Inspection on 07/04/09 for Murley House Nursing Home

This inspection was carried out on 7th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Murley House Nursing Home 24/02/10

Murley House Nursing Home 10/12/09

Murley House Nursing Home 28/04/08

Murley House Nursing Home 05/12/07

Murley House Nursing Home 03/08/07

Murley House Nursing Home 26/04/07

Murley House Nursing Home 10/01/07

Murley House Nursing Home 09/05/06

Murley House Nursing Home 12/01/06

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Murley House Nursing Home Wyvern Road Taunton Somerset TA1 4RA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gail Richardson     Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Murley House Nursing Home Wyvern Road Taunton Somerset TA1 4RA 01823337674 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : murley.house@ashbourne.co.uk Ashbourne (Eton) Limited care home 105 Number of places (if applicable): Under 65 Over 65 105 105 105 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 0 0 0 A Nurse (RMN) on sub-part 1, RN3 or RNHM, of the current NMC register must be on duty at all times when nursing beds occupied exceed 34. Up to 45 places for Service Users requiring personal care only in the categories OP and DE(E) to be accommodated on Rose Wing. Up to 60 places for Service Users requiring nursing care in the categories DE(E) and MD(E) to be accommodated on Redwood Wing. Date of last inspection Brief description of the care home Murley House Care Home is purpose built and is situated in a residential development on the outskirts of Taunton. The registered provider is Ashbourne (Eton) Ltd a subsidiary of Southern Cross Ltd. The home is registered with the 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 Care Homes for Older People Page 4 of 35 Brief description of the care home 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. 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 fee range per week is Residental 550 pounds, 695 pounds nursing and 850 punds for the Corner Unit. 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 CQC. This day care service is staffed separately but share some of the accommodation and facilities on Rose Unit. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, which took place over 3 days on the 6th, 7th and 8th April 2009. The first day of inspection was undertaken by CQC Lead Pharmacist Mr Brian Brown and the next two days were undertaken by Regulation Inspector Gail Richardson and Regulation Inspector Jane Poole. As part of the Inspecting for better Lives 2 process the Commission uses Experts by Experience to provide a view of what it may be like to live at the home. At this inspection an Expert by Experience visited on the second day and stayed for approximately two hours. The findings of her report are contained within the body of this report. Care Homes for Older People Page 6 of 35 The Manager Designate has been in post since August 2008.The company have been proactive in ensuring that the service is effectively managed in the absence of a registered manager. The company have implemented improvements in line with their supplied improvement plan and have liaised with the Commission during this period. All concerns and complaints have been responded to in a positive manner by the company and all issues raised have been resolved. A tour of the home took place and a selection of the bedrooms and all communal areas were seen. There were 55 people currently residing at the home, 20 people are receiving personal care and 27 receiving nursing care. There were 8 people receiving higher dependency care at the time of inspection. The inspector spoke to several people using the service, one visitor and 7 members of staff, the Manager Designate was available throughout the first and second day of inspection and a manager from another home within the company was available on the third day. The home has provided CSCI with a completed AQAA (Annual Quality Assurance Audit) which was completed by the Manager Designate and gives details of all aspects of the home. As part of this inspection we surveyed the opinions of a random selection of people using the service, GPs, District Nurses and Care Workers. We did not receive any surveys back from people using the service but received seven surveys back from staff and two surveys were received from visiting health professionals. Records relating to care including seven care plans, four 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 care home does well: What has improved since the last inspection? The home has provided adjustable beds for people with an assessed nursing need. This was identified at the previous inspections and has now been provided. Staff have received training and have shown as a result an improvement in the care plans in place. They now appear more detailed and person centered. Staff were aware of the content of the care plans and now ensure that the plan of care is followed. The home has begun to address the activity provision at the home with an increase in activity hours provided.Some staff training has taken place in this area and training in specialist activity provision has been recommended. All areas previously identified with reference to health and safety have been addressed. An ongoing maintenance program is in place and communal areas have recently been redecorated. The laundry service has now implemented the use of alginate bags to prevent the risks of cross infection. Care Homes for Older People Page 8 of 35 What they could do better: The Statement of Purpose / Service User Guide does not contain sufficient information for people about what specialist care provision is available. It does not outline that one unit provides a higher dependency level of care. The home is recommended to reflect further detail of the specialist dementia care input and outline the specialist higher dependency provision available. We found that when some medicines are prescribed to be administered when required that there were not always clear directions to guide staff on how to make the decision to administer these and it was also not possible to identify how people had made these