Inspection on 26/04/07 for Murley House Nursing Home

This inspection was carried out on 26th April 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 10/01/07

Murley House Nursing Home 09/05/06

Murley House Nursing Home 12/01/06

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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 26th April 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.V335682.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.V335682.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 murley.house@ashbourne.co.uk 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.V335682.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. 10th January 2007 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 people with dementia to include personal and nursing care. Murley House consists of two units: Redwood House which provides nursing care, for people over 65 years of age suffering with a dementia and Rose House which provides personal care for people 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 people. 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 people, Monday to Friday. This provision is not registered with the CSCI. This service is staffed separately. Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection of Murley House Nursing Home for the inspection year of 2007/8 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 people who use the service. Due to the short time between key inspections no surveys were sent out. The reason for this key inspection was due to four concerns received by the Commission for Social Care Inspection since the last key inspection in January 2007. During the evening visit to the home the inspectors had a discussion with a relative who also had concerns about the quality of the service and care delivered in the home. The details of the discussion were fedback to the registered manager who was asked to carry out an investigation and report back to the Commission for Social Care Inspection with the outcome. Two inspectors carried out this inspection. Unannounced site visits were made on two separate days. The inspectors were in the home to observe practices during the day and evening. During the site visit the two inspectors were able to spend time talking to relatives, people who use the service, staff and the registered manager. A tour of the home was made and the quality of the furnishings in the bedrooms and communal areas were observed. During the site visit the manager discussed the introduction of the new corner house into the home. This house has been developed from existing accommodation on the ground floor and is aimed at providing care for people with dementia, who have more complex care needs. The indication is that the people who will be accommodated into this house will come within the current registration categories. Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The concerns received from relatives were mainly about the service delivery. Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 7 The service could improve its communication with the people who use the service. The care plans could be improved to ensure they become working tools. The furnishings in the communal areas need to be replaced. 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.V335682.R01.S.doc Version 5.2 Page 8 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.V335682.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 1,3. People who use this service receive 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 persons personal and nursing needs. EVIDENCE: The information available to people who need to use this service is provided in the statement of purpose and service user guide. The organisation also has a glossy brochure describing the company’s commitment. During a tour of the home copies of the service user guide were found available in the service users rooms. Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 10 The statement of purpose and service user guide need to be reviewed and updated to include how the home can meet the care needs of people who will require palliative care and end of life care. The statement of purpose also needs to include the type of services available to people who will be accommodated in the Corner House and how this service will differ from other service levels in the home. The organisation has produced a detailed pre-admission assessment pro-forma for assessing the physical and dementia care needs of people who use the service. The inspectors found the assessments to be detailed and comprehensive. Unfortunately the assessed care needs were not fully transferred into the persons 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 admission of new people may be process driven and not particularly personalised or individual to the person. The organisation has the policies and procedures but the evidence suggests that the practices are not always followed consistently. An example is the identified care needs not being transferred into the persons care plan. There was no evidence recorded in the needs assessment of any palliative or end of life care actions. The registered manager is also encouraged to include a mental capacity assessment as part of the pre-admission assessment criteria. Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 7,8,9,10,11 The variable practice regarding the planning and delivery of care means that people who use the service cannot be sure that their health and personal care needs will be fully met. EVIDENCE: The care plans of people with dementia are now more detailed than previously seen. The inspectors reviewed six care plans on the nursing wing and six on the residential wing in detail. The significant finding was that the care plans were not reflective of the current state of the person 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.V335682.R01.S.doc Version 5.2 Page 12 not person centred. The care plan documentation is specific and detailed. The care plan would be very comprehensive if completed correctly. Since the last inspection visit in January 2007 the team leader on the residential unit has started to update and review the care plans. Twp care plans were updated and considered to be reflective of the persons care needs. There is still a considerable amount of work needed to involve the person or their representative in the development of the care plan. The principles of the mental capacity act were discussed with the team leader and the importance of ensuring that the code of practice is followed when developing the care plans. The care needs in the care plans reviewed had not been evaluated for six months in some cases. The nurse in charge felt the priority was to be with the people and not spend time writing care plans. 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. There was no definitive audit trail through the care plans reviewed. One care plan identified a need for the person to have eight glasses of fluid a day. There was no record of the drinks being given and no way of evaluating the desired objective. The inspector reviewed a care plan of a person who was residing in the corner house, however there was nothing in the care plan to suggest that the person needed to be there. After reviewing the care plans the evidence available was sufficient for the inspectors to conclude that the registered manager has not made a significant effort to improve care planning in the home. 