Inspection on 05/12/07 for Murley House Nursing Home

This inspection was carried out on 5th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Murley House Nursing Home Wyvern Road Taunton Somerset TA1 4RA Lead Inspector Gail Richardson Unannounced Inspection 5th December 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.V354818.R02.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.V354818.R02.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.V354818.R02.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. 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: £400.00 to £1175.00 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.V354818.R02.S.doc Version 5.2 Page 5 Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection was carried out over 2 days (16.5 inspection hours) by inspector Gail Richardson and regulation inspector Justine Button. On the second day of inspection one inspector visited the home Pre-inspection information (AQAA) was received and is referred to in this report. Surveys were sent to people using the service, relatives, carers and visiting professionals. It is noted that no responses were received. As part of the inspection the inspectors were accompanied by an Expert by Experience who was able to spend time in one area of the home, talk to people using the service and staff about some aspects of living at the home and the outcome of this experience is contained within this report. During the visit inspectors looked at the premises and facilities, observed care practices and daily life, spoke to people using the service and staff and viewed a range of records. The specific care of a number of individuals was also looked at in detail. The home’s Manager Designate Pat Shepherd and Operations manager were available on the first day of inspection. A deputy manager and an administrator support the manager and the deputy manager was available on the second day of inspection. The inspectors felt that this was a very positive inspection with significant improvements seen. The poor rating is reflective of one particular area which poses a potential risk to people using the service. For clarity within this report each House will be identified by the house name, Redwood House (dementia care with nursing) has 38 places, Corner House (High dependency dementia care and mental health needs with nursing) has 22 places and Rose House (Residential care for people using the service who have mild to moderate dementia and who need mainly personal care) has 45 places. What the service does well: The home has recently taken a significant number of people from another home as an emergency placement. This appears to have been managed well Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 7 with a good level of organisation and management skill by the nurses and staff at the home. The meals appear to be pleasant and appetising and people using the service confirmed that the quality, quantity and choice of meals is good. People using the service and staff confirmed that were able to raise concerns and that they were confident that they would be addressed in an appropriate manner. Staff were observed to treat people using the service with dignity and respect and people using the service who were able confirmed that they had confidence in the staff. The home appeared calm and organised in all areas. What has improved since the last inspection? Significant improvements have been made since the previous key inspection and the evidence would indicate that all improvements are supported by systems which will ensure their continuance. There were significant improvements observed in the care plan records. Work has been undertaken by the management and staff to improve the content and detail contained within these plans and an improvement was evident. Staffing levels had improved and staff were now happy to confirm that staffing levels are sufficient to meet the needs of people using the service and that staff morale had improved. Systems have been implemented by the Manager Designate to inform CSCI by Regulation 37 notifications of any occurrences which are within the scope of notification. Nutritional assessments are now undertaken to ensure that sufficient information is available to provide adequate nutritional input for people using the service. Pre admission assessments are undertaken to ensure that people using the service meet the registration criteria of the home, that the home are aware of the care needs prior to inspection and are able to supply the correct environment, equipment and care needed. Audit and investigation into incidents/accidents now take place to ensure that appropriate care has been provided and lessons learned where needed. Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 8 The storage arrangements for incontinence products has been reviewed to ensure that all products allocated are available to the person with identified assessed need. The home now ensure the correct, use, maintenance and risk assessment practices are in place for the safe use of bedrails to ensure people using the service are not placed at risk of accidental injury. What they could do better: Medication management needs to be improved to ensure the safety of service users. Some areas of assessed equipment need were not being met and an audit of equipment is to be undertaken by the Manager Designate. Staff skill mix is recommended to be reviewed to ensure that identified staff need is provided and that difficulties with communication are supported and improved. Social and recreational opportunities are very limited, this is due to the size of the home and limited staff resources. This area