CARE HOMES FOR OLDER PEOPLE
Muscliff 5 Tolpuddle Gardens Muscliff Bournemouth Dorset BH9 3RE Lead Inspector
Amanda Porter Key Unannounced Inspection 19th July 2007 10:00 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 Muscliff DS0000020452.V345126.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. Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Muscliff Address 5 Tolpuddle Gardens Muscliff Bournemouth Dorset BH9 3RE 01202 516999 01202 516371 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) Muscliff Medical Limited Miss Dedrey Charles Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The issued staffing notice must be adhered to at all times and staffing levels increased to meet the dependency levels of service users as necessary. One named person (as known to CSCI) under the age of 65 may be accommodated from time to time to receive care. 30th May 2006 Date of last inspection Brief Description of the Service: The Registered Providers are Muscliff Medical Limited, a group of four doctors and a pharmacist, who registered and opened the purpose built home in 1997. Muscliff Care Home is situated in the northern part of Bournemouth, close to the rural area of Throop, with a neighbouring Medical Centre, Pharmacy, convenience store and community facilities. The home is registered to accommodate 40 service users within the category of old age requiring nursing care. The bedrooms on the first floor are accessed by a passenger lift and the corridors are all spacious with wide doorways. All rooms are for single occupancy and provide en-suite facilities. The home is set in attractive gardens laid mainly to lawn with shrubs, herbaceous borders, paved areas and an ornamental pond. The weekly fees at the home at the time of inspection range between £650 and £750 per week, extra amounts are charged for chiropody services, hairdressing, daily papers /magazines. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 19th July 2007 over a period of approximately six hours. The purpose of the inspection was to review the requirements and recommendation made at the last inspection and assess all of the key standards. The Registered Manager, Miss Charles, was on hand throughout to aid the inspection process. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • The annual quality assurance assessment completed by the home. • 9 comment cards completed by residents, 5 by relatives and visitors and 3 by visiting GPs. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. During the course of the inspection four residents and five members of staff were spoken with and asked their views on the service provided at the home. Comments received in surveys and through discussion included: “It is a very happy home.” “I am very happy at the Muscliff.” “Excellent home with an enjoyable staffing.” “It is a good place to work.” “This is a very good home. They look after me well.” “From the Matron to the junior nurses they are all helpful and respond to any requests regarding the care of my Mother.” “Muscliff Nursing Home is run efficiently, and well organised – employing first class nursing and care staff.” The residents and staff were all extremely helpful and welcoming to the inspector. Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 6 What the service does well:
Each resident has a plan of care detailing for staff how to meet assessed care needs; care plans are reviewed with the resident. Residents’ health needs are identified and met by staff and visiting health care professionals and medicines are managed well in the home in the best interests of residents. Staff at the home support residents’ rights to privacy in care routines and residents spoken with confirmed they are able to enjoy the privacy of their rooms when they choose without interruption. The activities arranged within the home meet the expectations of the residents living there. Residents are encouraged to maintain their links with friends and family and all visitors are made very welcome. Residents are helped to exercise choice and control over their lives as far as possible. The complaints procedure can reassure residents that their views are important to the home and that any complaints they raise will be properly investigated. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. The Registered Manager runs the home well and very competent and committed staff, whose main aim is to give a good level of care and support to all the residents, support her. A robust quality assurance system is in place to ensure that the home is run in the best interests of the residents. Financial procedures within the home also ensure that residents’ interests are protected. The health and safety of the residents and staff are protected by the policies and procedures that the staff follow at Muscliff. Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
