Inspection on 12/01/06 for Murley House Nursing Home

This inspection was carried out on 12th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 10/01/07

Murley House Nursing Home 09/05/06

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 Caroline Baker Announced Inspection 09:30 12 and 13 January 2006 th th 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.V265500.R01.S.doc Version 5.1 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.V265500.R01.S.doc Version 5.1 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) 020 7929 3444 020 7929 3555 Ashbourne (Eton) Limited Vacant 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.V265500.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Where the Registered Manager is not a nurse on the current NMC register sub-part 1, RN3 or RNMH, there must be a nominated nurse employed as a Care Manager (Deputy) who is on this part of the register (RMN). 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. 28/04/05 2. 3. 4. 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. Since the last inspection, the registered provider has changed from Ashbourne Care Ltd to Ashbourne (Eton) Ltd a subsiduary of Southern Cross Ltd. The home was re-registered in December 2005 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 Wing which provides nursing care, for service users over 65 years of age suffering dementia and Rose Wing which provides personal care for service users over 65 years who require assistance by means of old age or dementia. The provision of a new extension which opened in December 2005 has increased the homes capacity from 69 to 105 beds. Conditions of Registration are detailed above. Since the last inspection, the registered manager resigned her post and a manager designate is in place at the home. The CSCI is awaitng an Application for Registration. The Responsible Individual is Liz Whyte. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first Announced Inspection since being registered with a new provider – Ashbourne (Eton) Ltd in December 2005 and since the home has increased its provision from 69 to 105 beds. The Inspection took place over two days and was conducted by two inspectors on the first day and three on the second day, which amounted to 37 Inspector hours. The inspectors felt welcomed by the manager designate, the staff and service users. There were 73 service users residing at the home at the time of this inspection, including one in hospital. 37 were in receipt of nursing care. 8 service users receiving nursing care were residing in the newly built extension. The inspectors were told that admissions had ceased for up to two weeks until the new wing was running smoothly. The home also provides day care for up to 14 service users, Monday to Friday; there were 8 each day, at the time of this inspection. The CSCI sent comment cards to service users and their relatives for their views on the conduct of the home. 11 service users responded and 21 relatives responded. Comments were mixed as reflected throughout the report. A tour of the premises took place where a selection of bedrooms and communal areas were seen. The inspectors consulted with at least 36 service users, six visitors and 12 staff during the inspection. The manager designate was available throughout the two days of the inspection. During the inspection the inspectors observed interactions between staff and service users. Selections of records were examined relating to care, health and safety, and staff. It was very concerning to find many regulatory shortfalls at this inspection, which put service users at risk of harm. The shortfalls are reflected throughout the report. Given the amount of concerns raised a Regulation Manager from the Commission visited the home unannounced on Saturday 14th January 2006 at 12:30 hours until 14:10 hours. Occupancy had gone up to 74 as a service user had been admitted to Rose Wing to receive personal care only – this was a Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 6 planned admission. Further concerns were noted as reflected throughout the report. What the service does well: What has improved since the last inspection? What they could do better: The home has been through a period of unrest over the past 12-18 months and it has been sold for the third time. The home has been without a manager for a period of 10-12 weeks until a manager was appointed in December 2005. This unrest has had an evident impact on staff morale and staff turnover, which in turn has affected the way the home is managing to meet the National Minimum Standards. Twenty-eight of the thirty-eight standards were assessed at this inspection and the home has only met four of those standards. Major shortfalls were identified in twelve of the standards assessed and minor shortfalls were identified in the other twelve assessed. This led to thirteen Immediate Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 7 Requirements being issued at the time of the inspection and many other Requirements being made as reflected later in the report. Service users will benefit more if they have been assessed, prior to admission, by someone from the home, to ensure their social and health care needs can be met. Service users would benefit from staff attending their basic care needs such as dental/oral care. On many occasions toothbrushes and toothpaste were found unused and dentures were left in bedrooms. Comments received from relatives included: ‘Dental hygiene seems to be somewhat lacking sometimes as does hand and nail care’. A recent complaint raised concerns with regard to health care and oral care. Service users would benefit from completed care plans that reflect their current needs, to enable staff to meet their needs. Service users would benefit if staff pay attention to respecting their privacy and dignity in all aspects of daily living. On many occasions at meal times service users were left to fend for themselves, allowing food to become cold and allowing them to spill it over themselves, the table and the floor. Shared rooms assessed had prescribed creams, toothpaste, toothbrushes, dirty hairbrushes all mixed together making it difficult to determine what belonged to whom. One screen seen was missing a curtain and this meant that privacy would not be promoted. In one lounge there were odd shoes displayed as no one knew whom they belonged to. Service users would benefit from the menus being reviewed and a variety of fresh fruit throughout the day and vegetables being available not just one choice. Those service users who require a soft diet would benefit from it being presented in a way that makes it look appetising. Comments received from relatives included ‘My relative complains about the quality and variety of the food’ and ‘the food provided is not liked’. One service user was heard to say “you get gravy whether you like it or not” and other comments included ‘It would be nice to have a choice of sauces with each meal, plus sachets of sauce are hard to open. Can we have cake on the menu for tea rounds not just plain biscuits?’ Service users would benefit if staff had available written instructions as to whom they could raise concerns with should they suspect any form of abuse. Service users would benefit from the home being refurbished in certain areas such as some communal bathrooms and toilets and worn armchairs being replaced. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 8 Service users would benefit from the home being clean and infection control measures being put into place and followed. Service users would be less at risk of abuse if staff who commence employment at the home have been thoroughly checked as to their fitness to work with vulnerable people. Service users would be at less risk of harm if the medication administration, recording and storage was in line with current legislation and staff practices were safe. Service users would benefit from being able to access a call bell at all times should they need assistance from staff. More staff supervising mealtimes and the communal areas would minimise the risk of any harm coming to service users and help to promote and maintain their dignity. There have been shortfalls in minimum staffing levels and service users health and welfare has been affected. Staff confirmed that they often turn service users in bed alone and unable to assist people to the toilet when they need to. It was evident that staff felt under pressure. Comments received from relatives included: ‘I do not consider there is enough staff on duty during the day shift. There is no time for one-one’s. If there were, it would give those residents who wish to, go for a short walk for fresh air and exercise. I would like to say however that the staff are very kind and caring, just not enough of them’. Service users would be at a less risk of harm if all radiators were guarded in the communal toilets, and if laundry and sluice areas were kept locked when not in use. Also denture-cleansing tablets not being stored securely put service users at risk of harm. Service users would benefit from the bath water being at a reasonable temperature to ensure their comfort at all times. Some bath hot water outlets tested below 35oC at the time of the inspection. Staff and relatives told inspectors that there have been a number of occasions when there has been a lack of hot water. The Commission had not been and must be informed, of any incident at the home that could affect the health and welfare of the service users, for example when there are shortfalls in staffing levels and no hot water. Given the serious concerns identified at this inspection, which are reflected throughout the report, representatives from Southern Cross Ltd agreed to meet with the Commission to agree an Improvement Strategy. At the meeting held on Friday 20th January 2006 at Murley House, it was acknowledged that areas identified needing improving and at this time the home had already made a positive headway in meeting the Immediate Requirements. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 9 The home will be monitored on a regular basis to ensure that service users are protected from any potential risks of harm. 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. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 10 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.V265500.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 3; 4; and 5. NMS 6 does not apply to this home. The home had not taken appropriate steps to ensure the needs of prospective service users can be met. Staff at the home had the skills individually and collectively to meet the current service user group’s needs, however basic needs were not always taken into consideration. Service users and/or their representatives are able to assess the home before they choose to live there. EVIDENCE: Seven individual care plans were assessed and the service users met at inspection as part of the case tracking process. Only one care plan assessed evidenced a pre-admission assessment being carried out by the home, to ensure it could meet the individual service users needs. There were details in each plan from Social Services and one contained a Single Assessment Plan. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 12 Staff training records examined evidenced that many of the staff had received specialist training in for example, dementia, communication, and abuse awareness as well as mandatory training. There are Registered Nurses on duty 24 hours per day including those with mental health training. Evidence gathered through this inspection highlighted that all staff are in need of training in basic care needs as detailed later in this report. The home encourages service users and or their representatives to visit the home prior to admission to help in their decision. The home runs a day care centre and some service users who attend can go on to become residents at the home. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 7; 8; 9 and 10. Care planning systems were in need of improvement. It would be difficult to meet an individual service users needs by following the care plan’s sampled. The home’s procedures for the management and administration of medication put service users at a serious risk of potential harm. Staff interventions and findings on assessment of the environment did not always respect the privacy and dignity of service users. EVIDENCE: Seven care plans were assessed and the individual service users met at this inspection. Some aspects of the care planning process were adequate but care plans sampled did not fully reflect an individual’s assessed needs nor did they always give clear instructions for staff to enable them to meet individual’s needs. Some assessment sheets were not completed and many did not reflect the service users name and were not signed by the person recording the assessments. GP’s telephone numbers were not always reflected. There was no evidence of service user and or their representatives being involved in the Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 14 development of their care plan. Only one of the care plans reflected a care needs plan for overnight care. Two service users assessed on Redwood were cared for in bed, their overnight fluid and turn chart was empty showing no evidence of interaction with staff from 20:00 until 09:00 the next day. All risk assessments were in place in each of the care plans including: falls risks, nutritional risks, moving and handling, pressure ulcer risks and bedrail risk assessments. As mentioned below, evidence gathered during this inspection concluded that basic care needs were often omitted for example oral care. Service users spoken