Inspection on 28/04/08 for Murley House Nursing Home

This inspection was carried out on 28th April 2008.

CSCI found this care home to be providing an Adequate service.

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 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

Murley House Nursing Home 12/01/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Murley House Nursing Home Wyvern Road Taunton Somerset TA1 4RA Lead Inspector Gail Richardson Key Unannounced Inspection 28th April 2008 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.V360609.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.V360609.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 Post 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.V360609.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. 5th December 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 three areas: Redwood House 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 House provides personal care only for older people, including those who have dementia care needs. The main entrance to the home is at the front of the property. 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. The current fees range from: £373.00 to £695.00 dependent on need. This does not include some items including hairdressing, chiropody and newspapers 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 but share some of the accommodation and facilities on Rose Unit. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection, which took place over 2 days (24.5 hours) on the 28th and 29th April 2008 by Regulation Inspector Gail Richardson and Regulation Inspector Sally Murphy. CSCI regional Pharmacist Mr Brian Brown was also involved in the inspection on the second day. A tour of the home took place and a selection of the bedrooms and all communal areas were seen. There were 64 people currently residing at the home, 23 receiving personal care and 40 nursing care. One person is receiving respite care on the Rose Unit. The inspector spoke to 6 people using the service, 3 visitors and 9 members of staff, the Manager Designate was available throughout most of the inspection. As part of this inspection the inspector surveyed the opinions of a random selection of people using the service and their representatives, GP’s, District Nurses and Care Workers. 11 responses were received from relatives and 1 response from a staff member. Surveys were sent to people using the service, no responses were received. Records relating to care including 10 care plans, 6 staff files, finances and health and safety records were examined The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Comment cards made reference to the kindness and caring attitude of the staff. One comment received was: ‘Staff at all levels show care, concern and skill in looking after my relative.’ At inspection a person commented, ’ It is very good here, you can’t fault it’ and ‘they helped me when I needed it’. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 6 Visitors spoken with confirmed that they are always made welcome, one comment card stated. ‘They welcome relatives, invite them to join in with mealtimes, friendly despite clearly being very busy, helpful, supportive’. Surveys received would support that communication with relatives/ representatives is of a good standard. One visitor told the inspector that the staff communicate well and said ‘It is valuable to know that they will contact us at any time, so if the phone doesn’t ring, I know all is well.’ What has improved since the last inspection? What they could do better: It was observed that people on the nursing unit with assessed nursing needs did not all have use of an adjustable bed. The Manager Designate must ensure that adequate equipment is made available where there is an identified assessed need to ensure needs can be met. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 7 The registered person must ensure that within each person’s care plan, all areas of identified need are assessed and a care plan must be in place. This is required to ensure that all staff are aware of the persons needs and have a plan of care to follow, to ensure that those needs are met. The registered provider is recommended to ensure that all people in the home are provided with opportunities for stimulation through leisure and recreational activities that suit their needs. The activity provision is recommended to be supported by training in dementia care and understood by all staff. The registered provider is recommended to include the contact details of CSCI or another external statutory body, within the homes complaints and whistle blowing policies to ensure staff and people using the service, have access to other statutory bodies. The registered provider is required to ensure that all areas outlined in the immediate requirement are confirmed in writing to CSCI The registered manager is recommended to review the practice of staff accessing the staff toilet facilities through a food storage area to ensure that good hygiene practice is maintained. The registered person is required to review the infection control practices used in the laundry to include the use of alginate bags to reduce the risk of cross infection by handling soiled or contaminated laundry. The responsible person is required to review the staffing levels of the home and in particular the Rose Unit to ensure that enough staff are available to meet the dependency level of all people using the service at all times of the day. The registered person is also recommended to ensure that over 50 of all care staff have achieved NVQ level 2 or above. The registered provider is strongly recommended to review the provision of handover time to ensure staff have adequate time to handover any changes in need to the next shift. 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.V360609.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.V360609.