CARE HOMES FOR OLDER PEOPLE
Murrayfield Care Home 77 Dysons Road Edmonton London N18 2DF Lead Inspector
Tony Brennan Key Unannounced Inspection 12th April 2007 11:00 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 Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Murrayfield Care Home Address 77 Dysons Road Edmonton London N18 2DF 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 8884 0005 020 8884 0006 Four Seasons (No 10) Limited Linda June Slade Care Home 74 Category(ies) of Dementia - over 65 years of age (74), Old age, registration, with number not falling within any other category (74), of places Physical disability over 65 years of age (74) Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Frail elders over 50 years require nursing care. Elderly mentally ill. Two specified service users who are under 65 years of age and also have a learning disability may be accomodated in the home. The home must advise the regulating authority at such times as either of the specified service users attains 65 years or vacates the home. Two specified service users who have a learning disability may be accommodated in the home. The home must advise the regulating authority at such times as either of the specified service users vacates the home. 27 April 2007 4. Date of last inspection Brief Description of the Service: Murrayfield care centre is a purpose built nursing home. There are three floors. One floor provides dedicated dementia care. There are dinning and sitting rooms located on each floor. There is a garden to the rear of the building. All bedrooms are single and en suite. Bathrooms and toilets have the necessary adaptation. The home is located near to shops and public transport. The home aims to provide care that meets the individual needs of people. Fees are on a sliding scale, dependent on the nursing needs of people. This report is available on the Commission web site. Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken as part of the annual inspection programme. I sought to confirm that the areas for improvement identified at the last inspection were addressed. The inspection took place over one day. Linda Slade, registered manager, assisted the inspector with the inspection. I spoke with the five people who live at Murrayfield, and five members of staff. I observed care practice and interaction between people living at the home and staff. I toured the building and examined a number of records relating to the care, health and safety and management of the home. I would like to thank Linda Slade and staff who assisted me by answering questions about the running of the home. I would also like to thank the five people who live at the home who discussed their views of the service they receive. What the service does well:
The records of medicines received, administered and returned to the pharmacist were all complete. I found that the medication for each of the people case tracked was accurately recorded. I spoke with people who live at the home who told me that they are provided with regular activities. The program showed the activities that take place each month. People living at the home were supported to maintain their religion. Records of the menu showed that two options are offered at each meal. I observed a number of people enjoying these food choices at lunch. People who live at the home were generally pleased with the quality of the food provided. The complaints policy was displayed around the home. A person who lives at the home said, “ they explained that if theres anything I dont like I can talk to them. I feel they would do something if I wasnt happy about anything”. I found that bedrooms were personalised with items of furniture, pictures and other personal possessions of people who live at the home. A person who lives at home said, “ Im pleased with my room, Ive got my things from home in there”.The registered manager also explained that as part of this capital bid funding had also been applied for to develop the garden. The aim would be to improve access to the garden for people living at the home. Another part of this project would be to develop a sensory room for people with dementia. Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 6 A person who lives at the home said, “ the staff are always around when you need them”. The rota showed that a consistent staffing level was being maintained in the home. People who live at the home with whom I spoke generally felt that staff understood how to meet their needs. The registered manager explained and was able to produce evidence to confirm that other training needs had been identified and would be met. Further training is planned on epilepsy, nutrition and PEG feeding, and wound care. The registered manager explained that staff are working with more people who have palliative care needs. The registered manager has a nursing qualification and has completed the registered manager’s award. As part of the ongoing development of the home the registered manager explained that a new dementia care training programme, which focuses on, a holistic approach to care planning a is to be introduced shortly. As mentioned in the outcome area environment, a capital bid has been made to further develop the home. The registered manager explained that training on meeting the palliative care needs of people who live at the home is to be introduced What has improved since the last inspection? What they could do better:
Fourteen areas for improvement have been identified at this inspection. Information was detailed but it did not reflect the personal preferences and cultural needs of people use the service. One person recently admitted to the home had only one personal preference recorded in the area choice of meals. Care plans were found to be brief, had not been reviewed and there was no record of consultation with people who live in a home about how care will be provided for them.
Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 7 The risk assessment and care plan to prevent falls had not been reviewed to address this increased risk. Manual handling assessments and care plans for this area were found not to provide clear guidance on how their manual handling needs were to be met. This is a serious concern as it affects the wellbeing and safety of people who live at the home. At a recent random inspection it was found that care plans and assessments for handling challenging behaviour were not in place. The support people needed had not been identified. This had not been addressed and it is of concern that the needs of people living at the home are not being met. A multidisciplinary review still needs to be held to establish the long-term needs of a person who uses the service. I found that these issues still need to be addressed to ensure that the person has all their needs met. Staff had not been on Enfields adult protection training. This must be addressed to ensure that people at the home can feel confident that they are effectively protected. I found a number of areas in the hallways where the paintwork was chipped. I observed that the televisions in the sitting rooms were small, given the size of those rooms. This made it difficult for people to see the television clearly. These issues must be addressed to ensure that the home’s environment meets the needs of people who live in the home. The registered manager explained that at present 35 of staff have achieved the National Vocational Qualification in care. 50 of staff needs to achieve this award to ensure that staff have the necessary skills to meet the need of people who live at the home. To ensure the consistent management of the home a deputy manager must be appointed. This will ensure that care practice is developed for the benefit of people who live at the home. Some training had been carried out in communication skills. As this had been identified as a contributory factor in a number of adult protection concerns, further training should be provided in this area. This will give staff the skills to communicate more appropriately with people who live at the home. Four requirements made at the last inspection have not yet been met and have been restated in this report, with a new timescale for compliance. In the ‘Timescale for Action’ column, the date in ordinary type relates to the timescale given at the last inspection. The date in bold type relates to the new timescale. Further information about unmet requirements can be found in the relevant section. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance.
Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 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 Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s needs are not fully assessed prior to admission to the home to ensure they receive the care and support they need. EVIDENCE: People spoken to told me that they had been given information about the home. This explained what the service would do to support them. One person who uses the service explained that, “ I visited and was offered a choice of which bedroom I would like”. I found that the needs of the people case tracked were within a range of those specified in the statement of purpose. There were assessments made prior to the people’s admission to the home. These included assessments from social workers and health professionals
Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 11 dealing with the nursing needs of people. Although this information was detailed it did not reflect the personal preferences and cultural needs of people use the service. One person recently admitted to the home had only one personal preference recorded in the area of choice of meals. Both care and nursing staff spoken to have an understanding of the medical and personal care needs of the people case tracked. A key worker system is in place, the people who use the service know about this. One person I spoke to explained that, “ one of the workers spends time with me, and I can talk to her when I like”. Since the last key inspection there have been a number of adult protection issues raised about the service. While these have generally not been upheld there have been concerns about the homes ability to meet the needs of people in a consistent and detailed manner. There has been a recent random inspection that investigated concerns about the care of one person who uses the service. It was found that there was insufficient detail in the care plan to meet this person’s dementia care needs and how their challenging behaviour should be addressed. Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s personal, social and medical care needs are not fully planned for. People who use the service are fully protected by safe procedures for handling medication. People’s right to privacy is supported. EVIDENCE: I case tracked six people living at the home and found there was not enough information on their personal, social and medical needs in either their care plans or risk assessments. One person case tracked had been diagnosed with end stage renal failure. The person’s care plan did not identify if professional guidance had been obtained regarding this. There were no records of the person’s preferences or wishes regarding his future. This was also reflected in the care plans of the other people case tracked. Generally, their care plans were brief, had not been reviewed and there was no record of consultation with people who live in the home about how care will be provided for them.
Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 13 Another person who lives at the home was case tracked. The person’s falls risk assessment identified that he had a high risk of falling. The care plan for this recommended observation every 30 minutes. Daily notes showed that in the period from the beginning of February to the beginning of April this person has had seven falls. The risk assessment and care plan to prevent falls had not been reviewed to address this increased risk. While all people case tracked had manual handling assessments, one person’s assessment and care plan for this area was found not to provide clear guidance on how their manual handling needs were to be met. The manual handling risk assessment and care plan for this person explained that they were to be supported to mobilise using a standing hoist. However, an occupational therapists assessment carried out on the 20/3/07 recommended the use of a different kind of hoist. I spoke with the nurse responsible for the floor where this person lives. The nurse informed me that two carers assisted this person when mobilising or standing. No mention was made by the nurse of the use of a hoist to assist this person. Also this was not recommended in the person’s manual handling care plan. At a recent random inspection it was found that the care plan and assessment for handling challenging behaviour for a person who lives at the home did not provide detailed guidance. Also the dementia care plan was very brief. It did not explain the specific individual issues (personal and individual history) and how these might be linked to the management of the person’s behaviour. A requirement was made that care plans and assessments need to be put in place that identify the individual preferences of people and how these might affect their behaviour. I found that this still needed to be addressed. A person who lives at the home was found at the random inspection to have been left unshaven and that he was not supported to maintain his personal care. A number of other people who use the service were dressed inappropriately and in a dishevelled manner. At this key inspection all people living at the home were found to be shaved. People living at home were appropriately dressed. A person spoken to said, “ staff help me to choose what I like to wear”. At the random inspection I examined the medical records and pain assessment for a person who lives at the home who has been diagnosed with prostrate cancer. The pain assessment identified the area where he experienced pain. The nurse on duty explained that when the person experienced pain (usually in his stomach area) he could become more agitated. No clear diagnosis of this had been made to establish if the cancer was spreading to other parts of the person’s body. There had been changes to the person’s pain relief. This was not fully effective in managing his pain. Daily records showed he was still in pain. A requirement was made that the person’s pain relieving medication is kept under continuous review. Given his medical needs a multidisciplinary
Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 14 review must be held to establish the long-term needs of the person who uses the service. I found that these issues need to be addressed. The records of medicines received, administered and returned to the pharmacist were all complete. Medicines were stored safely on all three floors. All medicines are now stored at the appropriate temperature. Separate records were maintained for controlled drugs on each floor. I found these were complete and the amount of medication held corresponded with those recorded in the controlled drugs book. I found that the medication for each of the people case tracked was accurately recorded. Since the last key inspection training has been provided to train staff on basic administration of medicines. Also advanced training has been provided on specific medication issues relating to specific medical conditions. I spoke with staff and found they were clear about their responsibilities and how to handle medicines safely. Training records also contained certificates confirming that this training had taken place. I was able to observe staff administering medication and confirm that this was done safely. Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are provided with varied activities to meet their needs. People living at the home are supported to maintain contact with relatives and other representatives of their choice. People living at the home are able to make choices about how they live in the home. The menu reflects the preferences of people living at the home and offers a balanced diet. EVIDENCE: I spoke with people who live at the home who told me that they are provided with regular activities. The program is of preferred activities, taking place each month. A person who lives at home confirmed, “ they ask us what we would like to do”. On the day of the inspection the hairdresser was in the home. I observed that activities were taking place on all floors at various times throughout the day. For example, a member of staff was observed discussing the weather and the days news with three people who live at the home. Other activities observed were ball games and listening to music. Daily notes showed that people who live at the home were engaged regularly in some form
Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 16 of social activity. I observed that staff spend time talking with people who live at the home and listening to what they had to say. People living at the home were supported to maintain their religion. Records showed that various faith groups or their representatives visit the home. The activities programme showed that a religious service was held each week. I spoke with relatives who confirmed they could visit when they choose. A person who lives at the home said, “they ask who you want to see, it’s your choice”. The inspector observed that staff treated visitors well and they were given information on the needs of people who live at the home. The menu showed that two options are offered at each meal. I observed a number of poeple enjoying these food choices at lunch. People who live at the home were generally pleased with the quality of the food provided. A person who lives at the home said that “ the food is good” and “there are no problems with the food ”. Another person commented about the choice of food offered and that staff had “asked about what food I like”. Also meals are provided that reflects the cultural diversity of people living at the home. There was specific guidance on individual people’s plans where they had dietary needs. I saw that meals were well presented and they were provided in a relaxed environment on all three units. Sufficient staff was available, and when necessary, people who live at home were observed being assisted to eat. Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are confident that their complaints will be listened to, taken seriously and acted upon. People who use the service are not protected from abuse as staff have not had appropriate training. EVIDENCE: The complaints policy explained how to make a complaint and how it would be dealt with. The complaints policy was displayed around the home. A person who lives at the home said, “ they explained that if theres anything I dont like I can talk to them. I feel they would do something if I wasnt happy about anything”. The complaints record showed actions taken to resolve complaints. I found that there is a monthly analysis carried out of complaints and how they had been responded to. There had been two complaints since the last inspection and these had all been responded to within the agreed time scale. There had been one complaint, which had been investigated by the Commission since the last key inspection. This concerned the care of one person living at home. Issues relating to this are discussed throughout this report.
Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 18 There were comprehensive policies on handling abuse and protection. I found that staff have received training on adult protection matters. This training was provided by the home. Staff had not been on Enfields adult protection training. The registered manager was asked to ensure that staff attend Enfield training so that they are familiar with the local procedures for handling adult protection issues. There have been a number of adult protection meetings since the last key inspection. These raised issues relating to the care and well being of people who live at the home. Although none of the issues raised in these adult protection investigations were upheld they do raise concerns regarding the continuity of care and safety of people living at the home. I discussed this with the registered manager. The registered manager felt that the causes of the recent increase in adult protection investigations could be located in two areas. The registered manager explained that there had been times when there had been a breakdown in sensitive communication with people who live at the home. As a result of this there had been times when issues were not dealt with sensitively. Also a deputy manager still needs to be appointed to oversee development of care practice within the home. These issues are addressed in the relevant outcome areas. Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a home that does not provide a safe and homely environment. The home is clean and hygienic. EVIDENCE: I found that bedrooms were personalised with items of furniture, pictures and other personal possessions of people who live at the home. All bedrooms are single occupancy and have en suite facilities. A person who lives at home said, “ Im pleased with my room, Ive got my things from home in there”. There are sitting and dining rooms on each floor. There are adapted bathrooms and toilets on each floor. These are accessible to people who have mobility difficulties. Hoists were available on the three floors. Records showed that these had been maintained.
Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 20 There was a record of ongoing maintenance. The registered manager explained that the hallways had been redecorated along with a number of bedrooms since the last key inspection. However, I found a number of areas in the hallways where the paintwork was chipped. This was raised with the registered manager who agreed to ensure that this was addressed. I observe that the televisions in the sitting rooms were small, given the size of those rooms. This made it difficult for people to see the television clearly. The registered manager explained that as part of a capital bid she had made, this was to be addressed. She had not as yet been given access to the necessary funds. I explained that this needs to be addressed to improve the environment of the home for people living there. The registered manager also explained that as part of this capital bid, funding had also been applied for to develop the garden. The aim would be to improve access to the garden for people living at the home. Another part of this project would be to develop a sensory room for people with dementia. At the recent random inspection it had been found that a bedroom carpet carried strong a odour urine. I visited this bedroom and found that the carpet is now clean. Other bedrooms visited were clean and there were no odours in any other part of the home. Appropriate measures are in place to prevent cross infection. Staff confirmed that they had access to disposable gloves and aprons. Liquid soap and paper towels were available throughout the home. The home has detailed policies on the prevention of cross infection. Staff spoken to understood how to work to minimise the possibility of cross infection. Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 21 Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are available at all times to meet the needs of people who live at the home. Staff do have all the skills to meet all the assessed needs of people who live at the home. People who live at the home are protected by the home’s recruitment practices. EVIDENCE: A person who lives at the home said, “ the staff are always around when you need them”. The rota showed that a consistent staffing level was being maintained in the home. The register manager explained that she is regularly monitoring the level of needs of people who live at the home to ensure that the appropriate staffing level is maintained. I spoke with staff who said that sufficient staff were available to meet the needs of people who live at home. I observed that staff were available at key times a day (e.g. mealtimes) to assist people. Staff were also observed to spend time with people both individually and in small groups. This allowed more attention to the individual needs of people who live at the home. Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 23 People who live at the home with whom I spoke generally felt that staff understood how to meet their needs. Staff spoken to confirmed that they had all the areas of required training. The training records confirmed this. Training records showed that staff had also received training in dementia care, mapping and person centred dementia care. The registered manager explained and was able to produce evidence to confirm, that other training needs had been identified and would be met. Further training is planned on epilepsy, nutrition and PEG feeding, and wound care. Some training had been carried out on communication skills. As had already been discussed in the outcome area, complaints and protection issues communication had been identified as a contributory factor in a number of adult protection concerns. It is recommended that further training be provided in this area. This will give staff the skills to communicate more appropriately with people who live at the home. The registered manager explained that staff are working with more people who have palliative care needs. The Company had identified this as a training priority. The registered manager was able to confirm that this training had been identified and planned for. Also a number of staff had already started a program of training on palliative care provided through the Open University. At the last key inspection, training on learning disabilities was identified as being required to ensure that staff had the necessary skills to meet the needs of people living in the home. Discussions with staff and training records seen confirmed that this training had been provided. The registered manager explained that at present 35 of staff have achieved the National Vocational Qualification in care. It was a recommendation of the last key inspection report that 50 of staff achieves this qualification. Although there has been an increase in the overall number of staff with this qualification, the target of 50 has not been achieved. The recommendation for this is therefore restated in this report. I examined six staff files and found that these contained all the required information relating to their recruitment. I found that there were no unexplained gaps in the employment history of recently recruited staff. A health check has been carried out to ensure that staff coming to work at the home could safely meet the needs of people. The files of two nurses were also seen, and these had evidence of their current professional registration. Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An appropriate management structure is not place to ensure that the needs of people living at home are met consistently. People who live at the home are consulted about the quality of the service provided and encouraged to make suggestions for improvement. People who live at the home financial interests are protected by the home’s procedures. People who live at the home and staff are protected by the home’s health and safety procedures. EVIDENCE: The registered manager has a nursing qualification and has completed the registered manager’s award. People who live at home and staff told me that
Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 25 the registered manager was supportive and understood their needs. The registered manager has recently completed a qualification in Person centred dementia care. As part of the ongoing development of the home the registered manager explained that a new dementia care training programme, which focuses on a holistic approach to care planning, is to be introduced shortly. As mentioned in the outcome area environment a capital bid has been made to further develop the home. The registered manager explained that training on “meeting the palliative care needs of people who live at the home” is to be introduced. There have been number adult protection concerns raised about people who live at the home. Discussions with the registered manager identified that one of the factors that has led to the increase in concerns about the care in the home, has resulted from there being no deputy manager. This has resulted in a lack of an overview of the care of people living at the home. The registered manager explained that she and the company are trying to identify a suitable candidate for the deputy manager’s role. I told the registered manager this needs to be addressed as a matter of priority. The home has a system for obtaining the views of the quality of the service it provides and ensures that any areas for improvement are addressed. A survey of the views of people who live at the home, relatives and professionals was in place. The Company also has a system to monitor all areas of the quality of the home. People who live at the home have meetings on a regular basis to discuss their views of how they wish the home to be run. Staff meetings are taking place to ensure staff are aware of plans to develop the service. The home does not hold money for people who live at the home. The home invoices their families or the relevant social service department for any expenditure made on their behalf. A system is in place to ensure receipts are obtained for any expenditure. Fire drills were taking place and the fire alarm was tested regularly. I found that the fire risk assessment had been reviewed and now included an assessment of all the potential fire risks in the home. I questioned staff on the fire safety procedures and found that they understood fire safety issues. All health and safety policies were available. Certificates for gas, legionella and electrical testing were in date. COSHH guidance was in place and chemicals were stored safely. I discussed health and safety issues with staff and they demonstrated their understanding. The home has an effective system for monitoring accidents. The temperature of food delivered to and cooked was recorded. The temperatures of the fridges and freezers were recorded and within safe limits. Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 14(1) Requirement Timescale for action 30/05/07 2 OP7 OP8 15(1) The registered persons must ensure that the personal preferences and cultural needs of people are included in the pre admission assessment. The registered persons must 30/05/07 ensure that there are detailed individualised care plans for supporting people who use the service who have dementia. (This requirement is restated) 30/05/07 3 OP7 4 OP7 15(2)(b)(c The registered persons must ) ensure that care plans are reviewed in consultation with people who use the service. 15(1) The registered persons must ensure that detailed assessment and guidance is available on how to support people who use the service who have behaviour that challenges. (This requirement is restated) 13(1)(b) The registered persons must ensure that pain relieving medication for the people who use the service is kept under
DS0000068280.V333299.R01.S.doc 20/05/07 5 OP8 01/05/07 Murrayfield Care Home Version 5.2 Page 28 continuous review. (This requirement is restated, the time scale of 10/04/07 was not met.) 6 OP8 13(1)(b) The registered persons must 10/05/07 ensure that a multidisciplinary review is held to establish the long-term needs of the named person who uses the service and states how these needs will be met. (This requirement is restated, timescale of 20/04/07 was not met.) The registered persons must ensure that the palliative care needs people who use the service identified and included in their care plans The registered persons must ensure that falls and manual handing risk assessments are reviewed. Where risks change to people who use the service the assessment must be updated. The registered persons must ensure that staff are trained in the Enfield adult protection procedures. The registered persons must ensure that all areas of the home are appropriately decorated. The registered persons must ensure that a deputy manager is appointed to ensure the effective management of the home. 30/06/07 7 OP8 OP7 13 15(1) 8 OP8 13(4)©(5 ) 30/05/07 9 OP18 13(6) 30/07/07 10 11 OP19 OP31 23(2)(d) 16 30/07/07 30/07/07 Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP19 OP28 OP30 Good Practice Recommendations The registered person should ensure that televisions of a suitable size are purchased for people living at the home. The registered person should ensure that 50 0f staff achieves the National Vocational Qualification at level 2 in care. The registered persons should ensure that training is provided in communication skills. Murrayfield Care Home DS0000068280.V333299.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Southgate/Harrow Area Office 4th Floor Aspect Gate 166 College Road Harrow Middlesex HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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