with did not always have their dentures and care plans sampled did not always reflect oral health needs. On inspection of the medication storage areas it was found that: • The temperature control of both the room and the medicines fridge on Rose wing was poor. The room temperature was recorded at 27C and the fridge had been recorded as having a current temperature of between 4C and –1C over the period between 28th October 2005 and the date of the inspection. Some medication was also stored in the medicines fridge whilst in use although recommended by the manufacturer to be stored below 25C at room temperature. There were many occasions where products for external use were prescribed. However it was not possible to determine from the records made if the had been administered in accordance with the instructions of the prescriber. Throughout the home there were many instances where prescribed medication was not stored securely. This was especially apparent with external products left unsecured in service users rooms. A discrepancy was found in the actual and theoretical stock of a sedative medication. There were many instances of unlabelled medication. For these it was not possible to determine to whom they were to be administered. Although the home has guidance on the expiry dates of medication after opening and instructions to the staff to enter an opening date onto these products it was found that many of these medications had not been dated. For service users prescribed medication with a variable dose it was not always possible to determine from the records the actual dose that had been administered. The home is keeping a list of medicines being returned as pharmaceutical waste for disposal. However from records made on the Medication Administration Record (MAR) charts indicating that medication had been refused and destroyed it was not always possible to reconcile these with the entries in the waste disposal book. • • • • • • • Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 15 • Some date expired sterile products were found in the medication room on Redwood wing. During this inspection evidence was found to conclude that the privacy and dignity of the service users was compromised. The findings and observations were as follows: • On assessment of the premises at least four shared rooms were assessed – in one shared room the screens were missing a curtain. In one there was a commode pot under the sink in need of cleaning and in the same room there were three tablets of soap, toothpaste, prescribed creams, toothbrushes and other items mixed together around the sink, making it hard to determine whose items were whose. In one shared room a dirty commode was found; again it was hard to determine whom this belonged to, as there was only one. Some toiletries found in a windowsill looked to have faecal matter on them and used pads were found. Dentures were seen in some of the empty rooms and toothbrushes looked as if they had not been used for sometime. One tube of toothpaste seen was very encrusted evidencing lack of use. In many rooms hairbrushes and combs were unclean. Disposable razors were left accessible used and unclean. One electric razor was in need of emptying and cleaning. At meal times on Redwood many service users needing some assistance were left for long periods with food. They were left to spill the food over themselves, the tables and the floor. One service user spilled their soup over them and was left crying and another was eating whilst almost lying down in their chair – the inspectors alerted staff to this. Food was left to go cold in front of service users on some occasion staff were seen standing over service users whilst feeding them with no conversation. Service users were left unable to reach tables and without protection in the corridor of Redwing at suppertime on the first day of the inspection. Service users in some areas of the home appeared to be left on their own without any interaction from staff for long periods of time. Some staff interacted well with service users others appeared not to speak to service users during any interaction with them. • • • On Rose Wing the atmosphere was happy, staff were seen interacting with service users in a kindly way and meal times appeared dignified. Staff spoken to during the inspection raised their own concerns of feeling unable to cope with the heavy workloads therefore compromising the service users privacy and dignity. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 16 Service users spoken to complimented the staff group and indicated that they were treated with respect. Comment cards received showed that 54 of service users felt that their privacy was respected and 72 felt well cared for. Comment cards received from relatives/visitors indicated that 85 were overall happy with the care provided at the home. 90 indicated that they could visit their relatives/friends in private. Relatives spoken to during the inspection indicated that they were overall satisfied with the provision of care at the home. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 17 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 the following standard(s): 12; 13; 14 and 15 The homes provision of activities was very good at the time of this inspection, although this provision was not accessible to many service users who required more support. The home provides a varied menu, which identifies choices, however it appeared that service users were not always given a choice and the soft diet served looked bland and unappealing. Improvements must be made in food and drink provision given the comments received from service users, relatives and staff. EVIDENCE: The activities co-ordinator for the home spoke to the inspectors and went through the programme of activities provided. Each service user had an individual social plan of care, however the most recent service users admitted to the home had yet to have their social plan developed. The last entries of activity provision for the plans sampled were dated 09/01/06. The activities co-ordinator explained that when there were shortfalls in staff for example, in reception, they helped out. They also helped collect service users using the day centre at times, and this was so on the second day of the inspection. This would impact on the activity provision within the home and Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 18 keeping social plans up to date. The activities co-ordinator also plans, runs and minutes meetings at the home for service users and relatives to air their views. Recorded evidence was noted that the following activities are provided at the home on a regular basis: • Visits from a donkey, live entertainment, bingo, daily walks in the home, animal visits (dogs seen during the inspection), arts and crafts, newspaper reading, reminiscence, and one-one care. It was the activity co-ordinators last day at the home and the inspector’s hope that the activity programme will continue to grow and that all service users at the home will be given a chance of joining in. During the inspection it appeared that many service users in the home did not receive any stimulation apart from at meal times when even then they would be left to eat alone on many occasions. 