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): 1 3 4 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service and their families are provided with sufficient information to make a choice about moving into the home. A pre-admission assessment is made regarding the needs and preferences of prospective people using the service to ensure that prior to admission identified needs are able to be met. The review of equipment prior to admission is required with reference to adjustable beds for people with an assessed nursing need. Statements of Purpose/Service User Guide contain sufficient information to enable people and their representatives to be clear about the terms of residency. EVIDENCE: 11 relatives’ surveys were returned to the inspector and 5 of these confirmed that they received enough information prior to admission, 3 said usually and 3 Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 10 said sometimes. No surveys were received from people using the service. The Home’s Statement of Purpose and Service User Guide are detailed and outline the services available, they are available in audio format; these documents have beep updated to reflect the change in management. However the complaints procedure within the service user guide needs to be updated to reflect the current Manager Designate. Pre admission documents were seen for 4 residents and had been undertaken by the manager. The documents were detailed and provided a good insight into the identified needs of prospective people using the service. It was noted that people using the service who have been assessed as having nursing needs were not all provided with an adjustable bed, this is required in standard 24 of the National Minimum Standards. As part of the pre admission assessment it is required that any equipment needs be identified to ensure these areas are met prior to admission. One relative commented ‘Beds with sides (should be) supplied as standard for the elderly people so they do not fall out at night.’ Contracts were not seen at this inspection. Murley House Nursing Home DS0000065815.V360609.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): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans identified the assessed areas of need and these were reflected in the plan of care and the detail recorded ensured that staff were advised of a clear plan of action for each identified need. Care plans and their use by staff in the Rose unit require further development to ensure a person centred approach to care. The management of medications had improved and was noted to be satisfactory. Staff were observed to mostly treat the people using the service with dignity and respect. People using the service felt well cared for and were confident in the staff. EVIDENCE: 10 care plans were examined and the care observed, these included care plans from each unit of the home. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 12 In the Nursing units the care plans examined showed that care needs were clearly identified and appropriate risk assessments and subsequent care plans were in place to support the needs identified. The care plans were seen to be detailed in content and specific to the person using the service. Changes were seen to be recorded in the daily record and the care plan adjusted to reflect those changes. Reviews of care plan were seen to be undertaken monthly and as required and showed the involvement of the person and their relative/representative as appropriate. One comment received from a relative was: ‘The senior carer discusses the care plan and checks if I have any concerns about my mothers needs.’ The reviews were detailed and showed an ongoing development of care. Short-term care needs were seen to be care planned. Care plans on the Rose unit were noted to not always have a suitably detailed care plan in place for each identified need. One care plan identified the need to assess the risk of falling but no strategy was in place to ensure the reduction and monitoring of that risk. Another care plan gave advice on the monitoring of blood sugar levels but did not give the normal range, signs and symptoms to observe for or advice for staff of action to take. Another person was observed to have a high blood sugar, care records did not evidence that subsequent monitoring had taken place. Risk assessments did not include all areas requiring assessment. In one case a free standing radiator was in place and no risk assessment was undertaken to ensure the safety of that person. A further care plan identified a person with a wound but no pressure risk assessment was in place. Care plans recorded the input of visiting health professionals and it was evident that people have access to chiropodists, district nurse, Community Psyciatric Nurses and opticians. Some social care plans were not fully completed and lacked sufficient documentation of social choices and preferences. The Manager Designate confirmed that further recording of social histories would be indertaken. When asked if the care home meet the needs, 4-always, 5-usually and 3sometimes. Comments included; ‘Care is very good in the nursing wing’ ‘Nursing is its strength. The home has had a lot of upheaval over the years due to changes in management and this has reflected on day-to-day running in the past. However improvement has been made recently’ Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 13 ‘Since the last change in the homes management I believe the standard of care has improved’ ‘I believe staff are more aware of my relatives problems and appear to be doing a good job.’ Staff were noted to be respectful towards people using the service and were observed treating people with dignity and kindness. It was however observed that some staff did not always respond to requests for assistance and discussion with staff highlighted that some staff do not undertand the scope of their role. These staff do not consider activity provision as part of there role as care assistants and see their role as more task led. This was discussed with the Manager Designate who confirmed that further training would be taken to address this issue. Each person using the service had a notice in their room indicating the name and picture of their key worker. There was also information for relatives about the role of the key worker to support the person. It was apparent from surveys received that the home maintains a good level of communication with relatives of people using the service Comments included When relatives were asked if the care home helped resident’s stay in touch, 2 said always and 3 said usually Comments included; ‘Good links with letters and telephone calls’ ‘Contact between myself and home is very good’ ‘Regular newsletters for general information’ ‘If I telephone they will always make it possible for me to speak to my mother’ ‘I was not informed when mother had a doctors visit’ ‘I have always been informed of trips to hospital and then updated and informed of return to the home and outcome’ ‘They notify me if anything more serious crops up and are sincere in their approach’ When relatives were asked if they are kept up to date, 9 relatives responded always and 1 responded usually. 7 relatives felt that the home always supported the resident, as had been expected and agreed and 3 felt they usually did and 2 said sometimes. The medication system overall was examined and the medication administration records for 6 people were looked at in greater detail. We found that medicines were mostly managed and stored appropriately. For some of the people whose records we looked at in greater detail we saw that there was good guidance available to indicate how their medicines were to be used and instruction available to members of staff on how to make decisions to administer or not. For some others the doses were prescribed as either variable or when required but full guidance was not always present. Members Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 14 of staff spoken to were able to explain how decisions were made but this is reliant on regular members of staff always administering the medicines which is not always the case. We also found that on some of the records the medicine was recorded as offered but not required although the clinical intervention the medicine had been prescribed for was not being carried out every day, for example one person was prescribed a medicine to be taken before “chiropody” this only happens every six weeks but is recorded every day. We also observed the administration of medicines and whilst the method was mostly satisfactory, concern was raised about the administration of eye drops to one person whilst they were having their breakfast. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are some opportunities for social stimulation and people using the service are supported to join in with organised activities or pursue their own interests. Further development is required to support specific and meaningful activity. Visitors are always made welcome and can visit at anytime. The meals in the home are of a good standard, development of snacks is recommended. EVIDENCE: Comments received on relative’s surveys about activities provided included: ‘They seem to do their best to entertain staff. There are some excellent staff working very hard ‘My main concern is inadequate levels of activities available. Various activity organisers have come and gone and the residents are left with nothing to occupy their minds/bodies.’ Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 16 ‘There is a limit to what the caring staff can do to bridge the gap’. ‘My relative would not be capable of joining in much activities but does have some brighter, more cooperative times when I am sure some interaction would give them some joy.’ ‘We would really appreciate a member of care staff sitting and trying to interact with my relative. Staff do what they can but there are simply not enough on each shift. Mealtimes are very understaffed. Our relative does respond well to one to one contact.’ ‘The outings on the mini bus seem to have been cut’ On the day of inspection, people using the service were seen to be either in their rooms or in the lounges. The home currently employs one part time activity coordinator and the receptionist undertakes some activity organisation. There was no activity see on both mornings in the Rose unit, however on the first day of inspection, after lunch, external entertainment had been organised and a man was playing the piano, this appeared to be enjoyed by people using the service. A small trolley shop was also seen on Rose unit enabling people to purchase sweets and toiletries. One relative survey commented: ‘Maybe the home could provide a small shop for patients to go to with their relatives. Might be good for encouraging independence on the residential wing by enabling residents to buy their own newspapers for example, lovely for relatives to pick up bits for their loved ones.’ Another commented that ‘ A Coffee machine for relatives’ would be an improvement and another relative commented ‘Post sent to the resident is not promptly handed out’. On Redwood unit upstairs, Jigsaws were being done by people using the service with support from staff and in Redwood Unit downstairs the TV was playing with a staff member sitting with the people using the service. No organised activity was seen on the Corner House. On the Redwood unit the Aroma therapist was seen to be visiting accompanied by her dog, who was received very well by people using the service and staff. The Rose unit does not appear homely and social interaction was noted to be limited. The provision of activities does not appear to be evident and as discussed in the previous outcome group staff do not appear to have a clear idea of their role in social activity. The Manager Designate has plans to implement reminiscence stations including a wedding area and dressing area. Further development of activities related to personal choice