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. Relatives commented, “the staff here are so understanding” and “I think the staff are great”. One relative said that she witnessed overseas staff talking in their first language when carrying out care tasks. This issue has been identified at previous inspections. It is important that the registered manager takes action on this as it impinges on the wellbeing of people with dementia. Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 13 Care plans include health care requirements and people felt that if they needed to see a doctor or attend an appointment this was arranged quickly. 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. At this visit one relative informed the inspectors that she was concerned at the lack of action taken by staff to look into the reasons for people loosing weight. The nutritional assessment used by the home is based on a medical model. The inspectors reviewed the weight records for a person needing a healthy diet as recorded in the care plan. The record showed a loss of 12 kilograms over a six month period 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. 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, for example, at lunchtime when service users needed assistance with their meals and when a mobile hoist was used to move a person. 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. People spoken with felt their privacy was respected and that staff were sensitive when they needed help with personal care. They were observed to be polite and respectful although the inspector did observe that a carer did not lock the toilet door when assisting the person, therefore allowing passers by to view the ongoing procedure. Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 14 Murley House Nursing Home DS0000065815.V335682.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 11,12,13,14,15 People who use the service have limited opportunities to participate in stimulating and motivating activities. EVIDENCE: During the time spent on site the inspectors spent a considerable length of time observing staff interaction with people. The inspectors observed that daily life styles were significantly different on each unit. People on the nursing unit were highly dependant with communication being difficult. All persons needed a high level of personal care. During the two site visits very little social care was observed on the nursing unit. What was observed was being carried out by the registered nurse. Staff interaction was positive, sensitive and appropriate to good dementia care practice. However the level of staff on this unit did not allow for any social care time. Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 16 At the last inspection the inspectors observed long periods when no staff were visible in the lounge area. This had not improved. Staff interaction with people on the nursing unit remains task orientated for example when someone needed the toilet or someone was given a cup of tea. During the first visit the inspectors were able to discuss the dementia care with the organisations dementia care specialist. The specialist informed the inspectors of the organisations strategies for dementia care based on researched evidence. Unfortunately the registered manager confirmed the lack of awareness of these strategies. The inspectors were unable to find evidence that the specific dementia care strategies had been introduced into this home. Most interactions observed between people and staff occurred during the serving of lunch and when the tea trolley went round. Staff carried out this interaction sensitively and respectfully. Social care was observed on the residential unit however this mainly involved people attending for day care. People permanently residing in the home were watching television or sitting in the easy chairs in little groups, but not communicating. The inspector spoke to one person who said, “we all get on together, there’s nothing great about it but everything is alright”. “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”. From discussions with people and relatives the inspectors concluded that the general well being of people on the residential unit was maintained although there was lack of social stimulation. Relatives spoken to were not happy with the standard of care delivery and the quality of the furnishings. Staff said that since the last inspection they have been able put the dementia training into practice due to a change in task allocation procedures. The inspectors observed this as being very variable. The evidence found indicates that people who use the service would benefit from a planned social activities programme carried out by a dedicated social care team. Evidence was seen to confirm people 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. Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 17 The lunchtime meal was observed on the first day of the inspection. The meal tables in the home are set fully. People 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 People had chosen what they wanted the day before but had forgotten on the day. The inspectors observed carers on the residential unit taking the two meal options plated to help the person choose the one they wanted. This was not observed on the nursing unit. The head chef said that people 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. This practice is institutional and is not based on recognised good dementia care practices. The catering records confirmed this practice. The meals were well presented and appeared nutritious. Murley House Nursing Home DS0000065815.V335682.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 16,18 People who use the service and visitors to the home have information available to enable them to make a complaint or raise concerns. The registered person takes all complaints seriously and will respond to all concerns in writing following the organisations procedure. Complainants cannot be assured that the registered person will put appropriate actions in place to ensure an improvement in service delivery. EVIDENCE: The complaints procedure is displayed in the main reception area. People 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 said they were aware of the whistle blowing procedure. Reference to it was seen on the staff facility notice board. Staff spoken to at the 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.V335682.R01.S.doc Version 5.2 Page 19 The home has recorded five complaints since the last inspection in January 2007. The Commission for Social Care Inspection has received four concerns relating to the quality of service delivery by the home since the last inspection. Further concerns were voiced to inspectors on the evening of the second visit by a visiting relative. The registered manager was aware of these concerns and has been asked to copy the outcomes of the investigation to the Commission for Social Care Inspection. Evidence found by the inspectors at this key inspection would support some of the concerns raised by relatives. Murley House Nursing Home DS0000065815.V335682.