is to be addressed to ensure that each person using the service has recreational and social activities tailored to their personal needs and preferences. Recording of activities also requires review to ensure that activity undertaken is meaningful to the person and that each activity is developed to be person centred. Bathrooms in Rose Unit are planned to be refurbished. This was raised at the previous key inspection in August 2007 and has not yet been met. Some areas of the home have a malodour which is required to be addressed. The Manager Designate confirmed that further cleaning equipment has been purchased. Some environmental changes are being planned and it is noted that these include an office for Corner House and provision for reheating or maintaining food temperature on Corner House. Recruitment procedures are not always thorough and robust enough to ensure that suitable staff are recruited and may place people using the service at risk. No clear plan is in place to identify who in the managers absence is in charge should an emergency take place. This was discussed with the Manager Designate and although some areas are planned further development is Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 9 needed to ensure that staff have clear leadership in the event of an emergency. Storage of documents in some areas of the home, relating to people using the service, are not secure an din line with the Data Protection Act and may compromise people using the service’s confidentiality. The storage of substances hazardous to health under the COSHH guidelines is required to be reviewed as access to the sluice on Rose Unit is available to some people using the service who are tall enough. The provision of weighing scales requires review to ensure that appropriate numbers of scales are provided for the large number of people using the service. Not all staff receive supervision and this is recommended to be implemented to included qualified and supervisory staff. A clear audit system is recommended for the management of people using the service personal monies to ensure that money stored is accountable. 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.V354818.R02.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 5 Quality in this outcome area is good. 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 will be met. Contracts and Statements of Purpose/Service User Guide contain sufficient information to enable people and their representatives to be clear about the terms of residency. EVIDENCE: The Home’s Statement of Purpose and Service User Guide were both examined at previous inspection and no changes have been made. It was stated at the Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 12 previous inspection The home has a comprehensive written Statement of Purpose and Service User Guide. The Service User Guide is also available in audio format, if needed. Both these documents are written in the corporate style but have been adjusted to reflect the particular service at Murley House. Both have recently been updated and provide all the relevant information, however, it is recommended that the acting manager reviews the Statement of Purpose and Service User Guide to ensure that they contain the correct information regarding care planning and the care provision for end of life care, including spiritual care, so that prospective residents and relatives have an accurate source of information. The home encourages people to visit the home before making any decision and move in on a trial basis of 4 weeks. Pre admission documents were seen for 2 residents, one of whom was due for admission on the day of inspection. The documents were detailed and provided a good insight into the identified needs of prospective people using the service. Sample contracts were examined and evidenced that sufficient detail is contained to enable people to be aware of the terms of residency. People who are funded by Social Services do not receive the homes contract but the Manager Designate confirmed that they receive the Statement of Purpose and Service User Guide which gives details of the services which will be provided. Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate or good depends if poor on meds This judgement has been made using available evidence including a visit to this service. Each person who uses the service has a care plan, the assessed areas of needs were reflected in this plan of care and the detail recorded ensured that staff were advised of a clear plan of action for each identified need. The poor management of medicines in some areas of the home has the potential to place service users at risk of harm. Staff were observed to treat the people using the service with dignity and respect at all times and residents felt well cared for and were confident in the staff. EVIDENCE: Five care plans were examined and the care observed. Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 14 Since the previous inspection significant amount of work has been undertaken to address the shortfalls in care planning. 5 care plans examined and all were of a good standard. 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. The inspectors would suggest that the care plans be adjusted on the front sheet as well as the review sheet for clarity. Evidence of the contact and input of people using the service’s representatives was seen and the home records all contact made by relatives/representatives and the content of those discussions. 