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. Comment cards received indicated that 100 of visitors felt welcomed. Care plans sampled did not always indicate preferred names or preferred times of getting up or going to bed. Those service users able indicated that they could do as they pleased at the home. Lunchtime and suppertime were observed on the first day of the inspection and two inspectors were able to have lunch on Redwood Wing on the second day of the inspection. On the first day the soft diet served to service users looked bland and unappetising and no thought had been given to its presentation. The care staff are expected to serve the meals out each day and it was evident that there was an identified training need in food presentation. One service user was heard to say “you get gravy if you like it or not all over the dinner”. Staff told inspectors that often the plates were very hot to touch and this put vulnerable service users at risk. There were no plate guards so service users having difficulty eating were often seen pushing food off the plates and eating off the tablecloths. As mentioned earlier there did not appear to be sufficient staff available to assist the more frail service users needing help with their meals. The inspectors were told by staff, service users and relatives that the food provision had changed over the past few months, for example: smaller quantities, less variety, and less choice of juices and fluids. Comments received from service users via comment cards indicated that only 9 of Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 19 service users liked the food on offer. Comments received from service users included: “Food portions too small and we get no sauces or nice biscuits anymore” and “It would be nice to have a choice of sauces with each meal, plus sachets of sauce are hard to open. Can we have cake on the menu for tea rounds not just plain biscuits?” these comments were passed onto the manager designate who discussed then with the catering manager. The inspectors met with the catering manager to discuss the menus. It was agreed that the menus be revised to include and reflect what is available at breakfast time. As discussed the menus should be revised with input from service users and/or their representatives. Comments received from relatives comment card audits included: “My relative complains about the quality and variety of the food”, “Food provided is not liked – have informed them of this” and “Not enough soft drinks available”. These comments were passed on to the catering manager. On the second day of the inspection the lunchtime meal was fish, chips and peas. The inspectors joined service users residing on Redwood Wing for lunch. It was concerning to watch the disorganisation at lunchtime. The tables were not laid ready for lunch and cutlery and drinks were given out at the same time as the meal. Tomato sauce was put on the plate without notice or choice. There were no condiments of vinegar or salt available unless asked for. Teas and coffees were served without asking first what the service users preferred. Many service users were left to feed themselves when it was evident they needed assistance. The meal served however was tasty and hot when served and those service users asked had enjoyed it. Fresh fruit was not readily available at the home and the inspectors were told that the choice was banana only. Only one piece of fresh vegetable was prepared and served on a daily basis. Frozen vegetables were available. It is required that the home take comments received from service users, staff and relatives seriously with regard to the food provision at the home. There should be a variety of fresh fruit available at all times and be offered to service users readily. The use of fresh vegetables should be increased. A variety of biscuits and cakes should be available on a daily basis, and cooked breakfasts should be on offer. Juices and soft drinks should always be available and it is fair to say that they were during the two days of the inspection. The presentation and amount of food should be monitored. Plate guards should be available for service users having difficulties and staff should be available to assist all those needing help at meal times. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 20 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 the following standard(s): 16 and 18. Service users and visitors to the home have the information to enable them to make a complaint or raise concerns. Arrangements for protecting service users from harm or abuse were poor. EVIDENCE: The home displayed a complaints procedure in the reception area of the home. The home had received two complaints in the past 4 months in regard to care delivery, cleanliness, laundry provision, food and fluid provision, staffing levels and staff morale. The CSCI had received copies of the complaints letters sent to the home and are monitoring the way the home responds to these complaints. Findings at this inspection would make the complaints feasible. There had been two POVA issues identified at the home since December 2005. Both issues were related to alleged abuse towards service users. A member of staff had been suspended at the time of this inspection. At the last, and previous inspection it was required that the home updated its Whistleblowing Policy to include the contact details of appropriate outside agencies including the CSCI. The Whistleblowing Policy made available to the inspectors had not been updated. Those staff spoken to at inspection were aware of steps to take should they suspect any form of abuse. Staff training records examined indicated that many staff had received abuse awareness training, however recently recruited staff had not. Given the large Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 21 changeover in staff in recent months and the recent POVA issues, the home must provide training in abuse to all staff without delay. Staff recruitment was not robust enough to protect service users from abuse, as detailed later under Staffing. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 22 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 the following standard(s): 19; 20; 21; 22; 24; 25 and 26. The home did not provide a fully safe environment for service users, at the time of this inspection. Arrangements for the control of infection were poor. The home had strong malodours in places and was unclean and unhygienic in many areas. Some areas of the home need refurbishment. Furniture was noted to worn in some communal areas and private bedrooms. Standards in shared rooms were poor with regard to personal items and toiletries. Many service users could not ring for assistance should they need help, putting them at risk of harm. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 23 EVIDENCE: The home is split into two units, Rose Wing which provides personal care only for service users over the age of 65yrs in the categories of old age or dementia and Redwood Wing which provides nursing care for service users over the age of 65yrs. Since the new extension has been completed the home would be able to provide care for up to 105 service users. To ensure the safety of service users all external doors are kept locked and alarmed and Redwood Wing is accessed via a keypad lock. Some stairwells on Redwood Wing were without keypads and the inspectors asked the manager to look into the reasons why not and ensure risk assessments were completed. The inspectors examined a selection of bedrooms, single and shared and all communal areas at this inspection. Some areas of the home, including some bedrooms, bathrooms and communal toilets especially on Rose Wing would benefit from redecoration. On Rose Wing there was one toilet without a toilet roll holder and without a toilet lid. Some armchairs on both wings were worn and in need of replacement. The home must send a copy of the homes plan of redecoration and refurbishment. The grounds were well maintained at the time of this inspection. From the maintenance records supplied at the time of the inspection it was seen that all portable electrical appliances had been tested in July 2005. Of the remaining records supplied to us at inspection regarding the Monthly testing of emergency lighting and other monthly tasks such as monitoring of hot water temperatures, the records appeared to end in August 2005. The home has a Mini-Bus that is used for the transport of service users, whilst it was possible to see a copy of the insurance certificate at the time of the inspection the current MOT certificate was not available. Communal areas were all in use on the second day of the inspection. It was evident especially on Redwood that communal areas were left for times without supervision from staff. This was brought to the attention of the staff and management. There appeared to be a lack of leadership and organisation of supervision for service users. Service users are encouraged to personalise their bedrooms though some bedrooms were noted to be quite sparse and some items of furniture needed repair or replacement. As mentioned previously where service users share a room it was unclear whose toiletry items belonged to whom. Screens were inadequate in one room and there only appeared to be one commode to share. En-suite facilities were available in single rooms, many items in these rooms were found to be in need of cleaning, in particular hairbrushes. Toothbrushes Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 24 and toothpaste had not been used in many rooms seen, and dentures were left. There were strong malodours noted at this inspection in one hallway and three bedrooms and a sluice area on Redwood. and the majority of areas had a poor standard of cleanliness. Many issues were noted that had implications for the control of infection. These were identified as follows; used bars of soap in communal bathrooms, placed in drawers. As mentioned before, shared commodes, which were unclean. Continence pads storage was poor as identified at other inspections. Used pads were seen in two rooms on armchairs. Used disposable razors were left in two rooms seen. An electric razor was full and unclean in one room. See Health and Personal Care for further evidence of poor infection control. A cotton towel was being used in a sluice on Redwood to dry staffs’ hands and there was no liquid soap available or paper towels in many areas in the new extension on both days of the inspection. This was very concerning that no action was taken on the first day of the inspection when this had been pointed out to staff and management. It was unclear where staff were washing their hands on the new wing. Some communal toilets and bathrooms had disposable bins without lids and some had net pants, pads and disposable gloves stored. A nailbrush was found in one communal bathroom. One laundry room had a damaged floor in the storage area, which needed replacement. A sluice area had an open top bin. One laundry room had damaged flooring and an area of flooring missing. The flooring was also cracked. There were open laundry baskets with dirty laundry in them stored in corridors seen on the second day of the inspection. The food trolleys had to pass these areas on the ground floor. In many rooms assessed there were unclean overlay mattresses stored and it was unclear as to their use. Wardrobes in two rooms needed fixing, one had no handle and one had no door. Specialist equipment was in use in many rooms assessed to include pressurerelieving equipment. Mobile hoists were available for use. Assisted baths were available for use and many baths could be accessed with a mobile hoist. Bath hot water outlets were tested on three occasions. The hot water temperatures ranged from 33oC to 38oC, which is far lower than the HSE guidelines state. Staff had recorded bath temperatures in one bathroom last in September 2005. It was unclear from records seen how often service users received a bath. Staff told inspectors that the home has had many problems with hot water therefore at times service users do not receive a bath. When the home was monitored on 14/01/06 the regulation manager was approached by relatives, who told her that there was no hot water again, and that their relative had not had a bath for ten days recently. The CSCI had not received any Regulation 37 forms informing us of these shortfalls. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 25 Loop systems are provided in communal areas throughout the home and signage appeared adequate. Many service users were found without access to a call bell during the first two days of the inspection, this put service users at risk. It was even more concerning that after an immediate requirement notice had been served on the first day, service users were found without access again on the second day. All bedroom doors had locks, one bedroom door had a star lock and at least three rooms seen had ‘baffle’ locks. Many rooms on the new wing still had keys in the doors. As discussed any locks or baffle locks should be removed as they could be seen as potential restraint. Consent must be gained and risk assessments in place if these types of locks are used. Lockable spaces were available in the rooms assessed. Two communal toilets on Redwood were noted to have unguarded radiators, putting service users at risk of harm. These must be guarded and/or risk assessed. An entrapment risk was noted in one room (shared) on the second day of the inspection where a mattress did not fit the bed and on the monitoring visit where a backrest had been placed under a mattress raising it off the bedrails. The bed was made. This was brought to the attention of the staff on duty and action must be taken to ensure all beds have well fitted mattresses and profiling beds with bedrails are used appropriately to reduce any risk of harm to service users. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27; 28; 29 and 30. The numbers and the way the skill mix of staff was used needed improvement. Staff morale was low. Service users were at a potential risk of harm by staff having a low morale, and a low standard of care. The homes recruitment practice put service users at risk of harm and abuse. Staff training needed updating and developing. EVIDENCE: The home records duty rotas reflecting the staff on duty at all times. The duty rotas are separated into the two wings. The inspectors took copies of duty rotas dated from 1st to the 14th January 2006 for each wing. According to the Rose Wing rotas there should be five staff on duty in the morning including the senior and four staff during the afternoon including a senior and three staff on duty overnight including a senior. At the time of this inspection there were 36 service users residing on Rose Wing, therefore these minimum staffing levels would be adequate. It has been agreed with the CSCI that when Rose Wing is at full capacity of 45 residents then there should be a minimum level of staffing to include 1 senior and five care staff during the day and 1 senior and 2 care staff overnight. Any shortfalls must be forwarded to Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 27 the CSCI in line with regulation 37. According to the rotas seen there have been shortfalls in staffing on Rose Wing on Sunday 1st and 8th January when staff went off sick in the morning on 5th, 6th and 11th January during the afternoon due to sickness. On 14th January during the monitoring visit it was identified that Rose Wing was one carer short all day due to sickness. Action to rectify this was taken once the shortfall was pointed out during the visit. Staff told inspectors that when one wing is short of staff they are sometimes asked to help, making the other wing short of staff. This must be addressed. At the time of this inspection there were 37 service users residing on the nursing wing – Redwood. It has been agreed that up to 40 residents minimum staffing levels should be 2 trained staff and 6 care staff during the day and 2 trained staff and 2 care staff overnight. According to the duty rotas given to the inspectors there have been shortfalls on 1st January there was only one nurse in the morning with five care staff. On 2nd January there was only one nurse in the morning and afternoon with five care staff in the morning and six in the afternoon. On 3rd January one member of staff during the afternoon was on Rose Wing making Redwood short. On 4th and 5th January there was only one nurse on duty during the afternoon and on 6th there was only one nurse on duty all day. There were further shortfalls in staffing noted for 14th and 15th January. According to staff spoken to there are often shortfalls in staffing. There appeared to be no cohesive leadership during the inspection and monitoring visit. Comment cards received from relatives/visitors indicated that 66 felt that staffing at the home was adequate Comments received included: “There has been a turnover of staff and management because of several changes of ownership. It is not always clear who is in charge and how qualified they are”, “There is not enough supervision of some more of the more vulnerable patients who bother my relative”, “I do not consider there is enough staff on duty during the day shift. There is no time for one-one’s. If there were, it would give those residents who wish to, go for a short walk for fresh air and exercise. I would like to say however that the staff are very kind and caring, just not enough of them”, And “I definitely feel there are not enough care staff on duty. The staff that work in the home are all lovely”. Service users spoken to and able complimented the staff group and indicated that they felt well cared for. The majority of service users seen during the inspection were well attired and appeared well cared for, however findings Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 28 reflected throughout this report are concerning and impact on the care of the service users. Staff spoken to indicated that they felt ‘pushed’ and under pressure with the tasks they had to carry out. Some felt that they were not meeting all needs of individual service users, the inspectors were told that toileting does not get completed and service users in bed were often turned by one member of staff as everyone was so busy. The records kept in the service users rooms evidenced this. Staff felt unable to follow manual handling policies and individual assessments correctly. As already mentioned, supervision at mealtimes was inadequate. Many overseas staff are employed at the home and as discussed the skill mix of staff should be monitored and duty rotas developed with this in mind. On both days of the inspection the majority of overseas staff were working together on the nursing wing. It was evident from attitudes of some staff that morale was low at this time and this will impact on care. The CSCI has asked that the home not admit any further service users to the nursing wing until the issues identified at this inspection have been resolved and an Improvement Strategy has been agreed. Eight staff recruitment files were examined and the findings were as follows: • • • • three of the files did not contain references two contained one reference only one contained evidence of a POVAFirst none of the files contained a Criminal Record Bureau enhanced disclosures. Given the recent issues of alleged abuse to service users from two members of staff it is very concerning that members of staff have been allowed to work at the care home before all checks to their fitness have been received. This puts vulnerable service users at risk of harm and abuse. An Immediate requirement Notice was issued in this regard. According to staff records there has been no staff training at the home since October 2005, the most recently appointed staff confirmed receipt of induction and mandatory training. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 29 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31; 33; 36; 37 and 38. There is no registered manager at the home at the time of this inspection. A manager designate has been in place since the middle of December 2005. The home is in need of clear leadership and effective management. At the time of this inspection the home was not taking appropriate steps to ensure the health and safety of service users, staff and visitors to the home. EVIDENCE: At the time of this inspection the CSCI was awaiting an application to register the newly appointed manager Tina Marshall. There had been a period of at least 10 weeks where the home was without a manager and any leadership. The manager designate has a lot of work to do to raise standards of care, food provision, infection control, health and safety, and staff morale. Staff spoken to felt supported by the manager and found her approachable. The manager indicated that she feels supported by the company. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 30 Since being manager designate Tina Marshall has undertaken her own audit of the home on 30/12/05 in line with company policy. Her own audit identified that many areas of the home and the running of the home needed attention and action. Her overall audit of all systems added up to 51.5 . A current Employers Liability Insurance certificate was displayed. The financial liability of the company was not discussed at this inspection. FIRE – A fire Risk Assessment had been carried out at the home in May 2005, however this did not cover the additional build that had been registered in December 2005. SERVICING – All gas appliances in the home had been checked in February 2005. The home also had inspection certificates available for the lifts, legionella testing, hoist maintenance, and weighing machine calibration. Bed rails were in place for those service users with an assessed need. Appropriate assessments were completed and regular checks are carried out. A number were checked at this inspection and problems were identified as mentioned earlier under Environment. Denture cleansing tablets were not securely stored and risk assessments had not been completed. ACCIDENTS – Accident records were maintained and the manager had carried out monthly audits. Appropriate action had been taken. PORTABLE APPLIANCES – The testing for these was carried out in July 2005 HOT WATER TEMPERATURE RECORDS – From the records available these did not appear to have been monitored since August 2005. Domestic staff spoken to were aware of COSHH guidelines. Evidence was seen in staff training records of COSHH training. All staff who serve meals had received Basic Food Hygiene training. The CSCI has not received any Regulation 26 visit reports from the provider to date. Staff supervision had not taken place in the last 6 months. As already mentioned the Whistleblowing policy must be updated, care planning, and medication policies and procedures must be improved. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 31 All staff without delay must receive up to date manual handling training and must not be allowed to move and handle service users nursed in bed and assessed as needing two carers on their own. All staff without delay including domestic staff must receive Infection Control training and all staff should be responsible to ensure they assist with infection control within the home. The staff facilities were seen during this inspection at a request of staff. It was very concerning to see that the facilities including the kitchenette and toilets were unhygienic and dirty. Even more concerning is that these facilities were near the main kitchen food store for the home. The kitchen was in need of a deep clean. Some areas pointed out to the catering manager were cleaned immediately. The food store had a dirty floor, which was cleaned by the second day of the inspection. The walkthrough flooring from the dining area on Rose Wing to the staff dining area was dirty. Risk assessments were in place for the environment; however need to be personalised to the home and updated now the new wing is in place. There were no Risk Assessments in place for the large ‘hot trolleys’ or tall food trolleys which staff have to push through the home, past service users, to each dining area. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 32 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 X X 1 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 2 2 2 X 1 2 1 STAFFING Standard No Score 27 1 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 1 1 1 Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 33 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 OP3 Regulation 14 Timescale for action The registered person must 28/02/06 ensure that service users are assessed before admission by the home to ensure it can meet their assessed needs. The registered person must 28/02/06 ensure that staff employed at the care home have a knowledge and ensure individual service users basic care needs e.g. oral hygiene, and ensure these are met. The registered person must 28/02/06 ensure that all care plans are completed and signed by the person recording them. They must reflect the individual service users current care needs, including overnight care, and GP telephone number, and there must be evidence of service user and/or their representatives’ input. The registered person must carry 13/01/06 out an investigation into the apparent discrepancy of stock of sedative medication and forward a copy of this report to the CSCI. DS0000065815.V265500.R01.S.doc Version 5.1 Page 34 Requirement 2 OP4 18(1)[c] {i} 3. OP7 15 17(1) [a] 4 OP9 13(2) Murley House Nursing Home 5 OP9 13(2) 6 OP9 13(2) 7 OP9 13(2) 8 OP9 13(2) 9 OP9 13(2) 10 OP9 13(2) The registered person must ensure that all medication is stored within the temperature guidelines as specified by the manufacturer. The temperature of the medicines fridge must be recorded and monitored using a maximum/minimum thermometer. An Immediate Requirement Notice was issued. The registered person must ensure that all medicines including those in service users rooms are stored securely. For emollient creams stored unsecured then risk assessments must be carried out and recorded. An Immediate Requirement Notice was issued. The registered person must ensure that there is a record for all administrations of medicine to service users. This record must also include the application of external products. An Immediate Requirement Notice was issued. The registered person must ensure that medical products are only used within the expiry dates and that the homes guidelines are followed. An Immediate Requirement Notice was issued. The registered person must ensure that for all those medicines prescribed with a variable dose that the actual dose administered is recorded at the time of administration. The registered person must ensure that the record of medicine returned for destruction also includes those medicines marked on the Medication Administration Record chart as refused and destroyed. DS0000065815.V265500.R01.S.doc 13/01/06 13/01/06 16/01/06 16/01/06 28/02/06 28/02/06 Murley House Nursing Home Version 5.1 Page 35 11 OP10 12(1)(2) The registered person must (4)[a] ensure that service users privacy and dignity is maintained at all times, with particular regard to shared rooms, personal belongings (toiletries), continence aids and meal times. An Immediate Requirement Notice was issued. 