CARE HOMES FOR OLDER PEOPLE
Murreyfield House 342-344 Beverley Road Hull East Yorkshire HU5 1LH Lead Inspector
Sarah Urding Unannounced Inspection 20th July 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Murreyfield House DS0000000863.V305522.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. Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 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.V305522.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th January 2006 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. The current scale of charges are £287.50-£368.50 per week. Additional charges include hairdressing, chiropody, magazines, papers, toiletries and taxis when requested. Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection and the visit to the home was unannounced, taking place over a period of six hours. The inspector received comments prior to the inspection from nine relatives of service users; three GP’s, nine health and social care professionals and three members of staff. Eight service users also commented upon the service. This information was used in the inspection and will be reflected in this report. On arrival at the home the building was looked around and a number of records and policies were inspected. The manager and three members of staff were spoken to. Eleven service users and a visitor to the home were also spoken to. What the service does well: What has improved since the last inspection?
The way in which the home monitors the quality of care they provide has improved. The system enables the manager to oversee the service given to service users and change things for the better. A cook has now been employed by the home and the food and choice provided has improved since the last inspection.
Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 Page 6 All of the requirements made at the last inspection have been met by the home. What they could do better: 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.V305522.R01.S.doc Version 5.2 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.V305522.R01.S.doc Version 5.2 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): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home’s assessment on admission ensures that the needs of service users are identified but the statement of purpose and service user guide although informative are not on display in the home. EVIDENCE: The home has a statement of purpose and service user guide that informs relatives and service users about the facilities on offer in the home. Some of the service users spoken to did not remember seeing the brochure prior to their admission although relatives said that they have received this. It would be good practice if the brochures were accessible to service users in the home so that they can be viewed if wished. All service users have an assessment of their needs prior to admission to the home. Privately funded service users are assessed as outlined in standard 3.3 so the home can be sure that prospective service users needs will be met. The home does not offer a service of intermediate care.
Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users health and personal care needs are met by staff who treat them with respect but the late arrival of some service users medication has not been thoroughly addressed by the home. EVIDENCE: Service users have up to date care plans in place that demonstrate how staff are to meet their needs. The plans are regularly reviewed. Records kept are clear and detailed and demonstrate that health care needs are met. Service users are registered with a GP of their choice and staff ensure that they receive the appropriate medical attention when needed. Daily records indicated individual time spent with service users, which is good practice. The manager raised concerns that some service users had not received their medication on time despite the home ordering this. The manager had made attempts to contact the service users’ GP’s but had been unable to get through. This must be given priority as the effects of service users not receiving their medication on time is unknown. Medical advice must be sought
Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 Page 10 regarding this matter to ensure that service users health care needs are fully met. The inspector views this situation as beyond the home’s control in this instance. However the home must ensure that it does all it can to promote the health of service users when faced with unforeseen circumstances. The home operates a safe medication system. Records kept are clear and concise which indicates that the staff administer medication appropriately. Controlled drugs are safely stored and records accurately reflect the amount of medication held in the home. Trained staff administer medication. Service users were positive about the way in which staff look after them. They felt that their dignity was maintained at all times. Staff spoken to understand the importance of respecting people’s privacy when they undertake personal care tasks. Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 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): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Facilities are provided for service users to experience activities, community and religious involvement and maintain contact with their relatives. Meals are nutritious and balanced, offering a healthy and varied diet for service users. EVIDENCE: Service users experience a range of activities in the home suited to their needs. The home has connections with a local help the aged group who organise activities for the service users away from the home. Two of the service users spoken to said that they had enjoyed a get together yesterday and were going again later in the week. The home has recently purchased a range of board games and playing cards in larger formats so that service users are able to play when they wish. Individual time spent with service users is recorded and service users said that staff spend time with them in the afternoons. It is recommended that a plan of activity be drawn up so that service users know what activity is taking place on what days of the week. This will enable them to choose if they wish to take part.
Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 Page 12 Religious and cultural needs of service users are met by the home. Church services and visits by a local priest take place for those service users who request this. The home’s pre-admission questionnaire asks service users if they attend church so that this service can be provided. This is good practice however, it is recommended that this form be revised to accommodate all faiths. Relatives who responded to questionnaires said that they were happy with the service that the home provides. They are able to visit their relatives freely and are made to feel welcome by staff. One visitor to the home said that she had no concerns about the home and felt comfortable visiting her friend regularly. She was offered a cup of tea by staff on the day of inspection. Staff spoke of their work with service users and how they empower them to make their own choices on a daily basis with a view to maintaining independence for as long as possible. One service user told the inspector that she wanted to be independent and liked to take care of herself. She said that staff respected her wishes and only helped her when she requested this. This is good practice and demonstrates that the home looks after people on an individual basis, taking in to account their wishes, feelings and capabilities. The food served in the home is varied and well balanced. Standards have improved since the last inspection in this area. The home has employed a cook who is responsible for the menus and meeting a broad range of diets. Service users said that they liked the food and were given choice if they did not like what was on offer. They are able to choose sugar free options at every meal and portion size. Staff were observed to assist with the feeding of some service users in a sensitive manner and on a one to one basis. Mealtimes are well organised. Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The arrangements for complaints and the protection of vulnerable adults are handled well and ensure that service users are protected but service users relatives were unclear about how to complain which could compromise standards. EVIDENCE: The home has a clear complaints procedure in place. Service users spoken to said that they had no complaints about the home but felt confident to raise issues of concern if they arose. Complaints are recorded and addressed by the manager. There had been one complaint since the last inspection, which had been responded to promptly and appropriately. The complainants level of satisfaction with the outcome is recorded which is good practice. The home has also reintroduced its grumbles book, which is accessible for all service users and visitors to the home. However, a number of questionnaires from relatives indicated that they did not know how to make a complaint. The manager must address this and make sure that the complaints process is shared with all visitors to the home. Without this knowledge issues may not get reported which could compromise standards in the home. The home has an appropriate policy in place for the protection of vulnerable adults. Staff spoken to were clear about reporting procedures should an allegation be made. Staff receive training in the protection of vulnerable adults. This means that service users will receive consistently safe care.
Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 Page 14 Service users spoken to said that they felt safe when being looked after by staff. There has been one vulnerable adults issue since the last inspection, which the home dealt with appropriately. Concerns have been raised by the owner however, that the home did not get the response from social services that it needed. CSCI will look in to these concerns to ensure that social services are following the procedures in place to protect vulnerable people. Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 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, and 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a safe, clean and comfortable environment, which is well maintained but deficiencies in the laundry service lower standards in this area. EVIDENCE: The home is clean, well presented and maintained. A planned programme of maintenance and redecoration is in place which means that environmental standards are continually improving for service users. All recommendations made from the previous inspection regarding the Fire and Environmental Health Departments have been addressed by the home. The recent visit from the fire department indicated that the home is practising safely in all areas. Policies for the control of infection are in place and followed in practice. Good levels of hygiene were observed during the inspection and appropriate steps taken to avoid cross contamination. Service users spoken to were positive about standards of cleanliness in the home. Laundry facilities in the home are
Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 Page 16 appropriate to meet the needs of service users however some service users said that they were not happy with all aspects of the laundry service. They said that clothes are always going missing and being found in other people’s rooms. They also said that some items of clothing had never been found. It is recommended that the home carry out an audit of the laundry service to ascertain levels of satisfaction with this service and identify any items of lost clothing. The manager agreed that any lost items of clothing would be replaced. Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 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): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are looked after by safely recruited and well trained staff. EVIDENCE: The home is staffed appropriately. Three or four staff are on duty throughout the day, which includes a senior member of staff at all times. Additional staff are on duty at times in the day when need is greatest. The home employs two domestics, a laundry assistant and a cook. Two staff are on duty at night. The manager is supernumerary to the rota. Three out of the eighteen care staff employed by the home are qualified to NVQ level 2 in care and six staff are currently undertaking this qualification. This does not yet meet the 50 recommended level but this standard will be met on their completion. Recruitment practice in the home has improved since the last inspection and is adequate to ensure that residents are protected. Application forms are fully completed and gaps in employment explored. POVA first checks and two written references are in place prior to staff being employed. This means that the risks of unsafe staff being employed are reduced. Staff are inducted appropriately to their role. Staff spoken to feel supported well by colleagues and senior members of staff. An ongoing training programme is in place and staff are appropriately trained for the work that they perform.
Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are looked after in a safe and well managed home. EVIDENCE: The registered manager has been absent form the home for some time however a manager is in place who has worked in the home for a number of years. She is currently undertaking the Registered Manager’s Award and plans to register as manager for the home with CSCI. Staff spoken to said they felt supported by the manager and they were clear about their roles and responsibilities. Good levels of consultation and regular reviews by the manager ensure that service users are looked after in an environment that is both safe and inclusive. The home operates an effective quality assurance system that seeks
Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 Page 19 the views of service users and staff on a regular basis. There is a monthly audit system in place that looks at key areas aimed at improving standards. Service users are protected by the financial procedures of the home. The home does not act as appointee for any service users and looks after monies for them appropriately. Written records of all transactions are accurately maintained. Records are well presented and appropriately kept. The home operates in the best interests of the health and safety of service users 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.V305522.R01.S.doc Version 5.2 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 3 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 Service users health care needs must be met. The manager must seek advice from GP’s regarding the late arrival of medication for some service users and the effect that this may have on their health. The dirty skylight must be cleaned. Timescale for action 31/07/06 2. OP19 23 31/08/06 Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 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. 4. 5. 6. 7. Refer to Standard OP1 OP12 OP12 OP16 OP19 OP26 OP28 Good Practice Recommendations A copy of the statement of purpose and service users guide should be available in an accessible place in the home. An activities programme should be drawn up for service users information. The pre-admission questionnaire should be revised to accommodate all faiths. The manager should ensure that relatives and friends of service users know how to complain. The recycling bins should be removed from the front of the premises. An audit should be carried out to assess the laundry service provided by the home. Lost items should be replaced. 50 of care staff should be trained to NVQ level 2. Murreyfield House DS0000000863.V305522.R01.S.doc Version 5.2 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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