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. Screening tools for nutrition were seen to be updated and used to reflect what action was required to meet any identified needs. Social care plans were not fully completed and lacked sufficient documentation of social choices and preferences. The Manager Designate confirmed that activity staff hours were being increased and further recording of social histories would be indertaken. Staff on each unit had been involved in accessing and recording some social history by involving relatives in information gathering. The care plan for a person being nursed for periods of time in bed identified the specific nursing intervention required and the daily record confirmed this action had been undertaken. People using the service with an identified need for one to one supervision were observed to be receiving this provision in a controlled and supportive manner. One Care plan identified the need for one to one supervision which was not being received, following discussion with the Manager Designate review of the care plan and this provision will be undertaken. It was noted that specific equipment or a profile bed and sensor mat for one person identified within the care plan was not available.The Manager Designate will audit equiment availability and ensure adequate equipment is provided to need identified need. Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 15 Staff confirmed that the ome has one set of scales and that this set was broken in November, further scales are recommended to be purchased to ensure regular access to all people using the service. People using the service were seen to have access to call bells or be able to summon assistance as required. Where this was not the case staff were observed to visit the person regularly. Staff were noted to be respectful towards people using the service and were observed treating people with dignity and kindness. All people using the service spoken to were complementary and felt supported by the staff. Staff were observed chatting with people using the service whilst undertaking their duties and sufficient time was available for social interaction. The Expert by Experience spent time in the Rose unit and observed ; “I spoke to a number of residents who were sitting in the very pleasant lounge and they all seemed well satisfied with the Home. “ Medication systems were examine on Corner House only and were inconsistent in practice, other areas of the home will be assessed at the next inspection. There was evidence of hand transcribed medications which were not all signed or dated which is required to ensure a clear audit trail of receiving and administration of prescribed medications. There was no evidence of ‘as required’ (PRN) protocols required to advise staff of the reasons and requirements of administration and there were gaps in Medication Administration Records which were not explained by any coded indicator or explanation. Medication disposals were not all signed by 2 staff which would ensure a clear audit trail of disposal. Some blood bottles were noted to be out of date. One controlled medication record was not signed in Medication Administration Records since 02/12/07 but signed in Controlled Medications Records and is required to be signed in both records. Accumulated dressings for people no longer at the home were observed to be stored at the home and dietary supplements stored but were now not being given. The Manager Designate advised on the second day of inspection that she had reviewed the medication systems in each unit and could confirm that the Corner Unit was the only unit with these shortfalls in practice. Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 16 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 quality, quantity and choice. EVIDENCE: The inspectors spent time talking with people using the service and observed people reading newspapers, chatting to other people using the service and visitors. 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. The Manager Designate confirmed that plans are in place to employ a further 2 activity staff. Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 17 One activity staff member was observed spending time with people using the day care service and assisting with meals in the Corner House. The staff member confirmed that the current programme of activities has been adjusted to incorporate some people using the service choices. The staff member confirmed that one to one sessions take place in the afternoons, however as lunch does not finish until about 1pm and the staff member finishes at 3pm, limited time for meaningful activity for several people would be limited. The Expert by Experience spent time on the Rose unit and noted that; “I asked about activities and was told they had visiting “entertainment” – recently the choir from Queens College had been in to sing carols. There were also occasional outings. Friends and family were welcome to visit at any time. There seemed to be no formal structure for residents to put forward ideas, but I was told that the staff were always ready to listen to any suggestions, or any concerns. I think everyone was happy with this informal arrangement, and were obviously well pleased with the way they were being treated. “ She further commented that “Everyone appeared clean and well dressed, and the ladies mentioned how much they appreciated the visiting hairdresser.” There is no specific activity provision for people with specialist dementia need. The Manager Designate is required to address the activity provision in all parts of the home to meet specific choices preferences and abilities. Recording of activities also requires review. Currently activities are recorded by a letter code, more detail is required to record f the activity was participated in, enjoyed and how this can be developed to ensure it is person centred. 