12(1)[a] 15 13/01/06 12. OP14 The registered person must 28/02/06 ensure that all care plans reflect individual service users preferred choices e.g. times of getting up or retiring and their preferred names. The registered person must 28/02/06 ensure that menus are reviewed at the home with input from service users and/or their representatives. Menus must include a well-balanced, nutritious varied diet, with a variety of fresh fruit, vegetables and varied drinks available. Also soft diet must be served in a way that makes it look appetising. Also a variety of sauces, and condiments must be available and tables laid before meals are served. The registered person must 28/02/06 ensure that the Whistleblowing Policy is updated to reflect outside agencies to contact. Also all staff must receive training in abuse awareness. 13. OP15 16(2)[i] 14 OP18 13(6) Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 36 15. OP19 23(2)[b] The registered person must 28/03/06 [d] produce a programme of routine maintenance and renewal of the fabric and decoration of the premises and submit a refurbishment plan to the CSCI by end March 2006. 23(2)[a] The registered person must 28/02/06 monitor the use or none use of keypads throughout the home to ensure the safety of service users. The registered person must ensure that staff supervise all communal areas at the home used by service users, and ensure that service users have access to a call bell at all times to minimise any risk to their safety. An Immediate Requirement Notice was issued. 13/01/06 16. OP22 17. OP22 12(1)[a] 13(4)[c] (6) 18. OP24 13(7) The registered person must 28/02/06 assess the use of ‘star’ locks and ‘baffle’ locks at the home. These must be removed unless there is a clear reason why they should be used with consent for the service users and/or their representative. The registered person must 13/01/06 ensure that adequate screening is always provided in rooms that are shared to maintain privacy. An Immediate Requirement Notice was issued. 19. OP24 16(2)[c] 20. OP25 13(4) The registered person must 13/01/06 ensure all radiators are guarded and /or risk assessed. An Immediate Requirement Notice was issued. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 37 21. OP26 13(3) The registered person must 13/01/06 ensure that the homes infection control policies and procedures are put into practice. This must include the provision of hand washing facilities for staff in all areas where personal care is provided; the removal of tablets of soap from bathrooms, the provision of lidded foot operated bins, and adequate and correct storage of continence aids. An Immediate Requirement Notice was issued. The registered person must 28/02/06 ensure that the laundry facilities flooring is repaired or replaced. Soiled laundry must not be stored in corridors, and staff must be updated to the homes infection control policies and procedures. The registered person must take steps to ensure the home is free from offensive odours throughout. An Immediate Requirement Notice was issued. 13/01/06 22. OP26 13(3) 23. OP26 13(3) 16(2)[k] 24. OP27 18(1)[a] The registered person must 15/02/06 [c] ensure that staffing levels and the 37(1)[e] skill mix at the home are adequate to meet the dependency levels and care needs of the service users and those levels must not fall below the minimum staffing levels agreed. The CSCI must be informed of any shortfalls. 17(2) 19 The registered person must 13/01/06 ensure that all fitness checks are received before a person commences employment at the care home to protect vulnerable service users from abuse. An Immediate Requirement Notice was issued. DS0000065815.V265500.R01.S.doc Version 5.1 Page 38 25. OP29 Murley House Nursing Home 26. OP38 13(4)[a] [c] The registered person must 13/01/06 ensure the safety of all those within the premise and ensure that denture cleansing tablets are stored securely and/or risk assessed in line with COSHH Regulations. An Immediate Requirement Notice was issued. 27. OP38 13(4)[a] [c] The registered person must 30/01/06 ensure that service users are not at risk of entrapment by ensuring that beds are fitted with well fitted mattresses and bedrails are used in line with HSE guidelines. The registered person must 13/01/06 ensure that all wardrobes or large tallboy types wardrobes are secure to prevent risk of harm to service users. An Immediate Requirement Notice was issued. 28. OP38 13(4)[a] [c] 29. OP38 13(5) 18(1)[c] {I} The registered person must 28/02/06 ensure that all staff work in accordance with the homes manual handling policies and assessed needs of service users. The registered person must 28/02/06 ensure that staff facilities provided, which are close to the kitchen are kept clean and hygienic. Also the kitchen must be deep cleaned within agreed timescales. The registered person must 25/01/06 ensure all sluice and laundry areas are kept locked when not in use for the safety of service users. 30. OP38 23(3)[a] 13(4)[c] 31. OP38 13(4)[a] Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 39 32. OP38 13(4) The use of ‘hot trolleys’ and tall 28/02/06 food trolleys, at the home must be risk assessed and records maintained. The registered person must 30/01/06 ensure that hot water outlets, in particular regard to communal baths, are tested and regulated to ensure they are running between 43-44oC at all times in line with HSE guidelines. If the home is without hot water at any time, the CSCI must be informed. 33. OP38 12(1)[a] 37(1)[e] 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. 6 Refer to Standard OP9 OP19 OP26 OP33 OP36 OP38 Good Practice Recommendations It is recommended that the home develop a system to regularly check and monitor the expiry dates of all sterile products stored in the home. The wardrobes identified without a handle or a door should be fixed as part of the routine maintenance at the home. Unclean overlay mattresses should not be left stored in service users private accommodation, without reasonable explanation. The registered person should conduct an audit of the home under Regulation 26 by end January 2006 and forward a copy to the CSCI. Formal supervision of staff should commence by end February 2006. It is recommended that the fire risk assessments include the new build by end March 2006. Murley House Nursing Home DS0000065815.V265500.R01.S.doc Version 5.1 Page 40 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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