Inspection on 09/05/06 for Murley House Nursing Home

This inspection was carried out on 9th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Murley House Nursing Home 24/02/10

Murley House Nursing Home 10/12/09

Murley House Nursing Home 07/04/09

Murley House Nursing Home 28/04/08

Murley House Nursing Home 05/12/07

Murley House Nursing Home 03/08/07

Murley House Nursing Home 26/04/07

Murley House Nursing Home 10/01/07

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 Caroline Baker Key Unannounced Inspection 9th May 2006 09:00 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.V290696.R01.S.doc Version 5.1 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.V290696.R01.S.doc Version 5.1 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) 020 7929 3444 020 7929 3555 Ashbourne (Eton) Limited Mrs Tina Mandy Marshall Care Home 105 Category(ies) of Dementia - over 65 years of age (105), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (105), Old age, not falling within any other category (105) Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 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. 12th January 2006 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 service users to include personal and nursing care. The Registered Manager is Tina Marshall and the Responsible Individual at the time of this inspection was Alison Glencross. Conditions of Registration are detailed above. Murley House consists of two units: Redwood House which provides nursing care, for service users over 65 years of age suffering with a dementia and Rose House which provides personal care for service users over 65 years who require assistance by means of old age or with a dementia. The current fees range from: £450 - £650 dependent on need. The home also provides day care for up to 14 service users, Monday to Friday. This provision is not registered with the CSCI. This service is staffed separately. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Inspection took place over two days and was conducted by three inspectors on the first day and two on the second day, which amounted to 32.5 Inspector hours. The inspectors felt welcomed by the registered manager, the responsible individual, the staff and service users. There were 64 service users residing at the home at the time of this inspection. 31 were in receipt of nursing care. Admissions to the nursing wing had ceased since the last inspection in January 2006 until the home had a period of stability. The CSCI sent comment cards to 8 of the service users and their relatives for their views on the conduct of the home. 8 service users and their relatives responded. Comments were mainly positive as reflected throughout the report. A tour of the premises took place where a selection of bedrooms and communal areas were seen. The inspectors consulted with at least 20 service users, four visitors and 13 staff during the inspection. The manager was available for the majority of the two days of the inspection. During the inspection the inspectors observed interactions between staff and service users. Selections of records were examined relating to care, health and safety, and staff. Since the inspection in January 2006 and because of the many concerning issues identified, the CSCI has monitored the home and undertaken additional inspections on Saturday 14th January 2006, Monday 13th February 2006,and on Tuesday 14th March 2006. Reports for these visits are available on request. Although the home was going through a period of unrest and low staff morale those and this inspection has identified that improvements have been made and requirements made are being addressed. On the second day of the inspection the inspectors were able to meet with the managing director for the home and discuss the future and Improvement Plan for Murley House. It was heartening to hear the investment and time planned for the home to continue and maintain its improvement. What the service does well: Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 6 During the two days of the inspection the atmosphere was relaxed and unhurried. Service users seen looked well cared for, clean and well dressed. Service users spoken to and able indicated their satisfaction with their care provision. Relatives spoken to were satisfied with the care provision at the home and also indicated an improvement. Comments received included: “you can’t fault them here”, “the staff are kind and helpful”, “their patience and care is outstanding”, and “they have all been lovely”. Staff appeared happy in their work and told inspectors that ‘things were improving’ and that they felt well supported by the manager. Staff training was taken seriously and had commenced. Staff told inspectors “it has been nonstop training”. Complaints to the home had been taken seriously and appropriate responses within set timescales had been given. Relatives spoken to were happy with the way the manager responded. Comments received via surveys to relatives indicated that 100 were overall satisfied with the care provided at the home. 98 of relatives felt that staffing levels were adequate. 2 of relatives thought they were ‘just’ adequate. What has improved since the last inspection? Since the last inspection the following have been addressed: Newly admitted service users had been assessed before admission to ensure it can meet their needs. Many staff have received training in Dementia Awareness and more is planned in line with the Alzheimer’s Society accredited training ‘Yesterday, Today and Tomorrow’, which will allow staff to understand the specialist complex needs of persons with a dementia. New care plan systems are in place, which aim to be ‘person centred’. Medication systems, recording and administration had improved ensuring service users are not at risk of harm. Staffing levels had been maintained at a reasonable level to ensure service users care needs are met and that supervision at mealtimes had increased. This also allowed for the dignity of service users to be maintained. Staff facilities had been made cleaner. Refurbishment of the home continues and includes a new carpet throughout the reception and hallway. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 7 Relatives and staff meetings have commenced on a regular basis. The home is much cleaner since the employment of a ‘housekeeper’. The home has a new mini bus, which will allow service users to be taken out on trips and enhance their social care. A deputy manager has been appointed to support the management team. A new receptionist and administrator have been appointed to support the management team. A further maintenance person has been appointed plus more care staff. Staff training has been implemented for all staff and staff supervision has commenced. More staff have been enrolled on NVQ in care training courses. What they could do better: Service users will benefit if their individual care plans are person centred to include life histories to allow the care plans to be built around the individual persons social care needs as well as their care needs. Service users will benefit from staff recording significant events in the care plans on a daily basis, for example, when a service user does not finish a meal; this will allow staff to recognise why a person, for example, may be losing weight and take action to prevent malnourishment. Service users will benefit if staff follow the instructions in individual care plans, for example, if a person should be monitored on an hourly basis then this should be recorded as evidence of this happening. Service users will benefit if they can choose their meals at the time of serving, as many have forgotten what they ordered the day before. Comments received from service users during the inspection, in regard to mealtimes included: “we have gravy on everything, whether we like it or not”, “we have mash with everything”, “its too peppery”, “the foods alright here” and “pudding is always a surprise”. Service users will benefit and be at less risk of harm of abuse if written references received for individual staff recently recruited are authentic in regard to those that require translation. The above issues were discussed during feedback given to the management personnel of the home, which took place at the end of both days of the Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 8 inspection. The inspectors were satisfied that the management will take these issues seriously and take steps to comply with requirements made at this inspection. Inspectors have come to the conclusion that the service has improved from poor to adequate standards of care within the last 6 months and hope this is acknowledged as a significant improvement. 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. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 9 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.V290696.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4. NMS 6 does not apply to this service. Quality in this outcome area was good. The home had taken appropriate steps to ensure the needs of prospective service users can be met. Staff at the home had the skills individually and collectively to meet the current service user group’s needs. EVIDENCE: Seven individual care plans were assessed and the service users met at inspection as part of the case tracking process. Two care plans assessed of recently admitted service users evidenced pre-admission assessments being carried out by the home, to ensure it could meet the individual service users needs. There were details in care plans from Social Services and three contained a Single Assessment Plan. Staff training records examined evidenced that many of the staff had received specialist training in for example, dementia, communication, and abuse awareness as well as mandatory training. There are Registered Nurses on duty Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 11 24 hours per day including those with mental health training. The management informed inspectors that plans are to involve all staff including domestic staff in dementia awareness and person centred care. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area was adequate. New care planning systems were in place, which needed further input to allow service user input and the benefit of staff knowing all of their individual needs. The home’s procedures for the management and administration of medication were good. Staff showed respect towards service users and allowed their privacy and dignity to be maintained. EVIDENCE: As part of the case tracking process seven care plans were assessed. The home has now implemented the corporate care plan and hard work has taken place to transfer all the care records to these new plans. One care plan had not been completed and the inspectors required that immediate action be taken to complete the plan. Staff completed the care plan. Many parts to the other care plans assessed were not completed, for example falls risk assessments. One care plan stated that the service user would be monitored hourly, as they could not use a call bell; there was no recorded evidence of this happening. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 13 Service user input was not evident and it was concerning that staff indicated that service users at the home would not be able to contribute. This was brought to the attention of the manager and should be seen as a training need. The medication systems were assessed. Since the last inspection in March 2006 a clinic room has been provided to store medications and house the medicine trolleys. New medication fridges had been provided. The inspector was informed that the home had ordered and was awaiting new max/min thermometers. Fridge temperatures however had still been recorded on a daily basis. Evidence was seen of monthly medication audits of systems and records being carried out to ensure competencies of the staff dealing with medications. The Medication Administration Records (MAR) seen at inspection evidenced good practice and was a vast improvement form the last three inspections. Throughout the inspection the inspectors were able to observe directly and indirectly the interaction of staff towards service users. Evidence was seen of respectful, kind and caring attitudes from staff. Dignity was maintained when staff were undertaking tasks with residents, for example, at lunchtime when serviced users needed assistance with their meals and when a mobile hoist was used to move a service user. Relatives spoken to told inspectors that the staff were always kind and caring. Six comment cards were received from relatives indicated the same. One comment received was “the staff are dedicated and professional, in the case of my relative their patience ad care is outstanding” and 100 of the comment cards received indicated that the relatives were satisfied with the overall care provided. One relative contacted as part of case tracking by telephone stated “ my relative has been a lot better since being at the home and for the first time in 2 years used my name”. 