decisions from the records made. We also found that people could not be confident that the home had in place a safe system to ensure that their medicines would be available to be administered as prescribed. We found that staff did not follow the audit system in place and had indicated that 7 days stock of medicines were present when they were not. Care plans were seen to have improved however,the manager designate is recommended to ensure that outdated information is removed from care plans to avoid confusion about current care needs.Furthermore the manager designate is required to ensure that changes in care needs which have been identified have a suitable care plan in place. Whilst the home provides some activities, further specialist activity training is recommended to ensure that specialist support is available to people using the service.Further training is also recommended in the recording of activities to support the development of specialist and meaningful activity. The home provides a choice of menu but it is recommended that the home develop a more appropriate method of demonstrating the choice of meals available to people using the service to support peoples choice. The home is recommended to include the contact details or an external agency with in the homes whistle blowing policy to enable staff a choice of places to contact should they have any concerns. The home is recommended to be audited and an ongoing refurbishment plan implemented to ensure that areas of the home which required repair are maintained. The home is required to review the decor of the toilet near the Corner Unit door to replace broken tiles and prevent any risk of cross infection. The manager designate is also recommended to ensure that all bedrooms have the appropriate lighting and access to nurse call facilities. If this is not appropriate to risk assess and then seek a suitable alternative. The home is required to keep under review the staffing levels of the home to consistently provide staff in sufficient numbers to meet the needs of people using the service. The manager designate must ensure that all records are stored securely, this is Care Homes for Older People Page 9 of 35 required to ensure the confidentiality, privacy and dignity of people using the service. The home is recommended to monitor the opinions of people about the care provided in the home and ensure that action is taken to address any issues raised . If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of 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. More information is recommended to be included about the specialist care provided. A pre-admission assessment is made prior to admission by a suitably trained person, to ensure that identified needs are able to be met. Contracts contain sufficient information to enable people and their representatives to be clear about the terms of residency. Evidence: The Homes Statement of Purpose and Service User Guide are detailed and outline the care services available, they are available in audio format; these documents have been updated to reflect the change in management. The homes registration is for people Care Homes for Older People Page 12 of 35 Evidence: over 65 years of age with dementia to include personal and nursing care. The home also currently supports eight people with high dependency, more complex dementia care needs. The Statement of Purpose/ Service User Guide does not currently reflect any detail of this unit . This is recommended to be included to ensure that people are aware of the range of units available. The home provides staff with both Registered General Nurse Training and Registered Mental Nurse training. Care staff receive training in dementia care and training to meet any specialist needs for example , training in managing restraint. Surveys were received from staff and they were asked if staff feel they have the right support, experience and knowledge to meet the different needs of people who use the service and one staff told us If unsure I would seek advice. The home provided us with an Annual Quality Assurance Assessment which said that, Prior to admission each prospective service user is met and a pre-admission assessment is conducted. Through this we create an initial assessment of needs and risks. On admission a care plan is created with the help and assistance of both resident and families, providing them with as much choice and independence as possible. Each care plan is personal to the resident and confidential. Pre admission documents were seen for 6 people and these had been undertaken by the manager designate. The documents were detailed and provided a good insight into the identified needs of prospective people using the service. People have the facility to visit the home prior to admission as a test run to see if they feel the home would need their needs. A sample of contracts were seen and these contained the terms and conditions of residency and included the fee scale and room number. When rooms are changed new contracts are issued. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were detailed and person centered, further review is recommended to ensure that changes are care planned. Peoples care needs are met with dignity and respect and medications are handled safely. Evidence: 7 care plans were examined and the care observed, these included care plans from each unit of the home. Care plans were detailed and person centered and it was evident that a significant amount of work had been undertaken by staff to ensure that care plans reflected areas of assessed need. There were risk assessments where needed and an associated plan of care in place to support that risk whilst ensuring that whenever possible independence was maintained. Care plans recorded the input of visiting health professionals and it was recorded that people have access to chiropodists, district nurse, Community Psychiatric Nurses and Care Homes for Older People Page 14 of 35 Evidence: opticians. In some cases the care plans contained a large amount of previously needed information which was either no longer needed or outdated.In one instance this information related to wound care. This