taking place and further information provided to the Commission for Social Care Inspection when the decisions have been made. The inspectors were able to have discussions with seven relatives during the day. Lunch was observed along with some care practices and the administration of medicines. The lead inspector for this care home sent out written service user survey questionnaires and comment cards to visiting health care professionals prior to the site visit. On this occasion only three completed surveys were returned. The reason for the poor return may have been due to a recent satisfaction survey carried out by the registered provider on the homes quality of service. The comments received back were very positive about the service delivery. One comment was “Murley house has had many changes over the last year, all for the better”. Another commented “The meals have improved due to the new chef”. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 6 The registered manager has introduced changes in care practices that have benefited service users. Unfortunately discussions with some staff indicated that they did not have the time to put into practice the training they have received in dementia care. What the service does well: What has improved since the last inspection? The registered manager informed the inspectors that a member of staff will take over the responsibility for the Yesterday, Today and Tomorrow (YTT) training. This is a recognised and accredited training in dementia care for staff. Most of the staff in this home have now received the training including housekeepers and catering staff. The registered manager felt this training was improving the quality of the service delivery. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 7 The organisations dementia care consultant has visited the home and had meetings with relatives to help with their understandings and fears of dementia. The registered manager has introduced open clinics for relatives on one day a week in the evening. Relatives meetings are being held every six weeks, the registered manager said the meetings have become more of a support group for those who attend. The registered manager has carried out staff appraisals with staff personal development plans being agreed as part of the outcome of the appraisal. Improvements have been made to the dinning and lounge areas in the home. A new laundry has been opened and the lighting in the Rosewood lounge has been improved. A significant improvement is the introduction of outings for service users. The registered manager has introduced outings on a Wednesday for service users. This unfortunately is limited to the number of service users who can be taken out in the minibus. To ensure service users get the opportunity to go out, a rota system has been introduced. The registered manager feels that service users independence is better supported as a result of the staff training in dementia care practices. The registered manager said there is more consistency in the management of the home. Heads of department meetings are now held daily and evaluation of regular management audits is making things more purposeful. What they could do better: The inspectors concluded that since the last inspection the service delivery in this home has improved however there are areas that need to be reviewed and improved. Nursing and care staff spoken to felt that the care planning system introduced by the registered provider is laborious and time consuming. This has resulted in poor quality care plans being produced. The inspectors discussed the level of social care being offered and delivered in the home with the registered manager. This could be improved with the Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 8 introduction of a dedicated activities team. Murley House can accommodate up to one hundred and five service users. At the time of this visit there were eighty service users in the home, and only one activities person. The introduction of a social activities team would enable many more service users to be involved and provided with stimulating and therapeutic activities. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3. Quality in this outcome area is good. People who use this service have good information about the home in order to make an informed decision about whether to take up the offer of accommodation. The personalised care needs assessment identifies the service users personal and diverse needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the statement of purpose and service user guide was provided with the pre-inspection information. The inspector has reviewed the documents and found them to be clear and informative with all the necessary information to meet the national minimum standard. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 11 Two relatives spoken to said they had received copies of the service user guide and had read them. They found the documents to be informative and helped them to make a final choice to place their relative in the home. None of the service users on the nursing unit could recall reading any of the documents. One service user on the residential unit said they could remember reading the service user guide. During a tour of the home copies of the service user guide were found available in the service users rooms. The inspectors were able to review the terms and conditions of accommodation. Signed contracts were seen for recently admitted service users. A relative or representative generally signs the contracts. The inspectors reviewed the pre-admission assessments of three recently admitted service users and six other service users who had been in the home up to three months. The organisation has produced a detailed pre-admission assessment pro-forma for assessing the physical and dementia care needs of the service user. The inspectors found the assessments to be detailed and comprehensive. Unfortunately the identified assessed care needs were not fully transferred into the service users care plan. Admissions are not made to the home until a full needs assessment has been carried out by either the registered manager or the deputy. The team leader from the residential unit may also carry out a needs based assessment. One recently admitted service user was of European origin. The registered manager was able to allocate a member of staff from the service users home country to assess and identify care needs. Other members of staff were then able to understand the diverse cultural needs of the service user. Staff training records examined evidenced that many of the staff had received specialist training in dementia care, using the Yesterday, Today and tomorrow programme of care and communication. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. Although improving, the variable practice regarding the planning and delivery of care means that all services users cannot be sure that their health and personal care needs will be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user care plans showed signs of improvement and were generally complete. The care plans of service users with dementia are now more detailed than previously seen. The inspectors reviewed six care plans on the nursing wing and two on the residential wing in detail. The significant finding was that the care plans were not reflective of the current state of the service user and they were not working tools. The findings indicated that the care delivery was based on a task orientated philosophy and Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 13 not person centred. The care plan documentation is specific and detailed. The care plan would be very comprehensive if completed correctly. None of the care plans reviewed were up to date. The care needs had not been evaluated for six months in some cases. The daily report did not reflect the care delivery as recorded in the interventions. In the main the interventions did not provide a pathway to an outcome. All the care plans reviewed had the same evaluation statement, “care plan remains effective”. Two care plans identified the service users as having a sore or a wound and one care plan recorded “to provide a healthy diet”. One care plan had been on going for twelve months. There was no record of progress or regress, just “care plan remains effective”. The other care plan described the care of a wound. The wound record form used is a generic form that is ticked by the person completing the wound care. The record of wound dressing changes was found in the daily record and not with the wound record form. The inspectors identified that the dressing had not been changed for 11 days. The registered nurse on duty was not aware of this situation. After reviewing the care plans the evidence available was sufficient for the inspectors to conclude that the service users receive a good standard of personal care that is based on rituals and practice and the care plans are a paper exercise. Comments from the staff who develop the care plans included “they are laborious and do not reflect the current state of the service user” The inspectors found that the staff responsible for developing the care plans did not fully understand the system, therefore neglected to develop or to maintain the plan appropriately. The staff did not place a high value on the care plans and in many instances did not read them. One carer that had worked in the home for six months said “I have read some of the care plans but not all”. “I do not read them daily, I know what needs to be done from handover and asking the seniors”. Service users spoken with felt their privacy was respected and that staff were sensitive when they needed help with personal care. Discussions with staff showed they had an overall understanding of the needs of people with dementia and were seen to be patient and kind when interacting with them. Visitors spoken to confirmed this. One relative commented, “the staff here are so understanding” and “I think the staff are great, compared to the last home”. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 14 Care plans include health care requirements and service users felt that if they needed to see a doctor or attend an appointment this was arranged quickly. Hearing aids, dentures and other aids are not regularly checked. One service user said that my daughter cleaned my hearing aid. There was evidence in the care plans of health care treatment and visits by health professionals including health monitoring such as monthly weight records and nutritional monitoring. Unfortunately the care plans did not link the two areas together. In one care plan the interventions recorded appeared appropriate to ensure an effective outcome. However the weight records for the service user needing a healthy diet showed a loss of 12 kilograms over a period of 10months and a total loss of nineteen kilograms over eleven months. The care plan evaluations did not link the weight loss with the care need and no action was identified regarding the weight loss. The care delivered is based mainly on the knowledge and experience of the staff in delivering a good standard of basic care and not on a needs based individual care plan. Comments recorded from satisfaction surveys included-“relative is wonderfully looked after”, “Very caring atmosphere”. Throughout the inspection the inspectors were able to observe directly and indirectly the interaction of staff towards service users. Evidence was seen of respectful, kind and caring attitudes from staff. Dignity was maintained when staff were undertaking tasks with service users, for example, at lunchtime when service users needed assistance with their meals and when a mobile hoist was used to move a service user. The medication systems were assessed. A clinic room has been provided to store medications and house the medicine trolleys. New medication fridges had been provided. Drug fridge temperatures are recorded on a daily basis. Evidence was seen of monthly medication audits of systems and records being carried out to ensure competencies of the staff dealing with medications. The Medication Administration Records (MAR) seen at inspection evidenced good practice. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is adequate. A limited range of activities within the home and community mean the service users do not have a range of opportunities to participate in stimulating and motivating activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the time spent on site the inspectors spent a considerable length of time observing staff interaction with service users, speaking to service users, relatives, staff and management. The inspectors observed the daily life styles were significantly different on each unit. The service users on the nursing unit were highly dependant with communication being difficult. All service users needed a high level of personal care. During the two day site visit very little social care was observed on the nursing unit. Staff interaction was positive, sensitive and appropriate to good dementia care practice. However the level of staff on this unit did not allow for Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 16 any social care time. The inspectors observed a period of thirty five minutes between one and two PM on day one, when no staff were available to any of the service users sitting in the lounge. The two staff members were busy attending to the needs of one service user who was in their room. When staff interacted with service users the majority was task orientated for example when someone needed the toilet or someone was given a cup of tea. There were long periods where service users were not spoken to and left to sleep during the morning and afternoon. The most interactions observed between service users and staff occurred during the serving of lunch. Staff carried out this interaction sensitively and respectfully. Very little social