100 of comment cards received indicated that visitors are able to visit their relatives in private. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality outcomes in this group were poor. Social opportunities and interaction with many service users was poor, however limited provision is available which was provided to a good standard. Maintaining links with families and the community was good. Menus looked nutritious and well balanced. The way the service users were able to choose their meals was poor. EVIDENCE: Over the two days of the inspection at least eight hours were spent observing staff interaction with service users, speaking to service users, relatives and staff and management. The activities co-ordinator spoke to the inspectors on the second day of the inspection. He had an excellent knowledge of the social care needs of many of the residents we discussed, he knew their past occupation and present needs, he had helped develop and record individual life histories and preference charts. It was evident that he had a mammoth task to meet everyone’s individual social care needs and needed support from the staff team. This was Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 15 agreed and acknowledged by the management of the home who informed the inspectors that all staff would be receiving Yesterday, Today and Tomorrow (YTT) training, which is accredited by The Alzheimer’s Society. When staff interacted with service users the majority was task orientated for example when someone needed the toilet or someone was given a cup of tea. There were long periods where service users were not spoken to and left to sleep during the morning and afternoon. Some service users were bored one told the inspector that they “would love to pick flowers” and two others stated, “I need to do some ironing”. It was interesting to hear from non-care staff who had actively allowed service users to help them with their chores, for example the handyman allowed a service user to assist him with changing a light bulb and the housekeeper allowed service users to help clean their rooms. This should continue to be actively encouraged to allow for ‘occupation’ to take place and minimise the times when all service users have to do is ‘sleep’. The training mentioned above and the involvement of ‘key workers’ and the activity co-ordinator should improve social care for many service users at the home. The activities programme is being re-developed with individual needs of service users in mind and this will be followed up at the next inspection. If this is developed with person centred principles in mind it should offer greater opportunity to the diverse needs of the service users with a dementia. Evidence was seen that service users are able to maintain contact with their family and friends. Throughout the two days of the inspection visitors were seen at the home. The visitors’ book reflected many visitors to the home at differing times. Of the eight comment cards received from relatives 100 felt welcome at the home. The lunchtime meal experience was observed on the first day of the inspection. Service users had appeared to have chosen what they wanted the day before. The head chef who agreed that service users should be able to make a choice at the time confirmed this. This would allow the service user to use their senses, i.e. smell and sight and make a positive choice. Discussion with management was positive and the home agreed to implement the changes. This will be followed up at the next inspection. Service users asked did not know what they were having for lunch. The majority told inspectors that the food was generally good. Others made the following comments “ we have gravy on everything”, “its too peppery”, “dessert is always a surprise” and “ its mash with everything”. Interestingly ‘mash’ was served on both days of the inspection. It was brought to the manager’s attention that many service users left the table before finishing and left food and the food was then taken away by staff. The same service users didn’t receive a dessert. None of these actions were recorded in the service users daily records and this potentially could cause malnourishment and loss of weight. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 16 There was a noted improvement at mealtimes however where tables were laid nicely with condiments in dining areas. Service users needing assistance were helped by staff and not rushed. It remains disappointing that staff do not actively encourage more service users to the dining room tables however. Menus have been developed with input from service users and relatives. They appeared well balanced and nutritious. Management told inspectors that plans are to have a menu posted on each table, which will assist in choice and knowing what is for lunch and that desert trolleys would be implemented. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 17 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area was good. Service users and visitors to the home have the information to enable them to make a complaint or raise concerns. There was provision to allow service users to have their legal rights protected. Arrangements for protecting service users from harm or abuse were good. EVIDENCE: The CSCI had received copies of complaint letters sent to the home raising concerns in regard to care issues since December 2005. The home has received four complaints and records indicate appropriate action had been taken. The complaints linked to the CSCI’s findings at the inspection in January 2006. Evidence has been seen that requirements made have been taken seriously and actioned. Relatives spoken to were happy in the way complaints had been dealt with. The complaints procedure is displayed in the main reception area. Those service users able knew who to talk to if they had a concern and relatives consulted with were aware of the complaints procedure. The home carried a Southern Cross Healthcare Policy on ‘Voting’ which states: ‘every service user is able to exercise their individual voting rights’. Postal voting is normally used. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 18 The ‘Whistleblowing’ policy has been updated since the last inspection as required. Reference to it was seen on the staff facility notice board. Staff spoken to at inspection knew the steps to take should they suspect any form of abuse. Staff training records examined indicated that many staff had received abuse awareness training, and further training is planned according to records seen. Service users able told inspectors that they felt safe at the home and comment cards from those able indicated the same. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 and 26 Quality in this outcome area was adequate. The homes provision of a safe environment for service users was adequate. Arrangements for the control of infection were good. Service users are able to individualise their private rooms. Service users are able to access secure gardens. EVIDENCE: The home is split into two units, Rose House which provides personal care only for service users over the age of 65yrs in the categories of old age or dementia and Redwood House which provides nursing care for service users over the age of 65yrs with form of dementia. The inspectors assessed a sample of at least six bedrooms through case tracking, and the communal areas. One room had been refurbished since the Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 20 last inspection and the service user had chosen the colour, which is very positive allowing choice and individuality. To ensure the safety of service users all external doors are kept locked and alarmed and Redwood House is accessed via a keypad lock; this was discussed and recommended that the doors be opened to allow more freedom and choice of communal areas throughout the home. Management informed the inspectors that the safety of stairwells was being addressed. At present there are large boards, which prevent service users using the stairs. This will be followed up at the next inspection. The home is compliant with the local fire department. It has not had an environmental health visit for over 12 months. All areas of the home seen at this inspection were clean and hygienic. Infection control measures were in place and staff were receiving training in infection control on the first day of the inspection. Staff told the inspector that they had learned a lot from the training and had found it useful. There was a vast improvement to the environment and service users private accommodation since the inspection in January 2006. The management informed inspectors that communal areas on Rose House are being re-developed with input from service users. On the second day of the inspection it was pleasing to see that service users had been encouraged to use the secure gardens and courtyard at the home, and doors to the gardens had been left open to allow service users to please themselves. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area was adequate. Staffing levels at the home are adequate. Service users are in safe hands as staff competencies are adequate. Staff recruitment systems protect service users and are adequate. I omission however led to an Immediate Requirement. Staff training is good. EVIDENCE: The CSCI has been monitoring the staffing levels at the home since January 2006. There were shortfalls noted on occasions, which the home acknowledged. Since the last inspection in March 2006 the home has consistently met agreed staffing levels according to the duty rotas assessed. Comments from service users and relatives via comment cards indicate that staffing levels are adequate. Staff spoken to indicated that they felt staffing levels were adequate. Evidence was seen at inspection through observation that staff although busy were not rushing and through required tasks were giving time to service users. Staff morale was better and staff told inspectors that ‘everything was improving’ and they felt ‘more positive’. 24 of staff had completed an NVQ training course in care. The home is working towards meeting the standard of 50 . At least 10 more staff had Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 22 signed up for NVQ training. Training records and discussions with staff evidenced that collectively staff have the competencies to ensure service users are well cared for and safe. Four staff recruitment files were assessed of recently appointed staff. Three evidenced robust recruitment procedures and contained items specified in Schedule 2 of the Care Home Regulations 2001. One contained a reference, which had allegedly been translated from a referee overseas – there was no evidence of this or evidence of the reference that required translation. This could potentially put service users at risk of harm therefore an Immediate Requirement Notice was issued to the home to obtain the reference within 14 days. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 37 and 38. Quality in this outcome area was adequate. Tina Marshall is managing the home effectively. Staff morale was good. Quality Assurance was adequate. Supervision of staff had commenced and was adequate. Service users are protected by the health and safety checks in place. EVIDENCE: Tina Marshall was registered under the Care Standards Act 2000 to manage Murley House care home in April 2006. Since she took up her post in December 2005 she has consistently worked to comply with the National Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 24 Minimum Standards and Care Home Regulations 2001. In January and February 2006, inspections at the home identified 39 statutory requirements and since that date the manager has ensured that requirements are complied with within agreed timescales. At the time of this inspection a further four requirements have been identified however 38 had been complied with since January 2006 