may cause confusion for staff trying to understand the most updated care needs and it is recommended that outdated information is removed to prevent any care being omitted. Care plans were seen to be regularly reviewed and the input of family members or representatives recorded. It was evident that short term care needs were being care planned however it is required that all changes in care needs are included in the care plan at the time of identification to ensure that staff are aware of changes. In one case a person had developed a risk of coughing and choking and thickened fluids had been prescribed. This was recorded in the daily record but there was no supporting care plan and this may place the person at risk. Carer plans were also being developed to support social and recreational needs and this work continues to be ongoing. Staff were noted to be respectful towards people using the service and were observed treating people with dignity and kindness. Staff surveys were asked if they were given up to date information about the needs of the people they care for , Responses were varied, three said they always received the information, whilst two said usually and two sometimes. Staff commented, The care plans have lots of information about the person which is useful when dealing with daily basic tasks. You get a picture of the background likes and dislikes etc. You also get to know families well. Care plans are being re written and the information written in them tells me everything I need to know about the residents. Staff were asked if the way information is passed about people using the service between staff worked well . Four staff told us that usually works well and two said that it sometimes works well. Staff were asked in surveys if there are enough staff to meet the individual needs of all the people who use the service. The responses varied, no staff stated that there was always enough staff, 2 staff said usually enough staff, two staff said sometimes and one staff said that there was never enough staff. One visiting health professional survey told us that the service does well by giving Friendly, person -centered care However a further comment was that At times I Care Homes for Older People Page 15 of 35 Evidence: have observed a need for Murley to take charge of a problem rather than looking externally for help and direction. 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. We spoke with people using the service and with one relative at the time of inspection, all were happy with the general care provided. We were told that people could choose what time they got up and returned to bed, within reason and staff availability and that they had a choice about how they spent their day. There are both male and female staff available at the home should people have any preference of gender to care for them, their choices would be recorded within their care plan. We found that staff administering medicines had received appropriate training and that they had all had been assessed as competent to administer medicines and that this was kept under regular review as part of the supervision process. We found that the records made gave a true picture of the medicines that had actually been administered and all actual doses administered, were recorded when a medicine was prescribed with a variable dose. We also found that for those people who received medicine with dose intervals of monthly or 3 monthly that the next administration date was carried forward to the next record chart and also an entry was seen in the communication diary. We found that dedicated medicine storage areas were provided that could all be kept secure. Dedicated refrigerators were present for medicines but we found that the temperature of these was not controlled in accordance with the manufacturers directions meaning that some medicines may not be stored safely and may therefore compromise the people receiving these medicines. We also found that some medicines were stored in the fridge that did not need refrigerated storage and this storage of these may cause undue distress to the person receiving them. We found that for some people prescribed a medicine to be administered when required that although a protocol had been drawn up this was very basic and did not give the staff member clear guidance on how to make the decision to administer or not. One example seen was for a person with a variable dose of pain relief prescribed where they received different doses but no further record had been made. We found that although the home had introduced an audit system to maintain appropriate stock levels that this had not prevented one person from not receiving one of their medicines for 8 days and another for 3 days. The audit sheet recorded that there were no issues with this persons medicines. We also found for another person that the audit sheet had been marked to indicate that there were 7 days stock available but we were only able to find 4 1/2 days stock in the home. This means that Care Homes for Older People Page 16 of 35 Evidence: people cannot be confident that they will receive their medicines as prescribed. We also found that although there was nobody at the home who currently had their blood glucose levels monitored that the equipment the home had available for this was only suitable for a person use for themselves and not for the staff to use. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some opportunities for social stimulation, both inside and out within the community and people using the service are supported to join in with organized activities or pursue their own interests. Further development is required to support specific and meaningful activity in all units of the home. Visitors are always made welcome and can visit at anytime. The meals in the home are of a good standard, development of how menu choices are made is recommended. Evidence: The home employs activity staff for 68 activity hours per week and have a rotating timetable of 3 sessions per week on each unit. There have been some staff sickness which has reduced the activity hours provided. The home also has external entertainers coming in such as musical entertainment and visits from the animal sanctuary. The home also has a mini bus available which takes people out of the home. This is dependant on the weather and staff availability. People at the home have access to visiting clergy and would be supported to access any specific religious preferences both at the home and in the community. Staff told us that they Feel they Care Homes for Older People Page 18 of 35 Evidence: still have a lot of work to do with reference to activities. Some training had been provided but further training is recommended to ensure that specialist support is available to people using the service. The Expert by Experience observed The initial impression on entering this part of the building was of space - the entrance corridor is very wide and has chairs in small groups, and the dining area and adjacent lounge are also quite large. I was told that the seating in this room can be re-arranged as required to suit various activities. However, there was little evidence of what these might be. A Newsletter displayed in the entrance hall listed only three events for the month of April all provided by outside organizations. One relative spoken with was noted by the Expert by Experience While having no criticism of the standard of care, felt very strongly that more needed to be done to provide activities, even something as simple a visit a to the local park. The Expert by Experience noted The residents to whom I spoke expressed general satisfaction with their care and with the food offered. There was reference in the lounge to a Suggestions Book re food but I could not find this. Some effort had been made to provide a memory corner in the lounge with memorabilia and old press cuttings, although it was a pity that these were mostly of unhappy events, e.g. the assassination of John Lennon, Chappaquiddick etc, and I wondered why it had not been possible to show something happier . There was no activity provided by the organizers in the Corner Unit as we were advised that it was not appropriate for the current client group and staff provided the activity there. No activity was seen to be undertaken and non was recorded on the notice boards, however people had access to a courtyard garden. Staff surveys told us that the home could do better by providing An activity coordinator for every area of the home It is recommended that further development of specialist activity provision is provided in the Corner Unit and areas of the home which require a more specialist approach to activity provision. All activities are recorded to include the content and level of participation. It was discussed at inspection with the Manager Designate that these records were not always appropriate and further training in record keeping may be necessary. People told us that visitors were always welcome and we saw visitors accessing the home throughout the inspection. People were seen to be treated with dignity and respect at all times by staff at the home and people appeared to look well cared for in their general appearance. Care Homes for Older People Page 19 of 35 Evidence: Lunch was observed in all areas of the home. People were able to eat either in their rooms or in the lounge/dining areas of each unit. The Expert by Experience noted that, Two weeks menus were displayed in the entrance hall, but in very small type and I wondered how useful these would be for residents. The amount of information was quite confusing. However, the food on offer appeared to be more than adequate and I was told that if anyone had any special request this would be available. There was a choice of menu which included any specialist dietary requirements and people were supported to eat and drink as needed. The meal looked pleasant and appetizing and was served hot, people who spoke with us said that the food was good and that they had plenty to eat. The way in which choices are provided is recommended to be reviewed to ensure that people are aware of the choice in ways other that a written notice, for example by pictures or photographs. Currently each unit addresses the issue of choice in a different way and in some cases staff make the choices they think best for peoples meals. The home has recently received a 4 star rating from the Environmental Heath Unit. Care Homes for Older People Page 20 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of 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 organizations 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, some copies of the procedure around the home have incorrect contact details and need to be changed. Relatives consulted with at inspection were aware of the complaints procedure and one relative confirmed that she they wish to complain they would approach the management of the home. The Commission for Social Care Inspection prior to becoming the care Quality Commission has received eight concerns about the home. The Manager Designate has responded to all promptly and within an acceptable timescale and has demonstrated a clear understanding of the Safeguarding Vulnerable Adults Policy for Somerset when this has been needed. The homes AQAA stated , The company has a comprehensive and robust complaints procedure in place which identifies key offices and people where Care Homes for Older People Page 21 of 35 Evidence: a complaint can be made. The procedure is also included in the Statement of Purpose and Service User Guide provided to each service user or their relative, representative, advocate. The home adheres robustly to this procedure. Comments received from staff surveys included. I would report any concerns to the nurse in charge or the manager as she is very easy to talk to and does listen to your concerns. All staff surveys confirmed that they were aware of policies about protecting vulnerable adults and how you report any concerns about poor care practice or allegations of abuse. Staff also confirmed that they understood the whistle blowing policy and would feel able to use it. It is recommended that the policy include the contact details of an external agency for people to contact. Staff training records examined indicated that staff had received all the mandatory training required and this included Abuse Awareness and POVA training. All recruitment checks were in place to support the protection of people using the service. People at the home have access to an independent advocacy service. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a large building which has an ongoing maintenance program. Some parts of the homes decor require repair and replacement. The standard of hygiene is adequate. The gardens are attractively laid out and are mostly suitable for people using the service. Evidence: The homes AQAA told us, The home has an ongoing maintenance programme, attractive gardens which are suitably laid out to meet the needs of the service users. The decor of the home is pleasant and we have just completed redecoration of all communal areas. The majority of our bedrooms are en-suite. There is ample car parking and the garden facilities are accessible to service users and their visitors. All rooms meet the minimum measurement requirements and day space is in excess of requirement per service user. All WC and bathroom facilities provide privacy to all individual service users. These are easily accessible. Murals have been painted on doorways to disguise the doors and lessen confusion. Adaptations have been made following taking advice from occupational therapists and other health and social care professionals as required. Two bathrooms have been refurbished and upgraded. The home is divided into three units with Rose Unit providing dementia care without Care Homes for Older People Page 23 of 35 Evidence: nursing and the Redwood units providing dementia care with nursing. The Corner Unit is a higher dependency unit for people with more complex dementia care needs. All areas have key pad access and are independent of each other but share a communal foyer. Each area has its own lounge, bathing, treatment and office space. The homes environment is adequate with Redwood Upper and Lower Units being of a much better standard than Rose and Corner Units. The Corner Unit is very bare with little evidence of specialist provision in the environment. There is a general lack of call bell leads and bedside lights on Rose and Corner units. The Manager Designate explained that these have been risk assessed and removed but there was no evidence of this within care plans seen. Curtains in some bedrooms are too short, some corridors and walls appear damaged and in need of attention. Whilst mostly the home is clean there are some areas of malodour. The toilet by Corner house entrance has tiles which are broken and may need replacing and this may post a risk of cross infection. The laundry facilities have been improved to include the use of alginate bags to prevent any risks of cross infection. The Expert by Experience noted Looking at the outside, I still have some doubts about the central paved area, parts of which looked quite uneven and I feel there could be a potential tripping hazard. It all looked a little uncared for, as did a grassed area which also needed some TLC. There was another area at the rear of the house which was a real sun-trap but was very overgrown and neglected One relative advised us that the garden area in Rose Unit is difficult to use. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of 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 and training provided is in place to protect people using the service from any risk. 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 for 20 people using the service. On the Corner unit and Redwood units there were 3 qualified nurses and 7 care staff during the day and 2 qualified nurses and 4 care staff overnight. This is to care for 27 people in the Redwood Units combined and 8 people in the Corner Unit. Staff in each unit told us that they felt there was sufficient staff to meet peoples needs. One relative felt that more staff would be beneficial as would make more consistent staffing levels. Each unit is now staffed independent of each other and staff have a unit responsibility to cover shifts. We were told this system had been an improvement. When staff were asked if there are enough staff to meet the individual needs of the Care Homes for Older People Page 25 of 35 Evidence: people who use the service, they old us The company says so but on the residential unit we have been dropped to 1:8 and only 2 staff at night. The person in charge is counted in the numbers. for 22 people there are four staff on duty when 5-6 would be nice. The service could do better by Providing more staff and by working above minimum staffing levels. All staff work very hard to give 100 care at all times. I really love to work at Murley House, it is a special home with special people (Staff and residents and families). Comments received from staff surveys also included, I was made to feel very welcome by staff when I started. The staff all work as a team which I think is important, I have had many visitors telling me that it is a lovely home with a caring atmosphere and staff that are special people. Have been short of nurses but agency staff have been brought in It was discussed at the last inspection and at this 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 will be continuing and the company has no plans to formalize the time for a daily handover. Seven staff returned comment cards to CSCI, three staff confirmed that they felt they had received induction very well whilst three said they had received induction only partly and one said they had not received any induction when they commenced their job. All the staff surveys received stated the staff felt they had received training relevant to their jobs. Six staff felt that the training helped them to understand peoples individual needs and one did not, whilst five staff felt training kept them up to date two did not feel this was the case 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. Staff were observed to be kind and considerate and people told us that they felt cared for and that the staff are kind. Recruitment procedures were examined and showed that all staff had undergone Care Homes for Older People Page 26 of 35 Evidence: robust recruitment