care was observed on the residential unit on day one as it was the day six service users were taken on an outing in the minibus. No other activities were being carried out for those service users in the home. Service users in the residential unit did have an opportunity to join the day care service users doing an activity but few took this up. Service users were observed to be sitting reading the daily paper or a magazine. Some were watching television. Three service users were just sitting with their chin on their hands. The inspector spoke to one service user who said, “I do go out for walks occasionally”. When asked about life in the home the replies were “ At first I found it difficult but now I am very happy with it”. “You can do things you want, everyone helps us”. “ I don’t have to worry about what to do, they are lovely people”. “The staff don’t talk to us much, if I ask them they would talk – but they don’t go out of their way to talk very much”. Comments from another service user about life in the home included, “ The food is good, and I’m reasonably comfortable”. Comments from visiting relatives included, “ The staff are very friendly and Tina informs us of the relatives meetings”. From the discussions with service users and relatives the inspectors concluded that the general well being of the service users on the residential unit was maintained although there was lack of social stimulation. The staff having received appropriate dementia care training are utilizing their acquired skills but find it difficult to put into practice because of the high level of care needs. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 17 Service users would benefit from a planned social activities programme carried out by a dedicated social care team. The social care needs of service users in the home are not being met satisfactorily. Evidence was seen that service users are able to maintain contact with their family and friends. Throughout the two days of the inspection visitors were seen at the home. The visitors’ book reflected many visitors to the home at differing times. The lunchtime meal experience was observed on the first day of the inspection. Service users had appeared to have chosen what they wanted the day before. Service users spoken to confirmed they were asked the day before but could not remember what they had chosen. The head chef said that service users are able to have a choice of main meal except on roast days, which are Wednesday and Sunday. A vegetarian option is available on these days. The meal tables in the home are set fully. Service users on the residential unit were observed to pour their own drinks or be assisted by staff. Menus were placed on the tables in large print. On the second day inspectors observed carers taking the two meal options plated to the service user to help them choose the one they wanted. The meals were well presented and appeared nutritious. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Service users and visitors to the home have the information to enable them to make a complaint or raise concerns. This judgement has been made using available evidence including a visit to this service. . EVIDENCE: The complaints procedure is displayed in the main reception area. Service users spoken to said they knew who to talk to if they had a concern and relatives consulted with were aware of the complaints procedure. Staff spoken to said they were aware of the whistle blowing procedure. Reference to it was seen on the staff facility notice board. Staff spoken to at inspection knew the steps to take should they suspect any form of abuse. Staff training records examined indicated that many staff had received abuse awareness training, and further training is planned according to records seen. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 19 Service users told inspectors that they felt safe at the home and comment cards from those able indicated the same. The pre-inspection information recorded twenty complaints received by the home in the last twelve months. The Commission for Social Care Inspection has not received any direct concerns about this home since the last inspection. The inspectors reviewed the investigation notes of the complaints. The issues in the main were concerns about missing personal items. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 26 Quality in this outcome area is adequate. Service users can be assured of a warm and well-maintained environment. Service users accommodation is homely and equipment suitable to meet the nursing needs of all service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspectors assessed a sample of bedrooms in both units, and the communal areas. The nursing unit is just over twelve months old and the fixtures and fittings are in good condition. The residential unit lounge has been redecorated and further work is planned. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 21 At the time of the site visit there was considerable redecorating going on in the home. The development of a third unit for service users needing close care was being developed, this has caused slight inconvenience to service users. One concern discussed with the registered manager was the number of usable baths in the home. The inspectors identified that only two baths were in a usable state for the total number of service users in the home. The nursing unit rooms have a shower built into the ensuite room. The residential unit ensuite rooms only have a toilet and wash hand basin. The lack of usable baths is concerning and the registered manager was asked to review this situation. The registered manager is proposing to develop a lounge on the first floor of the residential unit whilst redevelopment work on the third unit is being carried out. Although the room was suitable the location would present logistical problems for staff and restrict service users movements. Management informed the inspectors that the safety of stairwells has been addressed. The stairwells are now behind studded walls with door opening controlled by a keypad. All areas of the home seen at this inspection were clean and hygienic. Infection control measures were in place. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 22 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good Service users can be assured that competent and skilled staff will meet their care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector discussed staffing issues with the manager and individual staff members during the visit. The inspector reviewed the rotas and confirmed that the staff on duty were on the rota. Discussion with staff of different grades was positive and indicated that staff were happy in the home. Comments from staff included “I enjoyed the YTT training but can’t do as much as I would like”. All the staff spoken to said they would like to have more staff to carry out the activities. The home encourages NVQ training amongst carers and has qualified assessors to support the staff in training. Overseas staff spoken to were very positive about the way they were integrated into the staff teams. All felt supported and welcomed. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 23 Staff said they do activities with service users in the evening. All the staff felt they had received a good induction training into the home however the induction training did not include dementia care practices. All the staff said they had to learn the dementia care on the job. The inspectors were told that the organisations induction training is based on the skills for care standard however no records were available to substantiate this at the time. It is recommended that the registered manager consider the introduction of dementia care as part of the induction training. The manager has developed a staff training matrix and individual training records for the staff. The matrix and files were reviewed. Mandatory training is being carried out. Staff have attended Dementia specific training since the last inspection however most of the staff said they felt they were not able to spend as much time as they would like with the service users. The inspector checked the staff files of the three most recently employed persons. All the required information and security checks were received before the staff commenced employment. References were received from last employers however the reference requests are based on character. Comments from service users and relatives via comment cards indicate that staffing levels are adequate. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 24 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 33,36,38 Quality in this outcome area is adequate. The registered manager is experienced and runs the home for the benefit of the service users. The registered manager works to continuously improve services and quality for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 25 The evidence gathered during this inspection has shown that the changes made by the registered provider and manager have improved the well being of the service users. The registered manager encourages and provides staff training opportunities to develop competencies and strengthen the teamwork in the home. The registered manager is working towards a service user focused ethos and has developed stronger relationships with relatives since the last inspection. Unfortunately evidence suggests that the care practices are task orientated and not flexible to promote person centred care. There is a robust quality assurance system in place along with up to date policies and procedures. These are top down driven and have to be followed. The quality assurance system includes monthly audits of medication and a home audit that reviews health & safety, pressure sore incidence, complaints and staff files. The inspectors reviewed the recently completed audits of the above. The audits were comprehensive however there didn’t appear to be a working action plan to accompany the identified shortfalls in the audit outcomes. Without the action plan the value of the audit is questionable. This was very prevalent when looking at the care plan audits. The inspectors found the standard of care plans was poor and information out of date. The care plan audits identified only gaps where information was required to be input. The care plan audit did not assess whether the care plan was a working tool or whether it represented the current state of the service user. As described in section two (standard 7) the care plans reviewed by the inspectors were out of date and just a paper exercise. The registered manager indicated that the quality assurance process in the home is bottom up and staff made aware of action plans. There was no evidence of this. The conclusion is that the audit process although carried out does not produce an accurate record of the quality of service delivery in the home. Two relatives confirmed that they did look at the care plan occasionally however they pointed out information that was out of date and of no significance to the care process. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 26 Statutory maintenance records were checked. The fire logbook and hot water temperature records completed satisfactorily. Mobile hoists and passenger lift were serviced as required. There was evidence of adequate pressure relief equipment and other aids to meet service users needs. The inspectors visited one service users room and found a senor mat on the floor however the wire leading to the call system was trailing on the floor and would be a hazard to the service user’s safety. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 X X 3 X 2 Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(2) Requirement The registered person shall— (a) make the service user’s plan available to the service user; (b) keep the service user’s plan under review; (c) where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; this refers to the need to ensure care plans are kept up to date and are working tools. The registered person shall ensure that the assessment of the service user’s needs is— (a) kept under review; and (b) revised at any time when it is necessary to Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 29 Timescale for action 20/03/07 2 OP8 14 (2)(a)(b) 20/03/07 2 OP21 23 (j) 3 OP38 13 (4)(a) do so having regard to any change of circumstances. This refers to the need to link nutritional monitoring information to care needs. The registered person shall 20/03/07 having regard to the number and needs of the service users ensure that: there are provided at appropriate places in the premises sufficient numbers of lavatories, and of wash-basins, baths and showers fitted with a hot and cold water supply. This refers to the lack of usable baths in the home. 28/02/07 The registered person shall ensure that— (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; this refers to the trailing wire from the sensory mat. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The registered manager should ensure that all service users preferences are recorded in the care plans and that care staff respect those choices. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 30 2 OP12 3 4 OP27 OP33 The registered provider should ensure that all service users in the home are provided with opportunities for stimulation through leisure and recreational activities that suite their needs. The registered person should consider the development of a dedicated social care team in the home extraneous from the care team. The registered person should ensure that any quality audits carried out are robust and supported with an appropriate action plan. Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Murley House Nursing Home DS0000065815.V320342.R01.S.doc Version 5.2 Page 32 - 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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