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 around the home during inspection. Some people using the service’s bedrooms were decorated in a manner which reflected their tastes and lifestyles, some were very bare by comparison. Evidence was seen in some cases of people’s own furniture in their bedrooms. Those people who were able confirmed that they could get up and go to bed within a reasonable time of request. Most interactions observed between people and staff occurred during the assistance given and serving of drinks and meals and staff carried out this interaction sensitively and respectfully. One staff member was seen to instigate a carol singing time followed by some dancing. Some people using the service were observed to enjoy this time Breakfast starts in each House around 09:00 and continued until about 10am. Lunch is served from 12:30pm and evening meal is served from 5pm.Drinks and biscuits are served mid morning, afternoon and suppertime. Snacks and Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 18 drinks are available on request at any time and staff were seen to fetch people a cup of tea in between meal times. The Expert by Experience observed that ; “As usual, food was high on the list of priorities, and was described as “good, plain cooking” – breakfast, with a cooked option for anyone who wanted it, a two and sometimes three course lunch, a lighter cooked dish at tea-time and a hot drink and a sandwich at suppertime. Alternatives were on offer if asked for, including a vegetarian option. Residents started being moved to the dining area, which had individual tables seating four, some fifteen minutes before lunch was due to be served, which some people obviously found rather disorienting but I could understand why this had to be done. However, I noticed that for those who found difficulty in eating unaided each had a member of staff sitting next to them throughout the meal. This bore out the very favourable remarks made about the staff – that they were very kind without being unnecessarily intrusive. Judging by what I saw at lunchtime there seemed to be a sufficient number of staff on duty”. Lunch was a roast dinner and appeared to be served hot and looked plentiful and appetising. An alternative choice was available and was seen to be supplied on request. Puree diets were served individually to enable people to discern between taste and texture. Staff should be reminded to not mix each portion together. Meal times seen in each area were unhurried and staff provided suitable assistance to eat and drink as was required. Staff were noted to sit and assist each person individually ensuring a hot meal and drink were given. The dining tables in the home are set fully for lunch. Menus were placed on the tables in large print on the Rose House and Redwood units, the menu is displayed on a notice board on Corner House and was noted to be inaccurate. Examination of the 5 care plans evidenced that weight loss is monitored and action taken. The evening meal is prepared by the cook and served by the care staff. It was discussed with the Manager Designate that the Corner House meals are served ready plated and covered, however the unit has no facility to re heat or maintain food hot should there be a delay in serving. Various options were discussed and are being explored to ensure that food can be served hot at all times. Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 19 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 poor. 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 do not protect people using the service from the risk of abuse. 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. The complaints procedure requires updating to reflect a change in management. The Commission for Social Care Inspection has received 2 concerns and the home has received one complaint, which the Manager Designate has responded to promptly and within an acceptable timescale. Staff training records examined indicated that staff had received abuse awareness training and further training was planned the day following inspection, staff also confirmed that they knew how to access the whistleMurley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 20 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 these to be included. 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. 3 staff recruitment records examined evidenced that • Application forms were not completed to contain sufficient detail of previous employment. Three staff records did not contain employment history before September/October 2007. • Gaps in employment history had not been explored and documented. • Some references were noted to be from an agency which did not indicate what role that person had undertaken and had only been employed with them since September 2007 Staff who have received a POVA check were observed to work in a supervised capacity with an allocated mentor. It was noted that one staff observed had periods of unsupervised time in the lounge with people using the service, however staff were close by and available. It is required for the protection of people using the service that all recruitment processes are completed before staff commence employment. Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 21 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 is well maintained with a good standard of décor, the standard of hygiene is adequate. Service users bedrooms are decorated to reflect their own personal tastes. The gardens are attractively laid out and suitable for people using the service use. EVIDENCE: The homes AQAA states that “ The home is purpose built with large airy spaces and there are various quiet areas around the home for those that want this facility.” The décor of the home is pleasant with ample room for people to move around. Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 22 Some furnishings continue to require refurbishment, this is with reference to the bathrooms on Rose Unit which were identified at previous inspection and is continued to require refurbishment before it is used. Staff were observed to follow infection control procedures and the home has a team of domestic staff. The homes AQAA states that in the last 12 months “All staff have a better knowledge of infection control “. The home appeared generally clean. Some malodour was noted in some bedrooms and the rear corridor of Corner House. The Manager Designate confirmed that further carpet cleaning equipment has been purchased to address this issue. 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. The Corner House is required to be reviewed to ensure the adequate provision of suitable office space for staff. Currently files and personal records are stored in the dining room and any calls are made from a telephone in the corridor. This does not afford privacy for the person using the telephone. The Manager Designate confirmed that plans are in place for this refurbishment to take place. Murley House Nursing Home DS0000065815.V354818.R02.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 using the service. Mandatory staff training is ongoing and a suitably updated matrix is maintained. Recruitment practice is poor and may poor people using the service at risk of abuse. EVIDENCE: The homes AQAA states that “The dependency level of the Residents are met with an appropriate skill mix of staff and the off duty is planned in advance to ensure that optimum staffing levels are maintained”. The home have forwarded staffing rotas to CSCI offices each week and these evidenced consistent levels of staff being used with a reduction in agency staff being used. Staff and people using the service confirm that staffing levels have improved. Each unit appeared calm and unhurried, adequate staff were available to provide the one to one supervision which is identified and funded. Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 24 Induction training is undertaken by a mentor system and induction is based on the Skills for Care Common Induction Standards. No induction books were available as they are held by the staff themselves. Staff training was advertised in areas including abuse awareness and infection control. These sessions appeared to be 20 minutes in duration and the Manager Designate must ensure that this form of training is suitable to all staff and the content is substantive enough to provide adequate levels of training. A staff training matrix provided showed that all staff have received training in moving and handling and fire training. Further staff have been employed to be a moving and handling trainer. Staff communication and skill mix deployment was noted to be a problem in some areas with staff confirming that this can present as an issue. The Manager Designate confirmed that this will continue to be addressed. Recruitment procedures used in the home were noted to be poor and may place service users at risk of abuse (See Standard 18). Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 25 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. The Manager Designate is not registered with CSCI and so Standards 31 and 32 have not been assessed. The recording of personal finances is recommended to be clear about access to personal monies. 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. EVIDENCE: Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 26 The home has undergone a change of manager and the current Manager Designate is an experienced manager. As such standards 31 and 32 have not been assessed at this inspection. The inspectors noted that on arrival at the home there was no designated person in charge of the home in the absence of the Manager Designate and the Deputy Manager. No clear plan is in place to identify who in the managers absence is in charge should an emergency take place. This was discussed with the Manager Designate and although some areas are planned further development is needed to ensure that staff have clear leadership in the event of an emergency. The policies and procedures examined are relevant and updated and include policies of guidance for challenging behaviour, abuse awareness and gifts for staff. Staff records indicate that some policies are signed at recruitment. The financial records were examined and were noted to contain an audit of all transactions and include receipts, transactions were signed by two people. It was noted that a new system for management of personal monies is to be introduced. It was noted that the current system is unclear as to the ownership of the monies stored at the home. Accident records were examined, a corporate model of accident audit has been commenced and it was discussed that further detail is required to ensure a clear audit can be made. Action is taken as a result of the audit but no action plan is undertaken. 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 is required to be corrected and all documentation relating to people using the service is to be stored securely and so not compromise confidentiality. This issue remains outstanding from the previous inspection. Access to the sluice on Rose unit is made by a slide bolt on the upper part of the door, this would be easily accessible to a tall person and would enable access to substances hazardous to health. This must be reviewed to ensure the safety of people using the service. Supervision of staff is currently in need of review and will be further reviewed a the next inspection. Statutory maintenance records were checked. The maintenance records of the home were generally well organised and maintained by the homes handyman. Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 27 These included records of weekly fire alarm tests, emergency lighting and checks of nurse call bells. The Portable Appliance tests were last undertaken on 05/02/07 The lift was serviced on 02/08/07 LOLER checks were dated as 14/11/07 Some records listed below are required to be forwarded to CSCI including • Environmental health certificate • Gas safety certificate The Manager Designate confirmed that Fire service records and fire extinguisher service checks have been replaced by a new system which is awaiting certification. These certificates are required to be forwarded to CSCI. Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 1 3 3 1 3 3 3 3 1 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X x x 2 1 1 1 Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 29 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 OP8 Regulation 23(2)(n) Requirement Timescale for action 30/01/08 2. OP9 13(2) The Manager Designate 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 pressure mats, profile bed and weighing scales identified at inspection. 01/01/08 All medications administered must be signed for on the Medication Administration Records or an appropriate coded indicated noted. Hand transcribed medications are required to be signed by 2 staff and dated on commencement 3. OP12 16(2)(n) The acting manager is required to consult people using the service about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation. The registered provider must ensure that all people in the home are provided with opportunities for stimulation 01/01/08 Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 30 through leisure and recreational activities that suit their needs. This should also include opportunities for all to access the garden. 4. OP18 19 Schedule 2 The Manager Designate is required to ensure that suitable references and employment history is obtained for all staff prior to commencement of employment The Manager Designate must ensure that all gaps in employment history are explored and documented The home is required to ensure the repair and refurbishment of bathrooms to ensure adequate bathing facilities are available. This is to include the upper bathroom in the Rose House to an acceptable standard for use. The home is required to ensure that a suitable standard of hygiene is maintained which will ensure that the home is free from offensive odours The Manager Designate must ensure suitable plans are in place to support emergency action in the absence of the manager and Deputy manager The Manager Designate must ensure that all staff receive supervision up to 6 times each year to include all areas identified in the National Minimum Standards. The acting manager is required to ensure that the storage of DS0000065815.V354818.R02.S.doc 01/01/08 5. OP21 12(1)(a)2 3(2)(j) 01/01/08 6. OP26 16(2)(k) 01/01/08 7. OP31 12(1)(a) 01/01/08 8. OP36 22(1)(a) 01/01/08 9. OP37 12(4)(a) 01/01/08 Page 31 Murley House Nursing Home Version 5.2 care plans and other documents relating to people using the service are stored securely in line with the Data Protection Act 1988. 10. OP38 12(1)(a) The Manager Designate must ensure that substances hazardous to health are stored in line with the COSHH guidelines. 01/01/08 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. Refer to Standard OP33 Good Practice Recommendations The registered person should ensure that any quality audits carried out are robust and supported with an appropriate action plan. Not assessed at this inspection 03/08/07 2. OP4 The acting manager is recommended to ensure that the Statement of Purpose and Service User Guide contain the correct information regarding care planning and the care provision for end of life care, including spiritual care to ensure that prospective residents and relatives have an accurate source of information. The Manager Designate is recommended to provide PRN protocols for all medications given on an as required basis. It is further recommended that all medications disposed of as no longer required are signed as disposed by 2 staff. Dressings and dietary supplements are required to be disposed of if no longer prescribed for use. 4. 5. OP12 OP18 The Manager Designate is recommended to review the e recording of social and recreational activities to include detail of the activity, participation and review. The acting manager is recommended to ensure that the DS0000065815.V354818.R02.S.doc Version 5.2 Page 32 3. OP9 Murley House Nursing Home contact details for CSCI are included in the homes WhistleBlowing policy. 6. OP27 The Manager Designate is recommended to review the skill mix and deployment of staff to support staff and people using the service with communication difficulties. The management of the home is recommended to implement a system for clear auditing of the storage of personal monies. The Manager Designate is recommended to ensure that a system is put in place to ensure that all staff including supervisory and qualified staff receive supervision up to 6 times each year. 7. OP34 8. OP36 Murley House Nursing Home DS0000065815.V354818.R02.S.doc Version 5.2 Page 33 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.V354818.R02.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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