No requirements have been made as a result of this inspection. Five recommendations of good practice have been made. Some improvement in the documentation of the evaluation of what care is given would demonstrate how effective it has been and give a clear record of each resident’s progress. To protect residents a risk assessment should be undertaken and documented when a resident wishes to self-medicate. A clear audit trail of medicines in the home should be maintained so that it is clear what stock is held. Staff have a clear understanding of the protection of vulnerable adults but the home’s policy needs to be reviewed to ensure that it is in line with the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. The home has an ongoing training programme for staff, which means that residents will be cared for by skilled staff. However NVQ training needs to continue so that the home reaches the target of 50 of care staff holding this award. This training would provide the home with skilled and qualified carers at all times. The Registered Manager is committed to this training. Muscliff DS0000020452.V345126.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. Muscliff DS0000020452.V345126.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 Muscliff DS0000020452.V345126.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. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good admissions procedure enables prospective residents, and/or those acting on their behalf, to make informed decisions about admission to the home and ensures that only residents whose needs can be met by the home are offered places there. EVIDENCE: The files for three residents who had recently moved into the home were inspected. These showed that the home has a good procedure in place. Prior to anyone moving to the home the manager assesses his/her needs. Sufficient information was obtained so that a care plan could be drawn up and made
Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 11 available to staff. The registered manager confirmed in writing to the resident and/or chosen representative that needs could be met by the home. Nine residents responded to the question in the survey “Did you receive enough information about this home before you moved in so you could decide if it was the right place for you?” Seven people said “Yes” and two said “No”. One person said that they had not received information as the placement was made by a social worker. Muscliff DS0000020452.V345126.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 good. This judgement has been made using available evidence including a visit to this service. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The care documentation for four residents was reviewed. Files contained a variety of assessments including: • Moving and handling • Nutrition • Mental health • Risk of falls • Environmental risks • The risk of pressure sores
Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 13 • Continence Information from the assessments was used to formulate plans of care. Care plans clearly set out individual care needs and how they were to be met. Residents and/or their chosen representatives were invited to be involved in drawing up care plans. The care plans were generally evaluated on a monthly basis. However some of the written evaluations seen did not give a clear indication of the efficacy of the care given. Residents spoken with were happy with the care they received and staff treated them with respect and were supportive and kind. In response to the survey most residents responded to the following questions: “Do you receive the care and support you need?” Four people responded “Always” and five said “Usually”. “Do the staff listen and act on what you say?” Seven people said “Yes” and one said “No”. Comments included “They don’t always listen”. “95 are wonderful.” It was clear from discussions with staff and residents that they have access to the health services they need. There was evidence to show that residents get support from General Practitioners, chiropodists, opticians and dentists. Arrangements are made for residents to attend hospital outpatient appointments as necessary. The home has a well-written and informative medicines policy and procedure including reference to self-administration and associated risk assessment and arrangements for ordering, administration and disposal. One medication administration record seen did not make it clear that the resident was self administering one medicine, nor was there a corresponding risk assessment undertaken. Medicines were stored securely. However there was no clear audit trail to identify how much medication was held by the home. Examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use this service are supported to maintain their life skills and are encouraged to make choices as far as possible. Social, cultural and recreational activities meet individuals’ needs and appear to be very much enjoyed. EVIDENCE: Muscliff continues to provide a variety of activities, which residents enjoy. These include: • Minibus outings • Musical entertainment • Pursuit of life long hobbies • Quizzes and games. Each resident receives a monthly newsletter, which informs them of any planned activities.
Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 15 In response to the question “Are there activities arranged by the home that you can take part in?” Seven residents said “Always” and two said “Usually”. It was clear through discussion with residents that some of them preferred to arrange their own social activities, which they were free to do and they could spend their days as they wished. “I can do what I like when I like.” Residents confirmed that they could receive their visitors in private and that they were always made very welcome. One visitor said: “My husband and I on our daily visits are made most welcome and made to feel a part of the home.” The menu provided choice and the chef was aware of residents’ likes and dislikes. Residents confirmed they could take their meals where they wished and some preferred to eat in their rooms and most preferred to go to the dining room. They said they liked the food offered. “Excellent”. Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 16 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 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. Protection from abuse is promoted. EVIDENCE: The home has a clear complaints procedure available to everyone. Residents spoken with during the inspection said that if they had any concerns they would feel confident about talking to the manager, knowing that she would listen to them. “Matron’s door is always open.” The home has a policy and procedure to respond to suspicion or evidence of abuse or neglect. However it needs to be reviewed to ensure that it is in line with the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. Staff confirmed that they receive training on the protection of vulnerable adults. Through discussion it was apparent that they had a clear understanding of local procedures. Since the last inspection there has been one adult
Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 17 protection referral made to social services but the allegations made were not upheld. Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 18 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 excellent. This judgement has been made using available evidence including a visit to this service. The standard of the environment at Muscliff is very good providing residents with an attractive, homely and safe place to live. EVIDENCE: The home has a programme of routine maintenance and the home provides an extremely comfortable environment in which to live. Since the last inspection many of the bedrooms have been refurbished. Changes have been made to the front entrance and the conservatory to the right of the front entrance and residents’ views were sought and followed with regard to colour schemes. Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 19 Outside seating to the front of the building has been provided and residents have enjoyed sitting out there when the good weather has allowed. Records show that a variety of outside agencies have attended the home to undertake the routine maintenance of: • Fire safety equipment. • Gas installation. • Lift. • Hoists. A call bell system is available in every room. All areas of the home were clean and there were no unpleasant odours. The laundry was well managed and adequate supplies of clean linen were seen to be available. All satisfaction surveys received confirmed that the home is always clean and fresh. Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 20 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 nursing and care staff are employed to meet the needs of residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are given the training and support so that they can give a good standard of care to the residents living at Muscliff. EVIDENCE: At the time of inspection staff rosters demonstrated that there are sufficient staff on duty at that time. During the inspection staff were on hand to meet the needs of the residents. Nine people responded to the question “Are staff available when you need them?” Two responded “Always”, four said “Usually” and three said “Sometimes.” The home has an ongoing training programme, which includes NVQ level 2 in care. The Registered Manager confirmed that at the time of inspection less than 50 of care staff held this award. Five staff recruitment files were reviewed and they contained:
Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 21 • • • • • • Completed application forms Two written references Enhanced CRB and POVA first checks Terms and conditions of employments Documentary evidence of any relevant qualifications Proof of identity, including a photograph. Training files demonstrated that staff were receiving induction training and this was confirmed with staff spoken with during the inspection. Staff spoken with during the inspection confirmed that the registered manager had encouraged them to take up a number of training opportunities provided including: • NVQ in domestic services • Common induction training • Moving and handling • Fire safety • Health and safety • Basic food hygiene • Nutrition • Elder abuse awareness • Conflict management • First aid • Wound care • Catheter care • Foundation degree in care home management. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the daily management and running of the home centres round the care of residents. Good management practice, systems in place, and records kept, confirm the health and safety of all in the home. EVIDENCE: Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 23 The Registered Manager is very experienced in caring for elderly people and is suitably qualified. Residents and staff confirmed they found the management style at the home open and supportive. There is an effective quality assurance and quality monitoring system in place. The home takes steps to review its performance regularly and resident surveys are conducted and results analysed and action is taken as necessary. Residents spoken with during the inspection said that the management team did listen to what they had to say. Residents confirmed that they either deal with their own finances or have appointed a responsible representative to do so. This is frequently another family member. The home does hold some “pocket money” for any residents who request this. Clear records are kept of any monies held and how this is spent on behalf of the resident concerned. Records showed that staff had received recent training in fire safety and all had manual handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and analysed and appropriate action was taken as necessary. Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 24 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 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 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 3 X 3 X 3 X X 3 Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP7 OP9 OP9 OP18 Good Practice Recommendations The evaluations of care plans should indicate how effective care given has been. There should be a clear audit trail for all medications held in the home. Where a resident wishes to self-administer medication a risk assessment should be undertaken. The home should review its adult protection policy to ensure that it is in line with the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. The home should continue to work towards at least 50 of staff achieving a minimum of an NVQ 2 award. 5. OP28 Muscliff DS0000020452.V345126.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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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