checks prior to commencing employment to ensure that people using the service were not placed at risk of abuse. Care Homes for Older People Page 27 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of 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. Annual Quality Assurance has been monitored in house but not externally and this has not taken place since the last key inspection . Health and safety systems and documentation is well maintained and updated to promote the safety of people using the service. Evidence: The Manager Designate has chosen not to register with the Commission and as such standards 31 and 32 have not been assessed at this inspection. However both staff, people using the service and relatives told us that they found the current Manager Designate approachable and easy to talk to. Staff told us that they could approach the manager with any questions and that she was Lovely. Care Homes for Older People Page 28 of 35 Evidence: Comments received from staff surveys included, The manager of course is very busy but has found time to work alongside staff on the floor. We have a meeting every day to pass on important information which is very useful The manager has given me a lot of support Staff told us that the manager designate met with them to give them support and discuss how they were working two said regularly, one said often, one sometimes and two said never. The home undertakes internal quality assurance monitoring which includes Regulation 26 visits by the Operations Manager, which are forwarded on to CQC. These reports are not always completed to include the amount of accidents and also do not include a review of bathrooms. This was discussed at inspection and is recommended to be addressed to ensure that a robust audit is maintained. The home has not undertaken external quality monitoring since the last inspection is will be reviewed at the next inspection. 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 itemized spending is provided. Any requests for cash come out of the float and are deducted from the persons account. This system has remained unchanged since the last inspection. 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 and recorded in the individuals care plan. Policies and procedures used by the home are in place but some have not been reviewed or updated for some time. One was dated 2006. The manager designate is suggested to review and update policies as appropriate. Care records have now been removed from the Corner Unit dining area, however some documents had been stored there which may compromise the confidentiality and dignity of people in that unit. These were removed at inspection and the issue raised with the Manager Designate. Statutory maintenance records were checked. The maintenance records of the home were generally well organized 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 Care Homes for Older People Page 29 of 35 Evidence: 2006. Care Homes for Older People Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be kept 29/05/2009 under review to ensure that all changes in need are assessed and an appropriate care plan put in place. This is required to ensure that staff are aware of the changes and support the health and wellbeing of the person using the service. 2 9 13 (2) Arrangements must be made to have in place a system that ensures medicines are available to be administered as prescribed This is to ensure people receive their medicines as prescribed. 29/05/2009 3 9 13 (2) Arrangements must be 29/05/2009 made to ensure that there is clear guidance available to staff for the safe administration of those medicines prescribed to be Care Homes for Older People Page 32 of 35 administered when required. This is to ensure that people receive these medicines both appropriately and consistently 4 21 12 The home is required to 21/05/2009 review the decor of the toilet near the Corner Unit door to replace broken tiles and prevent any risk of cross infection. This is required to promote the health and safety of people using the service and visitors to the home. 5 37 17 The manager designate must ensure that all reords are stored securely. This is required to ensure the confidentiality, privacy and dignity of people using the service. 29/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose/ Service User Guide is recommended to reflect further detail of the specialist dementia care input and outline the high dependency provision available. This is recommended to be included to ensure that people are aware of the range provision available. The manager designate is recommended to ensure that outdated information is removed from care plans to avoid confusion about current care needs. 2 7 Care Homes for Older People Page 33 of 35 3 4 9 12 It is recommended that the monitoring and control of fridge temperatures is reviewed. Further training is recommended in the recording of activities to support the development of specialist and meaningful activity. Further specialist activity training is recommended to ensure that specialist support is available to people using the service. It is recommended that the home develop a more appropriate method of demonstrating the choice of meals available to people using the service to support peoples choice. The home is recommended to include the contact details or an external agency with in the homes whistle blowing policy to enable staff a choice of places to contact. The home is recommended to be audited and an ongoing refurbishment plan implemented to ensure that areas of the home which required repair are maintained. Some parts of the outdoor areas are recommended to be reviewed for potential trip hazards. The manager designate is recommended to ensure that all bedrooms have the appropriate lighting and access to nurse call families. If this is not appropriate to risk assess and seek a suitable alternative. The home is recommended to monitor the opinions of people about the care provided in the home and ensure action is taken as a result of any issues raised. 5 12 6 15 7 16 8 19 9 10 20 24 11 33 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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