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): Quality in this outcome area is adequate . This judgement has been made using available evidence including a visit to this service. 19,20,22,26. Accommodation is purpose built and meets the minimum requirements to provide a comfortable and warm environment. The equipment is suitable to meet the personal care and nursing needs of all people who use the service. The furnishings in the communal lounges are showing signs of wear and tear. The residential lounge area is not a homely environment for people with dementia. EVIDENCE: Since the last inspection visit the rosewood lounge/dining area has been redecorated and the organisation has installed a fence as a room divider. The Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 21 inspectors were told that the organisation did not seek any input from the people who use the service into the refurbishment. The décor is pleasant but the furnishings are showing signs of wear and tear and detract from the attempt to improve the area. A section of the sitting area is being used as a store for Zimmer frames and a mobile hoist. The inspectors observed easy chairs with the fabric worn and torn. Small stool with the fabric torn, dining chairs smeared in food and scratched. One relative told inspectors that whenever they visited the home was not clean. During the evening visit the inspectors observed food stains and debris on the dining room floor. The team leader explained that night staff cleaned the floor once everyone had gone to bed. This would mean that food spillages would be left after every meal and visitors would get the impression the room is not cleaned. Since the last visit the day care has been relocated to a small lounge on the first floor. Bathing facilities in the home have not been improved since the last inspection. Staff were observed to follow the infection control procedure and the home has a team of domestic staff. To ensure the cleanliness of the internal environment the registered manager should consider the need to have domestic staff in the evening. Murley House Nursing Home DS0000065815.V335682.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): Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. 27,28,29,30. The registered manager has a staff team with varied experience in caring for people with dementia. EVIDENCE: The nurses and carers observed in the home carried out their tasks skilfully. 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. 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. During the last inspection visit staff said they do activities with people in the evening. No activities were observed to take place during the evening visit of this inspection. Staff were observed to be assisting people to get ready for bed. Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 23 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. The induction records reviewed confirmed this. It is unfortunate that very little dementia care is taught to staff during the induction period. The inspector checked the staff files of the most recently employed persons. All the required information and security checks were received before the staff commenced employment. References were received from last employers in all but one of the files. The registered person is encouraged to make two reference requests based on experience and character , one being from the applicants last employer where possible. Murley House Nursing Home DS0000065815.V335682.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 33,36,38. The manager ensures staff follow the policies and procedures of the home. Practice and performance are discussed during supervision, staff training and team meetings. EVIDENCE: No significant changes were observed since the last inspection to the ethos of the home. Evidence suggests that the care practices are task orientated and not flexible to promote person centred care. Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 25 The quality assurance system in place is appropriate 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. One relative confirmed that they did look at the care plan occasionally. 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. Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 26 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 2 3 X X X 2 STAFFING Standard No Score 27 2 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 3 Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? yes 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(1) Timescale for action Unless it is impracticable to carry 30/07/07 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. This refers to the need to involve the person or their representative in the development of the care plan. The registered person shall 30/07/07 having regard to the number and needs of the service users ensure that— provide in rooms occupied by service users adequate furniture, bedding and other furnishings. This refers to the worn and torn furniture. The registered person shall 20/07/07 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 DS0000065815.V335682.R01.S.doc Version 5.2 Page 28 Requirement 2 OP19 16(2)(c) 3. OP21 23 (j) Murley House Nursing Home wash-basins, baths and showers fitted with a hot and cold water supply. This refers to the lack of usable baths in the home. Not met at this visit. 15/03/07. 4 OP26 23 (2) (d) The registered person shall 30/07/07 having regard to the number and needs of the service users ensure that— (d) all parts of the care home are kept clean and reasonably decorated; This refers to keeping the communal areas clean. 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 OP1 Good Practice Recommendations The statement of purpose and service user guide need to be reviewed and updated to include how the home can meet the care needs of people who will require palliative care and end of life care. The registered manager should ensure that all service users preferences are recorded in the care plans and that care staff respect those choices. The registered manager should ensure staff commitment to ensuring the care plan is a working tool and represents the persons care needs. The principles of the mental capacity act should be incorporated into the persons care plan. A definitive audit trail should be visible through the care plans. 2. OP7 Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 29 3 OP10 The registered manager should ensure overseas staff are respectful by not talking in their first language when carrying out care tasks. The registered manager is encouraged to introduce end of life care plans for people in the home. 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. 4 5 OP11 OP12 6 OP27 7. OP33 Murley House Nursing Home DS0000065815.V335682.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Taunton Local Office 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.V335682.R01.S.doc Version 5.2 Page 31 - 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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