and consequent inspections to the home in February and March 2006. This evidences the commitment of the management team at the home and the support from the company representatives. Staff, service users able, and relatives spoken to spoke highly of the manager. Staff told inspectors that “things were improving”, “people are happier in their work” and that overall staff felt more positive. This was evident throughout the two days of the inspection by staff’s attitudes and the relaxed happier atmosphere. The inspectors spoke with the managing director who explained the Quality Assurance auditing of the home in detail. The manager undertakes a monthly audit of the home, which covers all aspects. The operations manager validates the result of the audit. There is a monthly medication audit and a weekly audit of the amount of problems the home may be having with service users skin integrity. An action plan (improvement plan) is then devised by the company depending on the results of the whole audit trail. The manager is given a focused action plan to work with. Customer satisfaction surveys will be sent out to service users 6 monthly and being implemented is a managers ‘surgery’ so that relatives, visitors, staff and service users can meet with the manager at a set convenient time on a regular basis. Inspectors were able to take a copy of the manager’s action plan for continued improvement of the home. It was reassuring to find that the manager and her deputy undertake night checks as well as day checks to ensure the smooth running of the home. Four staff supervision files were sampled. These were not always completed but evidence was seen that supervision had commenced and staff spoken to indicated that they had found it useful. This will be more closely assessed at the next inspection, as it was understood that supervision had only commenced recently. FIRE – Evidence was seen of regular fire checks to include alarms, equipment and emergency lighting. Staff had received regular fire awareness updates and those spoken to confirmed this. SERVICING – All gas appliances in the home had been checked in February 2005. The home also had inspection certificates available for the lifts, legionella testing, hoist maintenance, and weighing machine calibration. Bed rails were in place for those service users with an assessed need. Appropriate assessments were completed and regular checks are carried out. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 25 ACCIDENTS – Accident records were maintained and the manager had carried out monthly audits. Appropriate action had been taken. Other falls were discussed which were not recorded as they had not resulted in injury. The manager told inspectors that these are also audited and added to the accident numbers. PORTABLE APPLIANCES – The testing for these was carried out in July 2005 HOT WATER TEMPERATURE RECORDS – these had been monitored regularly and it had been identified that four outlets were too hot and appropriate action was being taken to ensure service users were safe. New thermostatic valves were on order. Some records were written in pencil and it is recommended that ink is used. The inspectors discussed with the management the possibility of the maintenance staff having a separate workshop for themselves and the tools they use. The plan is to form a workshop within the home in the future, however the manager was not sure where at this time. Staff have toilet facilities available, however a further toilet, which was previously for service users use, has been given to staff and visitors. This was discussed with the manager and inspectors informed her that it is in need of refurbishment and should be available again for service users as it is so near the lounge. The conclusion was left with the manager and the home to decide and this will be followed up at the next inspection. Evidence was seen in staff training records of COSHH training. All staff that serve meals had received Basic Food Hygiene training. The CSCI has not received any Regulation 26 visit reports from the provider since January 2006 and copies were requested during this inspection. These were received which evidenced monthly visits. Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 3 3 Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 15 17(1) a Timescale for action The registered person must 31/05/06 ensure that all care records in consultation with the service user and/or their representative include: daily records with significant events recorded fluid balance, food and turn charts to evidence any intervention from staff and any action taken, in line with the plan of care. (Previous timescale of 1 March 2006 and 20 March 2006 not met) 2. OP12 16(2)[m] [n] The registered person must ensure that social care is person centred on the individual service users choice and life history. Staff must provide occupation for individual service users in line with their social needs and use the times in between tasks for social interaction. 20/06/06 Requirement Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 28 3. OP15 12(2) (3) The registered person must 20/06/06 ensure that service users are given a choice of meal at the time of the meal to include desserts. Menus must be available for all service users to look at and sauces must not be poured on meals without the individual service users input. The registered person must 10/05/06 ensure that if references received for staff require translation that the original is available and that a clear record of translation is available in the individual staff file. An Immediate Requirement Notice was issued. 4. OP29 19 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 OP7 Good Practice Recommendations The life histories of service users should be available in their individual plan of care, not in separate files. This will allow all staff to begin to understand the individual social care needs of the service users. The ‘training and competencies’ document for individual staff should include dementia awareness. 2. OP30 Murley House Nursing Home DS0000065815.V290696.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 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. 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