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Inspection on 24/02/10 for Murley House Nursing Home

Also see our care home review for Murley House Nursing Home for more information

This inspection was carried out on 24th February 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

As previously mentioned, the purpose of this inspection was to check the home`s progress in meeting some of the requirements raised at the last inspection.

What the care home could do better:

The home need to ensure that staff have the skills, including communication skills, to meet the needs of people using the service. The home need to ensure that peoples` nutritional needs are met. The home`s procedures for reducing the risk of pressure sores still requires improvements.

Random inspection report Care homes for older people Name: Address: Murley House Nursing Home Wyvern Road Taunton Somerset TA1 4RA zero star poor service 10/12/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: kathy McCluskey Date: 2 4 0 2 2 0 1 0 Information about the care home Name of care home: Address: Murley House Nursing Home Wyvern Road Taunton Somerset TA1 4RA 01823337674 Telephone number: Fax number: Email address: Provider web address: murley.house@ashbourne.co.uk www.southerncrosshealthcare.co.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashbourne (Eton) Limited care home 105 Number of places (if applicable): Under 65 Over 65 105 105 105 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 0 0 0 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. Date of last inspection 1 0 1 2 2 0 0 9 Care Homes for Older People Page 2 of 13 Brief description of the care home 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 Care Quality Commission (CQC) to provide a service for up to 105 people with dementia to include personal and nursing care. Murley House consists of four areas, Upper and Lower Redwood provides nursing care for older people with dementia care needs. Corner House provides nursing care for up to 22 people who have more complex needs associated with their dementia. Rose provides personal care only for older people, including those who have dementia care needs. There is ample car parking to the front of the home and secure garden areas. The main entrance is kept locked at all times for security of the home and the people. There is a bell on the front door for visitors to make staff aware they are there. Care Homes for Older People Page 3 of 13 What we found: This unannounced random inspection was conducted over one day (4hrs) by regulation inspectors Kathy McCluskey and Jane Poole. The purpose of this inspection was to check the homes progress in meeting the requirements raised at the key inspection conducted in December 2009 which resulted in a zero star poor quality rating. A company relief manager was available throughout this inspection. We were informed that a recently appointed acting manager was currently on leave. All records required for this inspection were made available to us and we were given unrestricted access to all parts of the home. We were informed that 61 people were residing at the home and that there have been no new admissions since the last inspection. We were also informed that the home were currently in the process of recruiting additional staff. Agency staff are currently used to cover shortfalls. Following concerns raised at the last inspection, we spent time observing care practices on the units accommodating people who required nursing care (Redwood Wings). We also examined care plans. On the ground floor (Redwood Wing), an agency registered general nurse was on duty. The numbers of carers on duty appeared appropriate to the numbers and needs of people. As identified at the last inspection, we found staff interactions and communication with people to be very limited. During our observations eleven people were sitting in the lounge/diner. All looked comfortable and well attired. We noticed that the television was on, showing a pre-school childrens programme. Nobody was watching the television and we questioned the appropriateness. During the morning we pointed out to staff that the orientation board needed updating as it stated that the day was Monday 22nd February, when it was actually Wednesday 24th February. This had not been updated by the time we left the home in the afternoon. During the morning we observed three carers assisting people with a drink and it was noted that only one carer was interacting/communicating with the individual they were assisting. We observed lunch being served. As identified at the last inspection, tables had not been laid and the days menu was not displayed. When asked, people did not know what was for lunch. Again, staff interaction/communication with people was noted to be very limited. One carer was observed placing protective clothing on people without explaining what they were doing. Meals were plated by staff in the servery. It was not clear how people were supported to make choices about what they wanted. We heard one member of staff say, This soft meal is for anybody that is on a soft diet. Gravy had also been added to meals without offering people the choice. We examined the care plans for two people who had been assessed as high risk of malnutrition. Diet and fluid monitoring sheets were in place for one person. We were Care Homes for Older People Page 4 of 13 informed by a carer that the other person no longer needed their intake to be monitored. The care plan in place was therefore not fully reflective as it stated that intake needed to be monitored. We noted that the other individual was continuing to lose weight. The care plan made no reference of any action taken to address this and intake charts did not evidence that additional snacks were being offered. There was no evidence that the home had sought advice from the GP or dietician. This was also identified at the last inspection. We looked at the care plans for two people who were being nursed in bed. One care plan contained a pressure sore risk assessment where the individual had been assessed as high risk. Daily records confirmed that the individual was nursed in bed most days. No care plan had been raised and there was no documented evidence that the individual was being assisted to change position regularly. The care plan for the second individual nursed in bed stated that they should be helped to change position every two hours. This was not reflected in the turn charts seen. The frequency of turns were not consistent and no turns were recorded during the night. Concerns about the homes procedures were also raised at the last inspection. On the day of this inspection, no activities were planned for people on Redwood Wing. throughout the visit, we did not observe staff engaging people in any form of activity. As identified at the last inspection, we found large quantities of incontinence pads in some bedrooms examined. These were in full view of not only the individual, but any visitors they may have. This impinges on peoples dignity and respect and should be addressed. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 12 (1) The registered person 31/12/2009 must ensure that staff follow the guidance in the care plan. This includes guidance relating to physical and mental healthcare needs. To ensure that people receive appropriate care and the effectiveness of care plans can be evaluated. 2 8 12 (1) [a] The registered person 31/12/2009 must ensure that peoples nutritional needs are addressed and advice sought from appropriate professionals. To ensure that people have an adequate diet. 3 8 18 (1) [a] The registered person 31/01/2010 must ensure that staff working in the home have the skills and experience to provide a specialist service. To ensure that care and support given meets the specialist needs of people living at the home. 4 10 12 (4)[a]The registered person must ensure that people are treated with respect at all times. 31/12/2009 Care Homes for Older People Page 6 of 13 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action To make sure that peoples dignity is promoted. 5 12 16 (m)(n) The registered person 31/12/2009 must ensure that there is a programme of activities which is able to include people with all interests and abilities. To ensure that everyone receives social stimulation and is able to take an active part in daily life. 6 19 23 (2) [a] The registered provider must ensure that there is adequate signage and points of reference around the home. To enable people to move easily around the home and maintain independence. 7 31 10 (1) The registered person 15/02/2010 must ensure that there is a clear management structure. To give clear leadership and direction to the home and ensure that care and support is of a high standard and appropriate to the needs of people living there. 8 33 24 (1) Quality Assurance systems must be more robust. To ensure that shortfalls in the service are identified and action is taken to address Care Homes for Older People Page 7 of 13 31/03/2010 31/01/2010 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action them. 9 38 13 (5) The registered person 31/12/2009 must ensure that all staff are competent in moving and handling practices. To ensure the safety and dignity of people who live at the home and the safety of staff. Care Homes for Older People Page 8 of 13 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 (1) The registered person 12/03/2010 must ensure that staff follow the guidance in the care plan. This includes guidance relating to physical and mental health care needs. Previous timescale of 31/12/2009 not fully met. To ensure that people receive appropriate care and the effectiveness of care plans can be evaluated. 2 8 12 (1)(a) The registered person 12/03/2010 must ensure that peoples nutritional needs are addressed and advice sought from appropriate professionals. Previous timescale of 31/12/2009 not met. To ensure that people have an adequate diet. 3 8 18 (1)(a) The registered person 23/04/2010 must ensure that staff working in the home have Page 9 of 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action the skills and experience to provide a specialised service. Previous timescale of 31/01/2010 not met. To ensure that care and support given meets the specialist needs of people living at the home. 4 10 12 (4)(a) The registered person 12/03/2010 must ensure that people are treated with respect at all times. Previous timescale of 31/12/09 not fully met. To make sure that peoples dignity is promoted. 5 12 16 (m)(n) The registered person 31/03/2010 must ensure that there is a programme of activities which is able to include people with all interests and abilities. Previous timescale of 31/12/09 not fully assessed. To ensure that everyone receives social stimulation and is able to take an active part in daily life. 6 19 23 (2)(a) The registered person 31/03/2010 must ensure that there is adequate signage and points of reference around the home. Previous timescale of Care Homes for Older People Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 31/03/2010 not yet up. To enable people to move easily around the home and maintain independence. 7 31 10 (1) The registered person 31/03/2010 must ensure that there is a clear management structure. Timescale of 15/02/2010 not yet met. To give clear leadership and direction to the home and ensure that care and support is of a high standard and appropriate to the needs of people living there. 8 33 24 (1) Quality assurance procedures must be more robust. Previous timescale of 31/01/2010 not assessed. To ensure that shortfalls in the service are identified and action is taken to address them. 9 38 13 (5) The registered person 31/03/2010 must ensure that all staff are competent in moving and handling practices. Previous timescale of 31/12/09 not assessed. To ensure the safety and dignity of people who live at the home and the safety of staff. Care Homes for Older People Page 11 of 13 31/03/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The registered person should ensure that medication is only administered by staff who have received specific training. (not assessed at this inspection) Easy to read menus should be displayed in each area of the home and everyone should be offered a choice of food. Support with meals should be given in a way that respects peoples dignity. (outstanding from the previous inspection) The home should ensure that all staff receive training in the protection of vulnerable adults and that training is clearly understood. The registered person should monitor and address malodours within the home. 2 15 3 18 4 26 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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