CARE HOMES FOR OLDER PEOPLE
Murreyfield House 342-344 Beverley Road Hull East Yorkshire HU5 1LH Lead Inspector
Sarah Urding Unannounced Inspection 10:15a 12th and 16 January 2006
th 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 Murreyfield House DS0000000863.V272917.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. Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Murreyfield House Address 342-344 Beverley Road Hull East Yorkshire HU5 1LH 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) 01482 492778 01482 470084 Carol Lesley Olive Murrey Mrs Ann Elizabeth Murrey Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23) of places Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th August 2005 Brief Description of the Service: Murreyfield is one of two homes privately owned by Carol Murrey and is part of a small family run business with a sister home in Cottingham. Murreyfield was originally two terraced townhouses that have been converted into a care home. The family insist on high standards of the care provided by their staff. The home is registered to care for up to 23 older people of either gender, who may also suffer from dementia. Accommodation is on three floors with 9 double and 5 single rooms. Communal space consists of a 3 separate lounges and an open plan sun lounge/dining area. There is an enclosed patio/garden area to the rear of the home. Murreyfield is situated on Beverley Road approximately 1 mile from Hull city centre. Nearby are local shops, pubs, churches and the home is on a major bus route into Hull. There is some available car parking to the rear of the home and on nearby side streets. Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over a period of six and a half hours over the course of two days. The building was looked around and a number of records were inspected. Twelve of the twenty-two residents and three staff were spoken to. One visitor to the home was also spoken to. What the service does well: What has improved since the last inspection? What they could do better:
The meals on offer in the home are well balanced and appropriate for the residents. However the home has been without a cook since Christmas and some of the menus in the last week have been repetitive. The acting manager has recently recruited two cooks who will begin work as soon as the Criminal
Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 6 Records Bureau clears them. The acting manager is confident that this will improve the variety of food on offer. The recording of complaints/grumbles could be improved upon. The home needs to demonstrate that minor complaints are acted upon through recording day to day issues on behalf of residents. There are some environmental factors that require attention so that residents live in a clean and comfortable place. One of the toilets in the home requires attention as was coated in lime scale and was dirty. The floor tiles in this room must also be replaced as they were heavily soiled, making the room smell unpleasant. The temperature of water and residents hand basins must also be checked on a regular basis and the sink in one resident’s room must be unblocked. The practice of keeping the cat food in the laundry with clean clothes must also cease. It was noted while looking round the building that some of the residents’ toothbrushes needed to be replaced. The home must keep on top of this. The home has an audit system in place, which has lapsed in recent month. The acting manager has said this is due to workload pressures. She hopes to recruit more managerial support so that standards in this area will be improved. There are some record keeping issues that require consistency. These include the need to secure two written references for all staff employed, as there was one instance where a member of staff had only one written reference. A verbal reference had been received for the second reference but a written one must be secured. Photographs of all residents must also be held. Visits to the home by the provider must take place and be followed up with a written report. This will demonstrate that practice in the home is being monitored. This is an on going issue that has not been addressed by the home for a considerable time and must be carried out by law. 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. Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 7 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 Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 8 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 6 Residents’ needs are met by a thorough assessment on admission. EVIDENCE: Residents undergo a thorough assessment of needs prior to admission, which demonstrates that the home works in partnership with residents, their families and health professionals to glean full information about the lives of residents. The assessment covers all aspects of standard 3.3 and is completed in detail and well presented. The assessment links clearly to the care plan. The home does not provide intermediate care. Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 9 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, 10 Residents’ health and personal care needs are well met by staff and carried out in a manner that maintains their dignity EVIDENCE: All residents have a detailed plan of care that provides staff with the information they need to ensure needs are met. The plan is clearly presented and in a format that is understood by staff. This links in to the home’s assessment on admission and is reviewed on a regular basis and when needs change. Residents’ health care needs are being clearly identified and met by the home. Appointments with all health professionals are recorded on the residents’ files. Residents spoken to are satisfied that staff access them to health care services they need. There are detailed moving and handling strategies in place for all residents. Staff are aware of how to move residents safely. One aspect of care requires improvement. During a tour of the building it was observed that the toothbrushes of two residents were dirty, old and in need of replacement. Staff must ensure that they are vigilant about maintaining standards in this area.
Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 10 The home’s policy for medication is sound and protects residents from potential abuse. Staff are trained in the administration of medication prior to taking on this role. Medication is stored appropriately, which includes controlled drugs. Generally the records held for the administration of medication were completed accurately. There was one error in the record, which did not correspond with the date on which the medication had been given. This was due to medication being started part way through the home’s usual cycle or recording. Care must be taken to ensure that the record corresponds with the correct date of administration. The inspector views this as a mistake and it was still clear that the medication had been administered appropriately. Staff carry out their duties in a positive and caring manner. They are aware of the need for sensitivities when carrying out personal care tasks. Residents said that staff treat them with respect and maintain their dignity. Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 11 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): 13, 14, 15 The arrangements for residents to keep their relationships with family and friends and maintain independence are good. Residents enjoy a well balanced diet but the lack of a cook in recent weeks has had an impact on the variety offered at mealtimes. EVIDENCE: Residents spoken to said that their friends and family can visit when they wish and are made to feel welcome by staff in the home. This was confirmed by a visiting friend of one of the residents who said she felt comfortable visiting and could “pop in” when she wished. Staff spoken to understood the importance of maintaining residents independence and knew how to encourage residents in this area. Staff respect the residents that they look after and give them choice when carrying out personal care tasks. Residents are encouraged to choose what they eat, what they wear etc on a daily basis. Staff were observed to check things out with residents and consult with them over daily routine issues. Mealtimes take place over two sittings due to the numbers of immobile residents in the home at this time. Some residents said that they liked the food on offer and it was evident that choice was given and various dietary needs were met. This was recorded on the menu. Meals offered are well balanced but the last weeks menu showed mashed potato being given every
Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 12 day. In discussion with the acting manager, she stated that the majority of residents didn’t really like anything else. Discussion took place around the need for the home to demonstrate that alternative carbohydrates were available for those residents who enjoyed a variety. This should be recorded on the menu also. The home has been without a cook since Christmas and the acting manager has recently recruited two cooks who will start employment shortly. She is confident that standards in this area will improve then. During the inspection one resident complained about the size of his meal being too small. This was rectified immediately by staff. Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 13 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, 18 Arrangements for the protection of vulnerable adults are handled well but the lack of rigour in the recording of complaints means that the home does not demonstrate its practice in this area well. EVIDENCE: The home has a clear complaints procedure in place. Residents spoken to said that they had no complaints about the home but felt confident to raise issues of concern if they arose. Past complaints have been recorded appropriately and addressed by the manager. There have been no complaints since 2004. The home has developed a niggles and grumbles book which is situated in the reception area for residents and visitors to the home. There have been no issues logged in this book for some time. In discussion with residents it was clear that minor issues have been recently raised. One resident was concerned about not being able to write things down in this book due to the nature of his condition but had raised the issue of portions at mealtimes. There was no record of this issue so the home is unable to demonstrate how this was resolved. The acting manager accepted that day to day issues have been verbally raised by residents but not recorded in this book. It would be good practice if staff recorded verbal issues on behalf of residents so that practice in responding to grumbles is demonstrated. The home has an appropriate policy in place for the protection of vulnerable adults. The local authority guidelines for the protection of vulnerable adults are also in place. Staff are aware of these guidelines and receive training on them. Residents spoken to said that they felt safe when being looked after by
Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 14 staff. Staff demonstrated a clear understanding of how to deal with allegations of abuse should they arise. Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 15 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, 25, 26 Residents live in a clean and safe environment but some work is required to ensure that all aspects of the home are comfortable for residents. EVIDENCE: The home is clean and homely. A planned programme of maintenance is in place and work is ongoing to further improve standards in the home. A recent visit by the environmental health required the home to address some maintenance issues in the kitchen area. The acting manager said that this work will be carried out shortly. This should be recorded in the home’s maintenance plan to evidence timescales. Some aspects of the environment require attention so that the home is comfortable place for all residents to live. One resident’s toilet was dirty and coated in lime scale. The carpet tiles in this room were heavily soiled and there was an unpleasant odour because of this. The toilet must be cleaned and the carpet tiles replaced. The practice of keeping opened tins of cat food in with residents’ laundry must also cease as is not hygienic.
Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 16 The heating and lighting supply to the home meets with health and safety requirements and relevant checks are in place. The temperature of the water is monitored in the communal areas of the home but not in residents’ bedrooms. The home must undertake regular checks of water temperature at residents’ hand basins to ensure safe temperatures. The water in one resident’s hand basin was slow to drain away. The plug must be unblocked. Policies for the control of infection are in place and followed in practice. Residents spoken to were positive about standards of cleanliness in the home. Residents clothes are clean and looked after. Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 17 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): 28, 29, 30 Residents are looked after by safe, well trained staff but the standard relating to NVQ levels in the home is not met. EVIDENCE: The home does not meet the standard on training staff to NVQ level 2. Currently only one member of staff is trained to this level. Three members of staff are completing the course at the present time. The acting manager discussed the fact that NVQ training has been an “uphill struggle” due to staff being supported on the course, then leaving when the qualification is gained. However, it is clear that the home is committed to supporting staff in this qualification but must continue to do so if this standard is to be met. Recruitment practice in the home is adequate to ensure that residents are protected. Application forms are fully completed and gaps in employment explored. Written references and POVA First checks are in place prior to staff starting work. This ensures that residents will be looked after by safe people. There was one instance where only one written reference was in place for a member of staff. A verbal reference had been secured for the other reference. The acting manager must ensure that this is followed up in writing. Staff are trained appropriately and receive a thorough induction. There is a training programme in place. Staff spoken to feel supported well by colleagues and senior members of staff. Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 18 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, 33, 35, 37, 38 Residents are looked after in an environment that is clearly and safely managed but the lack of consistency in reviewing the quality of care in the home does not ensure that practice is always monitored. EVIDENCE: The home’s manager is absent and the home intends to register the acting manager with the Commission for social Care and Inspection shortly. Standard 31 will be assessed fully when this occurs. The home has a quality assurance system in place and audits generally take place on a monthly basis to ensure a good level of service delivery for residents. Last years report on the review of care for 2004-2005 was available for inspection and appropriately detailed. The review of 2005 is due to be reported on at the end of this month. A copy of this must be sent to CSCI for information.
Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 19 In recent months, due to the pressures of workload, the acting manager has been unable to complete the monthly audits consistently. She is currently recruiting additional senior support to enable this aspect of her role to be carried out more effectively. Residents are protected by the financial procedures of the home. The home does not act as appointee for any residents and looks after the money for residents appropriately. Written records of all transactions are accurately maintained. The home has detailed policies and procedures in place. Appropriate records are kept but there is a current shortfall in the detail of some records held. Photographs of all residents must be kept by the home, along with two written references for staff as mentioned previously in this report. There is also a shortfall in the visits of the provider to the home. Although the acting manager said that the provider visits the home regularly, there is no written evidence of these visits taking place and of practice being monitored. This has been a requirement of the three previous inspections and has not yet been carried out. These visits are required to be carried out and recorded under regulation 26 of the Care Homes Regulations and are a valuable and necessary part of the registered provider’s duties. Failure to provide CSCI with Regulation 26 reports will invite enforcement action. The home operates in the best interests of the health and safety of residents and staff. All safety checks are carried out within the specified time frame and policies are in place for safe working practice. Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 20 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X 2 3 STAFFING Standard No Score 27 X 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X 2 3 Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 21 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 12, 13 Requirement The registered manager must ensure that the health care needs of residents are met. Dirty toothbrushes must be replaced. Residents must be offered a varied diet. One resident’s toilet must be cleaned and the floor tiles replaced. The practice of storing cat food in the laundry must cease. The water temperature at residents’ hand basins must be monitored. 50 of care staff must be trained to NVQ level 2 in Health and Social care. Records held by the home must be kept in line with regulation. To include a photograph of all residents and two written references for staff. The registered provider must comply with the requirements of Regulation 26 of the Care Homes Regulations 2001. (Target dates of 31/07/04, 31/05/05, and 31/10/05 not met).
DS0000000863.V272917.R01.S.doc Timescale for action 17/01/06 2 3 OP15 OP19 16 12, 16 16/01/06 31/01/06 4 5 6 OP25 OP28 OP37 12, 23 18 17, 26 31/01/06 31/12/06 28/02/06 Murreyfield House Version 5.1 Page 22 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 OP16 OP19 OP33 Good Practice Recommendations Minor complaints should be recorded by staff on behalf of residents. The requirements made by the environmental health department should be included in the maintenance plan for the home. Quality assurance audits should be consistently carried out. Murreyfield House DS0000000863.V272917.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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