and preference would be of benefit to people using the service. The activity provision is recommended to be supported by training in dementia care and supported by all staff. Visitors spoken with confirmed at previous inspection that they could visit at any time and were always made welcome by the staff; visitors were seen to be Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 17 around the home during inspection. Visitors who spoke to inspectors were happy with the level of the care their relatives were receiving but had concerns about staffing levels. See standard 27. Some people using the service’s bedrooms were decorated in a manner, which reflected their tastes and lifestyles. Evidence was seen in some cases of people’s own furniture in their bedrooms. It was observed that on the Rose unit the doors to each bedroom had been painted a different colour to promoted personalisation and recognition of the person’s own room. Lunch was observed on both days of inspection. The meals were served hot from a trolley and a choice was available. Staff sat with people to assist with eating and drinking and this appeared to be a social event with visitors also assisting with the meal. Staff and visitors were seen to be chatting with people using the service and lunch appeared to be a social event. On all units people using the service were observed to be assisted in an appropriate manner. People requiring dietary supplements had systems in place to ensure that the supplements were given. Relatives’ comments on mealtimes were varied and included: ‘The food was very good; it seems to have slipped quite a bit. More choice is required and more palatable meals- the elderly don’t all want bland food. Little extras seem to have slowly been cut out over the last few years as different agencies or manager come and go’. ‘They should also have more supervision at mealtimes. I try to visit at this time just to make sure my mother has food she can eat. It was not noticed she had broken bad teeth and was given inappropriate food.’ ‘More carers to be made available at mealtimes to feed the elderly residents unable to feed themselves’. ‘The food could be more appetising in that it is often served ’very dry’ and in old age most elderly find it hard to swallow. More moist food, perhaps gravy served for those needing same’. ‘I have taken friends from the medical profession as visitors and they have been very impressed with the ambiance, the attention the residents receive especially with meals.’ At previous inspection it was discussed that the home planned that snack boxes would be made available on each unit to ensure that people using the service could access snack foods at their convenience. This as not yet happened and is recommended to support choice and independence. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 17 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. Recruitment procedures undertaken in the home protect people using the service from the risk of abuse. EVIDENCE: The complaints procedure is displayed in the main reception area, this has been updated to reflect the change in management, however within the Statement of Purpose and Service User Guide the previous manager is listed as a point of contact, this should be updated. Relatives consulted with at inspection were aware of the complaints procedure. 6 relatives surveys confirmed that they knew how to make a complaint and 4 did not. 7 relatives confirmed that the home had responded to concerns and one stated- usually. Comments received included: ‘Would always go first to staff involved. Otherwise social services’ ‘We feel satisfied that if we raise any concerns that they listen to and address accordingly’ Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 19 ‘In the past we have written to the manager about a particular incident, this was dealt with very quickly’ The Commission for Social Care Inspection has not received any concerns about the home. The home has received four complaints, which the Manager Designate had responded to promptly and within an acceptable timescale. Two Adult Protection issues have been investigated using the homes disciplinary procedures and the outcomes recorded. Staff training records examined indicated that staff had received all the mandatory training required and this included Abuse awareness and POVA training. Staff also confirmed that they knew how to access the whistle-blowing procedure. It is noted that the whistle blowing policy used by the home does not contain the contact details for CSCI and it is recommended that details these be included. People at the home have access to an independent advocacy service. For the protection of people using the service the home is required to undertake recruitment procedures to check that staff are not included in the Protection of vulnerable Adults list (POVA), have a satisfactory Criminal Record Bureau check (CRB) and have 2 satisfactory references prior to commencing employment. 4 staff recruitment records examined evidenced that recruitment procedures are robust and well organized and that checks are undertaken prior to staff commencing employment at the home. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is a large building which has an ongoing maintenance program. The standard of hygiene is adequate. Laundry and staff facilities require review to meet good infection control standards. People’s bedrooms are decorated to reflect their own personal tastes. The gardens are attractively laid out and suitable for people using the service. EVIDENCE: The décor of the home is pleasant with ample room for people to move around. There is an ongoing plan of maintenance and further recruitment is currently taking place for maintenance staff to continue the level of decoration and refurbishment. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 21 The inspectors were pleased to observe that murals had been painted on blank walls to create the impression that the walls were not corridor ends. It was noted that each room was clearly named for the person using the service and some people had been supported to decorate the room in their own personal style. Small piece of peoples own furniture were seen. Each room has a sink and vanity unit, call bell and can be heated to the individuals own preference. One relative commented that the home was ‘Bright and cheerfully decorated’. The lounge area of Rose unit is a large and impersonal space, which would benefit from review to provide a more appropriate setting for providing dementia care in a person centred way. One relative commented that: ‘The main areas and lounge especially the furniture should be cleaned more, with food under the arms on chairs etc is not pleasant and leads to bad odours let alone infection. I have grown tired of pointing this out over the years to the various managers who always promise it will improve but never has for any length of time.’ Another relative commented: ‘Toilets should have ‘raised toilet seats’ readily available for those who would benefit. The same applies to other equipment such as wheelchairs for transporting residents to toilets etc. All equipment at the home needs updating and refurbished.’ The Manager Designate confirmed that equipment is available for those people with an assessed need. It has been noted under Standard 4, that not all people using the service with assessed nursing needs have an adjustable bed. On the first day of inspection a significant malodour was noted in the main reception area. The Manager Designate confirmed that this was due to the vacuum cleaner being used. On the second day of inspection no malodour was evident. The home appeared generally clean but odour was noted in some bedrooms and the lift. The bathrooms identified at the last inspection as requiring refurbishment were being completed on the second day of inspection and work was being undertaken on the connecting door to the Corner Unit. It was observed that in some areas bins were missing and some areas of the home were using bathrooms as storage areas for furniture and equipment. The Manager Designate confirmed that reorganisation of storage is planned and will be reviewed at the next inspection. Some areas of concern were raised and an immediate requirement made. These areas were that Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 22 • • • On a tour of the home it was observed that free standing wardrobes in 6 bedrooms were not secured to the wall and may pose a risk of injury to people using the service. These were confirmed as secured on the second day of inspection. It was also observed that a bathroom hot water outlet was delivering water at a temperature, recorded by the homes thermometer, of 48 degrees C. When hot water temperatures are in excess of 44 degrees C there is a high risk of burns and scalds. The Manager Designate confirmed on the second day of inspection that this had been adjusted to a safe temperature. Hot water pipes were also observed in the ground floor bathroom of the Rose Unit. This may pose a risk of injury from a hot surface to people using the service. These pipes were confirmed by the Manager Designate as being covered on the second day of inspection. Facilities within the Corner House must be required to be reviewed to ensure that there are appropriate office facilities for the storage of personal records and for staff to undertake their role. Currently files and personal records are stored in the dining room and any calls are made from a telephone in the Manager Designates office. Some comments were received about the laundry service within the home, these included: ‘Clothing does not always get returned to the resident’ ‘More care of clothing belonging to residents, even though it bears the owners names the people working in the laundry seem unable to find the name tapes and return such items to the correct owner’ The laundry has been moved to the Corner unit area of the home. Staffs in the laundry were aware of infection control procedures but advised the inspector that contaminated laundry was removed by hand from red bags for washing. It was discussed with the Manager Designate that the use of alginate bags would reduce the risk of cross infection by ensuring that staff do not have to handle contaminated laundry. One washing machine was out of use and had been broken for 4 days previously. The washing had remained in the machine for this period of time awaiting repair, staff did not know when the repair would take place. Staff toilet facilities do not promote good hygiene practices; there is no flip top bin available for staff to dispose of hand towels in a hygienic manner. Staff are required to walk past freezers and food stores to access staff toilets. Food storage areas are not acceptable as a thoroughfare for staff. The garden areas are well laid out for access by people using the service however the garden fence outside Rose unit is in need of repair. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels at the home are adequate to meet the assessed needs of people but require review to ensure that this is always maintained. Recruitment practice has improved and protects people using the service from the risk of abuse. Mandatory staff training is ongoing and a suitably updated matrix is maintained. EVIDENCE: On the day of inspection staffing levels on each unit were as follows Rose unit 1 senior carer and 4 care staff with the same in the afternoon and 1 senior carer and 2 care staff overnight. On the Corner unit and Redwood units there were 3 qualified nurses and 8 care staff during the day and 2 qualified nurses and 4 care staff overnight. The rotas examined for the 2-week period prior to inspection indicated that whilst the nursing units staff numbers showed a steady staffing level, staffing levels on the Rose unit dropped regularly to 4 staff in total and on occasion 3 staff in total. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 24 This was confirmed by staff members and visitors and would also appear to be supported by the comments received on relatives’ surveys. Relatives’ surveys asked, do staff have skills and experience to care properly? Responses are 3-Always, 6- usually. Comments received included: ‘Staff shortages are very obvious sometimes.’ ‘Would employ more trained and qualified nursing staff and more care staff to ensure the residents are washed and bathed regularly’ ‘Sometimes there are just not enough staff’ ‘They need more staff on the days when it is very hard for them to cope with the everyday needs of residents. Those they do have do not have enough time to do all that is needed.’ ‘Some of the staff may not be as experienced as others. But the nursing wing is very organised and well run.’ The responsible person is required to review the staffing levels of the home and in particular the Rose Unit to ensure that enough staff are available to meet the dependency level of all people using the service at all times of the day. Other comments received commented on the kindness and caring of the staff, these included: ‘They have comforted mother in the past when she has been fed up or upset’ ‘The staff are extremely friendly and kind to patients and residents’ ‘I must say how impressed I am by Murley House. Being able to let myself in at any time and go to Mothers room shows me that they have nothing to hide. Her clothes are always in good order and drawers and cupboards always tidy. I could not have found a better home for my mother.’ ‘The nurse and staff are kind, helpful and seem to have a good rapport with the patients. All in all, good marks for Murley House’ ‘Staff appear to be qualified and competent’ ‘Staff are always very good’ 1 staff comment received under the heading of what the home does well ‘Care for its residents’ and stated that the home could do better: ‘Use less paper’ It was observed by notifications of Regulation 37 to CSCI that staff have been calling upon the qualified staff from Redwood unit to the Rose Unit to assess people using the service who have sustained an injury. This practice is not appropriate as trained staff are required to be within the nursing unit at all times. The Manager Designate must ensure that care staff Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 25 working within Rose Unit have received the necessary training in first aid and that the emergency services are called when required. It was discussed at inspection that staff do not have a handover time to ensure that the next shift are aware of any changes of need for people using the service. Currently staff make a brief written list of changes to hand on to the next shift, and/ or use their own time to ensure a handover is given. The manager designate confirmed that this practice would be reviewed to ensure that a safe system is in place to ensure a comprehensive handover of all information is available to the oncoming shifty. All staff receive an induction training to the home, this training is not in line with Skills for Care and has been created by Southern Cross for use in all of its homes. Staff training is ongoing and an updated staff-training matrix received confirmed that all mandatory training is regularly updated. The Manager Designate confirmed that 41 of staff are qualified to NVQ level 2 and above. This level is recommended by the National Minimum Standards to exceed 50 . Recruitment procedures were examined and showed a clear improvement. All staff had undergone robust recruitment checks prior to commencing employment to ensure that people using the service were not placed at risk of abuse. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 26 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): 35 36 37 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Manager Designate is not registered with CSCI and so Standards 31 and 32 have not been assessed. The recording of personal finances is well maintained. Annual Quality Assurance has not taken place since the last key inspection and so cannot be assessed. Health and safety documentation is well maintained and updated. Not all care records are stored securely and may compromise the confidentiality and safe keeping of this information. Storage of Substances Hazardous to Health is required to be reviewed to ensure the safety of people using the service. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 27 EVIDENCE: The home has undergone a change of manager and the current Manager Designate is an experienced manager but does not hold a nursing qualification. CSCI have requested written confirmation of the named clinical lead at the home who will be responsible for ensuring the maintenance of clinical supervision of practice. As such standards 31 and 32 have not been assessed at this inspection. Relative’s comments on the management of the home included ‘Since my mother has been at Murley there have been 4 different managers in a 2 and half year period, this has resulted in quite a few changes and is difficult to build a rapport.’ ‘I have found Murley or southern Cross very hard to communicate with at management level.’ ‘The staff do their best but I feel they need support from management. I find it very worrying to visit and find residents left in the lounge for 10-20 minutes at a time, but management do not agree. ‘ ‘Administration of accounts has been very poor.’ ‘If I need to know anything about services costs, etc normally I would have to go to the office and ask; nothing given in writing or any form of notification’ ‘I am very satisfied with the care my wife receives at Murley House, it seems well run, well set up and maintained’. The financial records were examined and were noted to contain a monthly audit of all transactions and included receipts, two people signed transactions. The home does not hold individual monies but maintains an account for each person and a twice-yearly invoice of itemised spending is provided. Any requests for cash come out of the float and are deducted from the persons account. Accident records were examined, a corporate model of accident audit has been commenced .The Manager Designate confirmed that action is taken as a result of the audit but no action plan was seen. Care plans and details relating to people using the service are stored appropriately in the Rose and Redwood Houses, in line with the Data Protection Act 1988. Corner House had care plans stored in the dining area, which was easily accessible to other people and visitors. This issue had been raised at the previous 2 inspections. The Manager Designate organised the facility of a locked filing cabinet by the second day of inspection. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 28 Staff supervision is now ongoing and areas discussed included, areas of concern, staff training needs and practices within the home. Supervision will be reviewed again at the next inspection to confirm the frequency of supervision. Statutory maintenance records were checked. The maintenance records of the home were generally well organised and maintained by the homes handyman. A fire risk assessment is completed and maintained at the home. This is to conform to the Regulatory Reform (Fire Safety) Order 2005, which was effective from 1st October 2006. Some areas of concern were raised and an immediate requirement made. These areas included; • Dental tablets were observed in bedroom 24 of the Redwood Unit. They may pose a risk of accidental ingestion, which would be hazardous to the health of people using the service. These were confirmed as removed on the first day of inspection. The former laundry in the Rose unit was observed to be used as storage of cleaning chemicals. Access was available and may pose a risk of accidental ingestion of substances hazardous to health to people using the service. The Manager Designate confirmed on the second day of inspection that the chemicals had been removed and stored securely. • Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 29 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 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 3 1 3 2 3 3 1 3 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 3 3 3 Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 30 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 OP4 Regulation 23(2)(n) Requirement The Registered person must ensure that adequate equipment is made available where there is an identified assessed need to ensure needs can be met. This is with reference to adjustable beds for people with an assessed nursing need. The requirement has not been met from the previous inspection. Timescale 30/01/08. 2. OP7 12(1) The registered person must ensure that within each persons care plan all areas of identified need are assessed and a care plan be in place. The registered person is also required to ensure that staff follow the plan of care and are aware of all the person’s care needs. 30/07/08 Timescale for action 30/07/08 Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 31 3 OP9 13(2) 4 OP22 13(4) Arrangements must be made to 30/07/08 review the information available to direct staff regarding the administration of medicines prescribed to be administered “when required”. Immediate requirements were 30/05/08 made on 28/04/08 and confirmed in writing as completed on 13/05/08 • The registered provider is required to ensure that hot water is discharged from taps at a temperature no greater than 44 degrees c. This temperature is required to be monitored regularly to ensure that the temperature is maintained at a safe level. • The registered provider is required to ensure that all exposed pipe work, which may pose a risk of injury, is suitably guarded or managed to ensure no risk to people using the service. • The registered provider is required to ensure that all substances hazardous to health are risk assessed and stored in a secure manner to ensure that there is no risk to people using the service. • The registered provider must ensure that all dental tablets are stored securely and do not pose a risk of accidental ingestion. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 32 5 OP25 12(1) 13(4)(a) 16(2)(j) The registered person is required to review the infection control practices used in the laundry to include the use of alginate bags to reduce the risk of cross infection by handling soiled or contaminated laundry. The responsible person is required to review the staffing levels of the home and in particular the Rose Unit to ensure that enough staff are available to meet the dependency level of all people using the service at all times of the day. 30/07/08 6 OP27 18(1)(a) 30/07/08 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 Refer to Standard OP9 OP12 Good Practice Recommendations It is recommended that the home review the appropriateness of administering eye drops at meal times. The registered provider must ensure that all people in the home are provided with opportunities for stimulation through leisure and recreational activities that suit their needs. The acting manager is recommended to ensure that the contact details for CSCI are included in the home’s complaints policy and Whistle-Blowing policy. The registered provider is recommended to review the practice of staff accessing the staff toilet facilities through a food storage area to ensure that good hygiene practice is maintained. The registered provider is strongly recommended to DS0000065815.V360609.R01.S.doc Version 5.2 Page 33 3 OP16 4 OP22 5 OP27 Murley House Nursing Home review the provision of handover time to ensure staff have adequate time to handover any changes in need to the next shift. 6 OP30 The registered provider is recommended to ensure that above 50 of staff are trained to NVQ level 2 and above. Murley House Nursing Home DS0000065815.V360609.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V360609.R01.S.doc Version 5.2 Page 35 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!